Guidance on Quarantine and Isolation for Health Care Personnel (HCP) Exposed to SARS-CoV-2 and Return to Work for HCP with COVID-19

AFL 21-08.8 From the California Department of Public Health March 7, 2022 TO: General Acute Care Hospitals (GACHs)Acute Psychiatric Hospitals (APHs)Skilled Nursing Facilities (SNFs) SUBJECT: Guidance on Quarantine and Isolation for Health Care Personnel (HCP) Exposed to SARS-CoV-2 and Return to Work for HCP with COVID-19(This AFL supersedes AFL 21-08.7) ​AUTHORITY:     Proclamation of Emergency (PDF) All Facilities Letter (AFL) Summary The purpose of this AFL is to provide hospitals and SNF with updated guidance on:Exposure risk assessment and work restriction for asymptomatic HCP with SARS-CoV-2 exposures (quarantine)Work restrictions for HCP diagnosed with SARS-CoV-2 infection (isolation)This revision incorporates updated Centers for Disease Control and Prevention (CDC) guidance on Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 and Strategies to Mitigate Healthcare Personnel Staffing Shortages.Pursuant to Welfare and Institutions Code section 14126.033 a SNF’s receipt of the annual increase in the weighted average Medi-Cal reimbursement rate may be conditioned on the facility’s good faith compliance with CDPH AFLs related to the COVID-19 Public Health Emergency, as a result the recommendations included in this AFL are requirements for SNFs.This AFL update supersedes and removes the temporarily adjusted return-to-work criteria in place from January 8, 2022 – February 1, 2022, which was not renewed. Hospitals should and SNFs must now resume using the table, below, to guide work restrictions for HCP with SARS-CoV-2 infection and for asymptomatic HCP with exposures based upon HCP vaccination status and facility staffing level.

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Coronavirus Disease 2019 (COVID-19) Vaccine and Booster Recommendations for Clinically Eligible Individuals

AFL 22-09 From the California Department of Public Health February 24, 2022 TO: All Facilities SUBJECT: Coronavirus Disease 2019 (COVID-19) Vaccine and Booster Recommendations for Clinically Eligible Individuals ​All Facilities Letter (AFL) Summary The California Department of Public Health (CDPH) recommends facilities offer COVID-19 vaccinations and booster doses to clinically eligible individuals.  ​The circulation of more transmissible recent variants of the SARS-CoV-2 virus has led to surges in COVID-19 cases.

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Coronavirus Disease 2019 (COVID-19) Testing, Vaccination Verification and Personal Protective Equipment (PPE) for Health Care Personnel (HCP) at Skilled Nursing Facilities (SNF)

AFL 21-28.3 From the California Department of Public Health February 22, 2022 TO: Skilled Nursing FacilitiesSUBJECT: Coronavirus Disease 2019 (COVID-19) Testing, Vaccination Verification and Personal Protective Equipment (PPE) for Health Care Personnel (HCP) at Skilled Nursing Facilities (SNF)(This AFL supersedes AFL 21-28.2) All Facilities Letter (AFL) Summary This AFL requires SARS-CoV-2 diagnostic screening testing for HCP in SNFs.

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Coronavirus Disease 2019 (COVID-19) Vaccine Requirement for Healthcare Personnel (HCP)

AFL 21-34.3 From the California Department of Public Health February 22, 2022 TO: All Facilities SUBJECT: Coronavirus Disease 2019 (COVID-19) Vaccine Requirement for Healthcare Personnel (HCP)(This AFL supersedes AFL 21-34.2) ​AUTHORITY:     State Public Health Order – Health Care Worker Vaccine Requirement                           State Public Health Order – Adult Care Facilities and Direct Care Worker Vaccine Requirement All Facilities Letter (AFL) Summary This AFL notifies all facilities of the August 5, 2021 Public Health Order related to mandatory vaccination for healthcare workers in identified healthcare settings.

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Suspension of Regulatory Enforcement of Specified ADHC Requirements

AFL 22-34.5 From the California Department of Public Health February 8, 2022 TO: Adult Day Health Care Centers (ADHCs) SUBJECT: Suspension of Regulatory Enforcement of Specified ADHC Requirements (This AFL supersedes AFL 20-34.4) ​AUTHORITY:     Executive Order N-35-20 (PDF), N-08-21 (PDF), N-17-21 (PDF), and N-21-21 (PDF) All Facilities Letter (AFL) Summary This AFL notifies ADHCs of a temporary waiver of specified regulatory requirements due to the state of emergency related to the Coronavirus Disease 2019 (COVID-19) outbreak.This revision extends the temporary waiver of specified regulatory requirements in this AFL until March 31, 2022.  Pursuant to the Governor’s Executive Order N-35-20 and Executive Orders N-17-21 (PDF) and N-21-21 (PDF) related to COVID-19, the Director of the California Department of Public Health (CDPH) may waive any of the licensing and staffing requirements of Chapter 3.3 of Division 2 of the Health and Safety Code (HSC) and accompanying regulations with respect to any ADHC identified in HSC section 1575.

