SMALL HOUSE SKILLED NURSING FACILITIES PILOT PROGRAM

APPLICATION PROCEDURES & REQUEST FOR APPLICATIONS

 I.    Definitions

The definitions in the DEFINITIONS section of the standards for the Small House Skilled Nursing Facilities Pilot Program (SHSNF PP) apply to the SHSNF PP Application Procedures & Request for Applications.

II.    Overview of the Application Process for the Small House Skilled Nursing Facilities Pilot Program

Health and Safety Code (HSC) sections 1250(c)(2) and 1323.5, et seq. authorize the California Department of Public Health (CDPH or Department) to create the SHSNF PP and accept up to ten pilot facilities into this program. The statute further specifies that applications for participation are to be submitted at intervals during the first two years of the pilot program, as indicated below.

III.   Request for Applications

This Request for Applications (RFA) is being issued to implement the SHSNF PP. Applicants must meet all of the standards of the pilot program, including all skilled nursing facility (SNF) regulations not modified by those standards.

IV.   Application Deadlines

CDPH will select a maximum of ten applications, total, in two rounds, as follows:

• First Round applications must be submitted not later than 5:00 p.m. on June 15, 2018. 
• Second Round applications must be submitted not later than 5:00 p.m. on December 14, 2018.
• Third Round  applications must be submitted not later than 5:00 p.m. on June 14, 2019.
   

V.    Focus of the Application

(a) Applicants must submit an operational overview that addresses how their proposal differs from the traditional SNF concept and includes small house concepts such as:

(1) resident-centered care;
(2) self-directed care;
(3) self-managed work teams; and
(4) the versatile worker staffing model.

(b) Applicants must demonstrate in their application that:

(1) they have experience in operating one or more health care facilities that offer the same level of care to be furnished in a SHSNF pilot facility;
(2) the proposed pilot facility will meet all of the requirements of the locational and building design standards for the SHSNF PP, including providing assurances that the pilot facility will meet all requirements of the local jurisdiction having authority over planning and zoning for the proposed site;
(3) the applicant will be able to complete the development process and become operational on or before October 31, 2021; and
(4) the applicant possesses the requisite financial qualifications outlined below.

(c) Applicants must certify that they will participate in the SHSNF PP evaluation and will comply with all of the operational standards for a SHSNF, including the staff training and orientation requirements. See Attachment C.

VI.   Submission Procedure 

Applicants must submit one complete copy of each application package by mail, on or before the submittal deadline. CDPH will not consider late submissions. The applicant is responsible for any delivery failures or errors. The applicant must also submit the entire application package electronically, either by email, USB flash drive, CD, or other electronic storage medium.

All required information and materials must be submitted by the due date. CDPH will not review any information or materials received after the submission date, unless requested by the Department pursuant to HSC section 1323.5(l)(2). Applications received after the deadline for a round of applications will be held over to the next round, if there is one, unless withdrawn by the applicant.

The addresses to which all submittals shall be made are:

Email address:SHSNFPilotProgram@cdph.ca.gov. 

VII.   Specific Contents of the Initial Application Package

(a) All of the required information/documents must be submitted to the Department. CDPH will not consider any application lacking any required document or information. 

(b) The CDPH forms cited below, as well as instructions for completing them (as modified or supplemented herein), may be obtained from the Department’s website at the following link:

SNF/Intermediate Care Facility Applications

(c) All applications for the SHSNF PP shall include:

(1) one copy of the Department’s form HS 200 (Licensure & Certification Application), or a successor form, with all required attachments except:

(A) the licensing fee (Item A.3 on the HS 200), and
(B) the OSHPD forms cited in Item A.11 of the HS 200;

(2) one copy of the Department’s form HS 215A (Applicant Individual Information), or a successor form, for each of the following persons in the applicant organization, the parent company, and the management company:

(A) individuals having a beneficial interest of five percent or more,
(B) directors,
(C) board members,
(D) corporate officers,
(E) LLC members/managers, and
(F) partners; 

(3) one copy of the Department’s form HS 215A (Applicant Individual Information), or a successor form, for each of the following persons, if their identity is known at the time of the initial application:

(A) facility administrator, and
(B) director of nursing;

(4) one copy of the Department’s form HS 309 (Administrative Organization), or a successor form, for all applicants except sole proprietorships, with each applicant providing the information requested in Corporation Item 8, as well as the following:

