California SNFs Face Increase To 3.5 HPPD Minimum On July 1

California is making a change to its minimum staffing requirements for skilled nursing facilities (SNFs).  Effective July 1, 2018 (the start of CA fiscal year 2018/2019), facilities will be required to staff to a minimum of 3.5 direct care hours per patient day (HPPD), a .3 increase from what was previously mandated. Senate Bill No. 97, Chapter 52, also requires that SNFs must meet 2.4 direct-care hours for certified nursing assistants (CNAs). 

This requirement applies to all SNFs except those that are a distinct part of a general acute care facility or a state-owned hospital or developmental centers, or Institutes for Mental Disease (IMDs). Read the full bill here.

Available Waivers

The bill includes two waivers for application.

• The Workforce Shortage Waiver is for facilities that are unable to hire sufficient staff to provide 3.5 direct care service hours and/or the 2.4 CNA hours due to a workforce shortage in their local market. These facilities will still be required to meet California’s current 3.2 labor hour standard.  
  
  
• The Acuity Waiver is for facilities that run total direct care hours of 3.5 or greater but don’t meet the 2.4 CNA hour requirement because they run higher nursing (RN & LPN) hours. Typically, this would apply to facilities such as transitional care units that, due to their patient population, provide more nursing care and consequently, don’t need to staff CNAs at 2.4 HPPD.

In both cases, the facility is required to file the waiver for CA FY 2018-2019 by Sept. 30, 2018.  The waiver, if approved, would then apply from July 1, 2018 to June 30, 2019. The department has until January 31, 2019 to notify facilities if their waiver is approved and the waiver approval is retroactive to the beginning of the applicable state FYE.

At this point the California Department of Public Health (CDPH) – who is responsible for approving the waivers – has not specified how a facility whose waiver application is denied will be reprimanded if the facility fails to meet the new staffing requirements during the period from July 1, 2018 to Dec. 31, 2018.

Also, in both cases, facilities can apply for waiver extensions in future years. For fiscal year 2019-20 and beyond the extension application needs to be submitted no later than April 30 each year. The department will not grant more than two consecutive Workforce Shortage Waiver renewals. CDPH has not specified if the acuity waivers will be limited to two years.

The process to apply for a waiver is very detailed and includes a review of compliance history in addition to the merits of the application itself.  Click here for more information and wavier eligibility.

Regarding Providers That Receive QASP

For those facilities that meet the requirements to receive CA Quality Accountability Supplemental Payments (QASP), the current staffing requirement of 3.2 remains in effect until the beginning of the 2019-2020 QASP performance period (July 1, 2019 to June 30, 2020). 

Note that the HPPD calculation for the minimum staffing requirements is different than those used for Payroll Based Journal. Also, the staffing requirements are also predicated on CA continuing to receive the full Quality Assurance Fee.

Learn staffing strategies for meeting your HPPD goals.

Proper Staffing & Employee Engagement Are Key

It's apparent that the skilled nursing facilities will continue to face tighter and tighter regulations related to resident care. It's imperative that providers evolve -- adjusting staffing levels to meet resident care and labor budget goals, and focusing on employee engagement to reduce costly turnover. With special attention paid to these practices, quality resident care and organizational success are possible. 

OnShift will continue to keep providers in the loop as regulation changes arise. Please feel free to reach out to us if you have any questions or want to learn more about how OnShift supports mandates like this one.