AFL 20-47.2 From the California Department of Public Health
July 16, 2021
TO: Hospice Providers
SUBJECT: Suspension of Regulatory Enforcement of Hospice Requirements
(This AFL supersedes AFL 20-47.1)
AUTHORITY: Executive Order N-35-20 (PDF)
All Facilities Letter (AFL) Summary
- This AFL notifies hospice providers of a temporary waiver of specified regulatory requirements due to the state of emergency related to the Coronavirus Disease 2019 (COVID-19) outbreak.
- Effective July 17, 2021, waivers permitting a hospice provider to provide care prior to obtaining license renewal or reinstatement or to add a location or service will expire. All hospice providers with an existing waiver must have their license issued, renewed or reinstated prior to July 17, 2021 to continue providing care.
- This AFL notifies hospice providers that the temporary waiver of specified regulatory requirements for services contained in this will expire September 30, 2021, and this AFL will be rescinded.
Pursuant to Governor Newsom’s Executive Order N-35-20 (PDF), 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 8.5 of Division 2 of the Health and Safety Code (HSC) and accompanying requirements by the California Hospice and Palliative Care Association, as published in the “Standards for Quality Hospice Care 2003” (SQHC).
CDPH is temporarily waiving specified licensing requirements and suspending regulatory enforcement for the following requirements as specified in this AFL.
California has made significant progress in the response to COVID-19 as a result of the collective efforts taken by Californian’s and the widespread availability of COVID-19 vaccines. With stable case rates and hospitalizations and widespread availability of vaccines, California moved beyond the Blueprint for a Safer Economy on June 15, 2021.
As a result and in compliance with Executive Order N-08-21 (PDF), the temporary waivers contained in this AFL will expire September 30, 2021.
1. HSC sections 1747 (a) and (b)
A hospice provider 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
2. HSC section 1751 (c) and 1754
- Any licensee that has applied to CDPH for renewal of a license, or for reinstatement of a license that has been voluntarily suspended, may begin or continue providing care prior to obtaining approval of the renewal or reinstatement by CDPH.
Effective July 17, 2021 these licensure waivers allowing a hospice provider to provide care prior to obtaining approval from CDPH for renewal or reinstatement of a license or to add a location or change a service will expire. All hospice providers with an existing waiver must have their license issued, renewed or reinstated prior to July 17, 2021 to continue providing care.
3. SQHC Article 6, section 6.3 (A)
- Due to the state of emergency, health examinations, tuberculosis testing, and background checks for new employees are temporarily suspended. The hospice provider shall ensure each employee completes these actions as soon as practicable but no later than September 30, 2021.
- Hospices are temporarily not required to provide or make provision for volunteer services.
5. HSC section 1749 (b)
- Hospice providers will have flexibility in how they provide basic services to patients. Basic services include skilled nursing services, social services/counseling services, medical direction, bereavement services, volunteer services, inpatient care arrangements, and home health aide services. Services may be provided via telehealth or other remote methods. This will allow for, but is not limited to, check-in calls, health screening calls, and video conferencing.
- Hospice providers may use healthcare professionals 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.
6. HSC section 1747 (d)
- Small and rural hospices may temporarily provide services to more than 50 patients per year.
Effective September 30, 2021, these service waivers will expire and hospice providers shall resume providing services following HSC requirements and SQHC standards.
Additionally, CMS is providing temporary regulatory waivers to certified hospices, allowing maximum flexibility to respond to the COVID-19 pandemic. Hospice providers may apply for the waivers via the CMS Coronavirus Waiver and Flexibilities webpage.
If you have any questions about this AFL, please contact your local district office.
Original signed by Cassie Dunham
Acting Deputy Director