(A) all health care facilities located inside and outside of California that the applicant has operated or had an ownership interest in during any portion of the four-year period preceding the application,
(B) the license number of each, and
(C) whether each is/was federally certified; 

(5) for sole proprietorships, a list of the health care facilities, both inside and outside California, that the applicant has operated or had an ownership interest in during any portion of the four-year period preceding the application, which shall include all of the following:

(A) the name and address of each facility,
(B) the license number of each,
(C) facility size,
(D) level of care provided,
(E) dates and duration of ownership/operation, and
(F) whether it is/was federally certified; 

(6) a description of the proposed project, including a narrative describing:

(A) the nature of the proposed physical development, including whether the application involves:

(i) the conversion and remodeling of an existing care facility, and the licensure type of that facility,
(ii) the expansion of an existing SNF,
(iii) new construction on an existing care facility site (including the types of care offered elsewhere on the site), or
(iv) new construction on a new site;

(B) the design of the proposed resident rooms;
(C) the provision of distinctive SHSNF features;
(D) the design features specific to the targeted population(s);
(E) the operational features of the proposed SHSNF;
(F) the manner in which the SHSNF staffing standards will be met; and
(G) the manner in which the training and orientation program standards will be met;

(7) the proposed timeline and schedule for the planning and construction process for the pilot facility, including a projected date for completion and commencement of operations; 

(8) preliminary physical design documents that include all of the following:

(A) preliminary site plan showing existing and proposed buildings, exterior spaces for use by the SHSNF residents, parking, property lines, rights-of-way, easements, etc.;
(B) preliminary building elevation drawings with proposed palette (required only for new construction or for a remodel when the building exterior is to be modified);
(C) preliminary proposed floor plans for the SHSNF;
(D) a copy of the local planning jurisdiction’s general plan, with a land use map showing the designated land use(s) for the vicinity of the facility;
(E) locational map(s) showing surrounding existing zoning; and
(F) assessor’s parcel maps for the facility property and the immediately surrounding land;

(9) a list of the local planning jurisdiction’s required development permits, with that entity’s estimate of the amount of time necessary to obtain each, and a projected date for completion of the local permit process; 

(10) the policies and procedures (P&Ps) that the applicant intends to adopt for the pilot facility, indicating the applicant’s willingness and ability to comply with the operational standards for the pilot program. The P&Ps should contain information that demonstrates the focus on SHSNF concepts such as resident-centered care, self-directed care, self-managed work teams, and the versatile worker staffing model. The P&P topics shall include, at a minimum:

(A) administrative, including policies regarding smoking/non-smoking;
(B) dietetic service;
(C) infection control;
(D) staffing and resident care, including personnel duty statements; and
(E) staff training and orientation programs; 

(11) the proposed training and orientation programs, including, at a minimum, the following information:

(A) a brief description of each proposed training or orientation module in compliance with the SHSNF Training and Orientation Standards;
(B) the number of hours to be dedicated to each module;
(C) the methodology to be used to determine each employee’s initial and on-going competency/proficiency in a given module;
(D) the identity of the company, organization, or other parties that will instruct each training module; and
(E) the identity/position of each employee of the SHSNF who will conduct each orientation module; and

(12) each request for waiver that the applicant intends to seek pursuant to HSC section 1323.5(k), accompanied by detailed supporting information.

VIII.    Licensing Fee 

(a) Upon notification from the Department that an applicant has reached Stage Three in the selection process and is a finalist for the SHSNF PP, as described in paragraph IX.(d), below, CDPH will collect a licensing fee pursuant to HSC section 1323.5(h)(2), subject to the following:

(1) for current SNF licensees that intend to only convert existing beds into a distinct part (DP) SHSNF pursuant to CCR, Title 22, section 72041, without adding any beds, no additional licensing fee will be required;
(2) if a current SNF licensee intends to develop a DP SHSNF that will add beds to its license, its annual license fee will be adjusted to reflect the new bed count;
(3) for all other types of health care licensees that intend to add a DP SHSNF to an existing facility, the bed count of the DP SHSNF will be added to the license of the associated facility, with the licensing fee adjusted to reflect that addition; and
(4) for all other types of health care licensees that have an existing DP SNF and intend to convert DP SNF beds to a SHSNF, no additional fee will be required, with the licensing fee for the SHSNF beds being the same as for the DP SNF beds. 