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Guidance for Limiting the Transmission of COVID-19 in Skilled Nursing Facilities (SNFs)

AFL 22-07 From the California Department of Public Health February 7, 2022 TO: Skilled Nursing Facilities SUBJECT: Guidance for Limiting the Transmission of COVID-19 in Skilled Nursing Facilities (SNFs)(This AFL supersedes AFL 20-22.9) All Facilities Letter (AFL) Summary This AFL notifies SNFs of updated CDPH, Centers for Medicare and Medicaid Services (CMS), and Centers for Disease Control and Prevention (CDC) guidance for improving their infection control and prevention practices to prevent the transmission of COVID-19, including guidance for visitation.This AFL provides CDPH guidance for group activities and communal dining based upon vaccination status of residents.This AFL requires SNFs to develop and implement processes for verifying the vaccination status of all visitors, and for obtaining and tracking documentation of SARS-CoV-2 diagnostic test of all visitors.This AFL updates restrictions on visitation and also removes outdated exemptions to visitation restrictions.

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Coronavirus Disease 2019 (COVID-19) Vaccine Recommendations for Eligible Individuals Prior to Discharge

AFL 21-20.1 From the California Department of Public Health February 7, 2022 TO: General Acute Care Hospitals (GACHs)Acute Psychiatric Hospitals (APHs)SUBJECT: Coronavirus Disease 2019 (COVID-19) Vaccine Recommendations for Eligible Individuals Prior to Discharge(This AFL supersedes AFL 21-20) All Facilities Letter (AFL) Summary This AFL recommends GACHs and APHs offer COVID-19 vaccinations and booster doses to eligible individuals prior to discharge.

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Notice of Testing Supply Availability and Distribution Process

AFL 22-02 From the California Department of Public Health  January 14, 2022 TO: Skilled Nursing Facilities SUBJECT: Notice of Testing Supply Availability and Distribution Process All Facilities Letter (AFL) Summary This AFL notifies skilled nursing facilities (SNFs) that the state is sending roughly 330,000 Clinical Laboratory Improvement Amendments (CLIA) waived BinaxNow antigen tests to SNFs for the purposes of testing visitors seeking indoor visitation.

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Guidance on Quarantine and Isolation for Health Care Personnel (HCP) Exposed to SARS-CoV-2 and Return to Work for HCP with COVID-19

AFL 21-08.7 From the California Department of Public Health TO: General Acute Care Hospitals (GACHs)Acute Psychiatric Hospitals (APHs)Skilled Nursing Facilities (SNFs) SUBJECT: Guidance on Quarantine and Isolation for Health Care Personnel (HCP) Exposed to SARS-CoV-2 and Return to Work for HCP with COVID-19(This AFL supersedes AFL 21-08.6) All Facilities Letter (AFL) Summary The purpose of this AFL is to provide hospitals and SNF with updated guidance on:Exposure risk assessment and work restriction for asymptomatic HCP with SARS-CoV-2 exposures (quarantine)Work restrictions for HCP diagnosed with SARS-CoV-2 infection (isolation)This revision incorporates updated Centers for Disease Control and Prevention (CDC) guidance on Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 and Strategies to Mitigate Healthcare Personnel Staffing Shortages.Pursuant to Welfare and Institutions Code section 14126.033 a SNF’s receipt of the annual increase in the weighted average Medi-Cal reimbursement rate may be conditioned on the facility’s good faith compliance with CDPH AFLs related to the COVID-19 Public Health Emergency, as a result the recommendations included in this AFL are requirements for SNFs.From January 8, 2022 until February 1, 2022, HCP who test positive for SARS-CoV-2 and are asymptomatic, may return to work immediately without isolation and without testing, and HCPs who have been exposed and are asymptomatic may return to work immediately without quarantine and without testing.

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Centralization of Program Flexibility Application Process

AFL 22-01 From the California Department of Public Health  January 7, 2022 TO: All Facilities SUBJECT: Centralization of Program Flexibility Application Process All Facilities Letter (AFL) Summary This AFL provides the rollout schedule for centralization of the program flexibility process by district office and prioritization criteria for registering users for the online application.This AFL announces the new online application for Program Flexibility and Patient Needs Waiver and Workforce Shortage Waiver Applications and provides information on how to register as a user.

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