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RN level of care and reassessment: the steps to remember

The short step lists from each lesson of The RN's part: nursing-facility level of care and the semiannual reassessment, on one page. Print it for the station or the break room. Each list points back to its lesson, where the sources are linked.

Open the coursePrint a poster with a QR code

Decision guide

Level of care and the reassessment: what does the RN do next?

Has DHCS mailed a Notice of Action after a reassessment you submitted?

  • Yes

    Go over the Notice of Action with the participant: the reason, 90 calendar days to ask for a State Fair Hearing, the date at the top that keeps services going, and the legal aid number. The choice is theirs.

  • No

    Has the participant's condition changed since the last assessment?

    • Yes

      Reassess now with the same Assessment Tool. Do not wait for the six-month date. Record what changed and who told you.

    • No

      Is the reassessment due date more than 30 days away?

      • Yes

        Book the visit inside the window: from 30 days before to 30 days after the due date. Plan it early enough to move it if needed.

      • No

        Is the due date already more than 30 days past?

        • Yes

          The window has closed. Reassess as soon as you can, and tell your supervisor: DHCS audits timeliness and can require a corrective action plan.

        • No

          Are you a qualified RN who has done the DHCS training on the tool?

          • Yes

            Assess with the participant, the family and the records. Enter what you observe and confirm, sign the tool, and send the ISP and documents within seven days. DHCS makes the final determination.

          • No

            Ask your supervisor to send a qualified RN or social worker who has done the DHCS training. You may come along to learn.

This guide sorts your next step. It does not score anyone or decide level of care, a tier or services: the Assessment Tool scores, and DHCS makes the final determination. Follow your agency's procedures and DHCS direction.

Step through it one question at a time: alwbeta.com/training/courses/rn-level-of-care-reassessment#decision-guide

Lesson 1

What nursing-facility level of care means in ALW

Every ALW case turns first on one question: does this person meet nursing-facility level of care? As the CCA nurse, you gather the facts the answer rests on. This lesson prepares you to explain the criterion as the waiver and Title 22 state it, and to keep it apart from one diagnosis or one task.

  1. Level of care: the care a nursing facility provides, due to medical needs
  2. Basis: Title 22 sections 51120 (NF-A) and 51124 (NF-B)
  3. NF-A: protective, supportive care; no continuous nurse supervision
  4. NF-B: skilled nursing continuously available; one procedure is not enough
  5. The scored tool decides: tier 1 about NF-A, tiers 2 to 5 within NF-B
  6. DHCS makes the final determination

Lesson: alwbeta.com/training/courses/rn-level-of-care-reassessment#lesson-rnloc-criterion

Lesson 2

The RN's assessment: qualified, trained and complete

The tool is only as good as what goes into it. You are the person who gathers the facts, enters them and signs. This lesson prepares you to check that you may give the tool, that you have the facts you need, and what you send to DHCS for the final decision.

  1. RN: current, unsuspended, unrevoked California license
  2. 1,000 hours acute care or 2,000 hours in a home setting, similar needs
  3. DHCS training on the tool, the ISP and the procedures manual first
  4. Assess with the participant and family; read the records
  5. Judgment items: devices, communication, nutrition, medications, transport, treatments
  6. An RN signs the tool; DHCS makes the final determination

Lesson: alwbeta.com/training/courses/rn-level-of-care-reassessment#lesson-rnloc-rn-assessment

Lesson 3

The six-month reassessment and its window

Each participant has a reassessment due date, and the waiver gives you a window around it. Miss the window and your agency can face a corrective action plan. This lesson prepares you to schedule the reassessment, count the days, and know when a change means you go sooner.

  1. Every six months, same tool; DHCS reviews every one
  2. Window: 30 days before or after the due date
  3. Then seven days for the ISP and all documents
  4. DHCS 1330: RN-signed tool within 30 days of the due date
  5. Condition changed? Reassess now
  6. The ISP ends six months after its start date

Lesson: alwbeta.com/training/courses/rn-level-of-care-reassessment#lesson-rnloc-reassessment-window

Lesson 4

What changes the result, and a record that supports it

A reassessment can raise the tier, lower it, or find the person below nursing-facility level of care. Each result matters to the person and the home. This lesson prepares you to tie the result to measured need, and to leave a record that DHCS can check against what you saw.

  1. Score the need for help, not a diagnosis or a request
  2. Tier change: DHCS 1329, RN-signed tool within 60 days of signing
  3. Below NF-A or NF-B: record it as found; DHCS decides
  4. Needs the home cannot safely manage: reassess, report, DHCS decides
  5. Notes show the help needed, how often, who gives it, where you saw it
  6. Originals kept ten years; the home gets the current ISP and RN assessment

Lesson: alwbeta.com/training/courses/rn-level-of-care-reassessment#lesson-rnloc-what-changes

Lesson 5

When the determination changes: the Notice of Action and the hearing

When DHCS lowers or ends services, the participant has rights with deadlines. You are often the first person they call. This lesson prepares you to explain who decided, what the Notice of Action says, how to ask for a State Fair Hearing in time, and where to get free legal help, without choosing for them.

  1. DHCS decides; DHCS mails the NOA
  2. The NOA: the reason, the hearing steps, free legal aid numbers
  3. Hearing request: within 90 calendar days of the mailing
  4. Keep services: ask before the date at the top, or within ten days
  5. Toll-free number on the back: hearing rights and legal aid
  6. Explain; do not choose, predict or give legal advice

Lesson: alwbeta.com/training/courses/rn-level-of-care-reassessment#lesson-rnloc-when-it-changes

Beta’s ALW team, course version 2026.10.3, text checked against its sources on October 22, 2026. Educational only. Not continuing-education, licensure or regulatory credit. Follow your employer’s current procedure and the person’s current plan. Call 911 for a medical emergency.

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