AFL 20-72 From the California Department of Public Health
September 17, 2020
TO: Home Health Agencies
SUBJECT: Suspension of Regulatory Enforcement of Home Health Agency Requirements
AUTHORITY: Executive Order N-75-20 (PDF)
All Facilities Letter (AFL) Summary
This AFL notifies home health agencies of a temporary waiver of specified regulatory requirements due to the state of emergency related to the Coronavirus Disease 2019 (COVID-19) outbreak.
Pursuant to Governor Newsom’s Executive Order N-75-20, and consistent with federal guidance issued by the Centers for Medicare and Medicaid Services (CMS), the Director of the California Department of Public Health (CDPH) may waive any of the licensing and staffing requirements of Chapter 8 of Division 2 of the Health and Safety Code (HSC) and the accompanying regulations with respect to home health agencies.
CDPH is temporarily waiving specified licensing requirements and suspending regulatory enforcement for the following requirements:
A home health agency that has submitted an application for any of the following may begin providing care prior to obtaining approval and licensure by CDPH:
- Additional location
- Change of Service
Home health agency applicants seeking initial licensure must be licensed and receive approval prior to providing care.
Any licensee that has applied to CDPH for renewal of a license, or for reinstatement of a license that has been voluntarily suspended within the previous 12 months, may begin or continue providing care prior to obtaining approval of the renewal or reinstatement by CDPH.
Services and Staffing
3. HSC section 1727.1 and Title 22 California Code of Regulations (CCR) sections 74701 and 74697 (a) (4)
Home health agencies will have flexibility in how they provide therapeutic services to patients. Therapeutic services include, but are not limited to, physical, speech, or occupational therapy, medical social services, and home health aide services. Services may be provided via telehealth or other remote methods. This includes initial and monitoring assessment visits. This will allow for, but is not limited to, check-in calls, health screening calls, and video conferencing.
4. Title 22 CCR sections 74697 (a) (4) and 74701 (a)
Home health agency patients may be under the care of a nurse practitioner, clinical nurse specialist, or a physician’s assistant regulated under Division 2 of the Business and Professions Code and authorized by the Department of Consumer Affairs and the applicable licensing boards to provide services for the duration of the declared emergency.
5. Title 22 CCR section 74707 (a)(2)
Home health agencies may allow an occupational therapist to conduct an initial assessment of a home health patient if the assessment is limited to therapy needs which may be conducted within the occupational therapist scope of practice.
Please note that CDPH provided suspension of specified home health aide certification requirements in AFL 20-49.1 to allow home health aides to continue providing care during the COVID-19 pandemic.
6. HSC 1727.5 (c) and (d), Title 22 CCR section 74709
Supervision of licensed and unlicensed personnel may be conducted via virtual means, within the scope of practice of the supervising registered nurse.
Additionally, CMS has issued Home Health Agencies: CMS Flexibilities to Fight COVID-19 (PDF) providing temporary regulatory waivers to home health agencies, allowing maximum flexibility to respond to the COVID-19 pandemic.
CDPH will continue to investigate and conduct enforcement activities for allegations of the most serious violations impacting health and safety, pursuant to Executive Order N-27-20 (PDF).
CDPH understands the importance of ensuring the health and safety of all Californians and maintaining vital access to healthcare services. CDPH encourages providers to implement contingency plans to address staff absenteeism and find innovative ways to continue providing care to patients. CDPH will continue to promote quality healthcare, provide technical assistance, and support compliance with core health and safety requirements, pursuant to Executive Order N-27-20 (PDF). CDPH is taking this unprecedented action due to the significant challenges California’s health care system is facing as a result of the COVID-19 outbreak. As a result of this temporary waiver, hospice providers do not need to submit individual program flexibility requests for the regulations specified above.
This waiver is valid until the end of the declared emergency.
If you have any questions about this AFL, please contact your local district office.
Original signed by Heidi W. Steinecker
Heidi W. Steinecker