(b) The amount of the fee that each SHSNF PP finalist must submit, subject to the above, is the SNF per-bed fee in effect at the time that the applicant is accepted into Stage Three, as indicated on the following web link:

(c) CDPH will collect an additional annual fee from each SHSNF, as permitted by statute to cover the costs of the pilot program, at the time of the annual license renewal. The amount of the pilot program fee is yet to be determined but shall be calculated based on the costs to administer the pilot program. 

IX.    Selection Process 

(a) The review and selection process has three stages:

(1) Stage One  – ineligible applications will be eliminated;

(2) Stage Two – a competitive review will be made using the evaluation criteria in Attachment B, with the highest ranking applications being designated by the Department as pilot program finalists; and

(3) Stage Three – the finalists' applications will proceed to completion and facility licensure.

(b) Stage One: Elimination of Ineligible Applications. CDPH will review all applications completeness and eliminate incomplete application packages.

►The projected date for notification of the results of this stage is approximately 30 days after the deadline for submittal. 

(c) Stage Two: Competitive Review and Selection. CDPH staff will review all remaining applications and select which applications will to proceed to Stage Three. The evaluation process will include the review and analysis of each applicant’s full application package, together with any supplemental information/material that is requested by the Department. If supplemental material/information is requested, the applicant shall have 30 days within which to provide the required documents. Failure to do so shall constitute grounds for elimination from further consideration.

(1) CDPH will use a numeric rating system to judge the extent to which each application meets the pilot program criteria. The rating criteria are listed in Attachment B.

(2) In addition to the scored criteria, the following will be included in the evaluation process:

(A) a comparison among the applications for variations in the care models and type and design of each proposed pilot facility;
(B) a comparison of operational differences between the proposed facilities;
(C) the geographic locations of the proposed pilot facilities;
(D) the amount of prior experience in operating a SNF/NF; and
(E) the compliance history of each applicant.

(3) CDPH may reject proposed projects that will not be able to become operational by October 31, 2021.

►The projected date of notification of the results of this stage is approximately three months after notification of the results of Stage One. 

(c) Stage Three: Final Selection. In this stage, pilot program finalists shall:

(1) respond to questions and concerns of the Department regarding the details of their proposals;

(2) update all required licensure forms/information submitted during the initial application process;

(3) pay the applicable licensing fee, if any;

(4) sign the SHSNF PP participation agreement (Attachment C);

(5) complete all local planning jurisdiction permits;

(6) submit the following materials pertaining to its training program and its orientation program:

(A) a detailed description of the proposed curriculum for each;

(B) the instructional materials, including lesson plans and outlines;

(C) the competency/proficiency testing materials and procedures;

(D) any revisions proposed to the prior training and orientation submittal that accompanied the initial application; and

(E) the documentation method(s) that will be used for the training and orientation programs;

(F) documentation verifying the qualifications of the instructors of the company, organization, or other party who will instruct each training module represented on a completed departmental form CDPH 279 (Director of Staff Development (DSD) Instructor Application);

(7) apprise the Department of all approvals received from the Office of Statewide Health Planning and Development (OSHPD), as they are received; and

(8) provide the Department with monthly progress reports, including a projected opening date for the facility. 

(e) Grounds for removal of a Stage Three finalist from the SHSNF PP:

(1) failure to obtain all of the required local planning permits in a timely manner;

(2) failure to pay the required licensing fee within 30 days of the Department’s notice of the amount due;

(3) evidence of a change in the applicant’s financial condition that will prevent compliance with the project’s timeline and schedule for becoming operational;

(4) evidence that the proposed facility will not be eligible to be both licensed and certified pursuant to HSC section 1323.5(h);

(5) inadequacy of the proposed training program or the proposed orientation program;

(6) evidence that the proposed facility will not be able to obtain all necessary approvals from OSHPD;

(7) failure of the applicant to timely provide the Department with requested information, data, or other materials;

(8) refusal by the finalist to comply with the SHSNF PP standards or other laws described in section A.II. Applicability of Existing Law of the SHSNF PP standards;

(9) a material change in compliance history that occurs between application submittal and final selection;

(10) failure to provide evidence of the ability to comply with the SHSNF PP standards or other laws described in section A.II. Applicability of Existing Law of the SHSNF PP standards; and

(11) evidence that the facility will be unable to become operational by January 1, 2020. ​