Patient Needs Waiver (PNW)
Overview
Effective July 1, 2018, all freestanding skilled nursing facilities (SNFs), excluding distinct parts of general acute care hospitals (GACHs), state-owned hospitals, or developmental centers, are required to provide 3.5 direct care service hours per patient day, with CNAs performing a minimum of 2.4 hours per patient day.
Health and Safety Code section 1276.65 (c)(2) requires the California Department of Public Health (CDPH) to develop a waiver process for SNFs seeking a waiver of the 2.4 CNA requirement to address individual patient needs. A patient needs waiver will allow a facility to waive the 2.4 CNA requirement as long as the SNF continues to meet the overall 3.5 direct hours requirement as required by the legislation. A SNF seeking a patient needs waiver must submit a waiver application to CDPH. In addition, facilities must post notice of a pending or approved waiver request in the facility and must notify potential residents of the facility that they either have an approved or pending waiver application.
How to Apply 
The application filing period for PNW opens on January 1 and must be filed no later than April 1. The online application portal located on the CDPH Flex Waiver Webpage will open on January 1. All applications must be submitted no later than April 1. CDPH will not accept applications submitted outside of this timeframe.
An applicant must be an authorized user to submit a completed online application.
For first time waiver applicants, providers will receive an invitation from CDPH to create a password. The provider's username is their email address. The provider may log in at Flex Waiver Webpage (only using Google Chrome, Mozilla Firefox or Microsoft Edge). Detailed instructions for registering and submitting an application will be available.
After successfully submitting an online application, the system sends a confirmation e-mail with an identification number (tracking ID number) to the provider's designated point of contact listed on the application. All correspondence regarding the application will be sent to the point of contact. CDPH must receive all required documentation to process the application.
Resources