Hospital Topics

Overview

CDPH Licensing & Enforcement

The California Department of Public Health (CDPH) Licensing and Certification surveyors may visit a hospital at any time to determine whether the hospital is in compliance with state licensing requirements. Visits may result from a complaint by a patient, employee or other third party; a newspaper article; or a report by the hospital itself regarding an unusual occurrence, privacy breach or adverse event.

CHA News Article

CDPH Issues Updated SNF Relicensing Workbook
New version implemented March 1

The California Department of Public Health has issued the attached updated state relicensing survey workbook for skilled-nursing facilities. Licensing and Certification district offices began using the new workbook March 1. 

CHA News Article

CDPH Pilots Use of Non-RNs as Breach Investigators

SB 857 (Chapter 31, Statutes of 2014) required the California Department of Public Health (CDPH) to report on the possibility of using professional position classifications other than health facilities evaluator nurses (HFEN) for licensing and certification surveys or complaint investigation. CDPH’s licensing and certification program explored this issue, and— based on a review of federal requirements for survey staff, California civil service classification requirements and complaint investigation workload — determined that it would, beginning in 2015, conduct a pilot project to use associate governmental program analysts or special investigators to perform medical information breach investigations currently performed by HFENs. More information is available in the attached report. 

Recording

CDPH’s New Hospital Relicensing Survey Webinar
Important changes begin March 2016

Webinar Recorded Live February 18, 2016

Overview

Changes are coming!

Education event

Consent Law Seminar
End of Life Option Act, labor and delivery, decision-making process, new laws and updates

Five Locations:
May 3, Fresno; May 10, Pasadena
; May 11, Irvine;
May 25, San Ramon; June 1, Sacramento

Managing risk in a hospital is hard. In many situations, the laws aren’t clear or conflict — but a decision has to be made anyway. The annual Consent Law seminar is the one educational program that will expand your knowledge and critical thinking to help you make tough decisions with confidence. As an added bonus, all attendees take home a free copy of CHA’s 2016 Consent Manual.

CHA News Article

2015-16 State Budget Increases Funding for Licensing Oversight in Los Angeles County

The 2015-16 state budget provided the California Department of Public Health’s (CDPH) Licensing and Certification (L&C) Division with additional funds to augment its contract with Los Angeles County. L&C has a long-standing contractual relationship  for Los Angeles County to provide licensing and certification oversight to facilities in the county. Recently, L&C renewed its contract with the county, including increased funding to hire approximately 70 additional L&C staff. In recent years, L&C (including its work in Los Angeles County) has been under scrutiny to improve performance related to timely completion of complaint investigations and mandated licensing surveys.

To allow Los Angeles County sufficient time to hire and train additional staff, the contract provides that CDPH L&C will assume the non-long-term care facility complaint investigations for one year, including hospitals and acute psychiatric facilities. Hospitals in Los Angeles County should continue to report adverse events and unusual occurrences to the county as usual. However, investigations may be performed by staff from other CDPH district offices.

L&C calculates provider fees based on the associated survey activity within each provider category (hospital, clinic, etc.). As L&C is able to hire and train additional staff and complete more survey work, provider fees may increase in coming years.

Overview

Community Benefit Programs
Hospitals give back to their communities

Health care is undergoing tremendous change and uncertainty as California implements the federal Affordable Care Act (ACA). Hospitals are working to ensure there will be enough beds and an adequate supply of health care professionals to meet the demands of the millions of Californians who are signing up for health insurance coverage under the ACA. In addition, California hospitals are meeting the needs of their communities through locally developed community benefit plans by supporting health care programs that provide preventative care to those in need.

Tax-Exempt Status of Nonprofit Hospitals

The tax-exempt status of nonprofit hospitals is being reviewed by policymakers, regulators and public interest groups. There are various proposals to impose burdensome and inflexible standards on nonprofit hospitals in order to obtain tax-exempt status and financing. CHA supports the development of appropriate guidelines that are not unduly burdensome and will allow sufficient flexibility to ensure nonprofit hospitals are able to carry out their mission. They must be based on broad measures of community benefit without establishing rigid formulaic thresholds.

CHA News Article

Updated Hospital Financial Assistance Policies and Community Benefit Laws Guidebook Now Available

CHA is pleased to announce the release of the Hospital Financial Assistance Policies and Community Benefit Laws, third edition. The guidebook can help simplify compliance with charity care and community benefit laws and explains the requirements of the California Hospital Fair Pricing Policies law, the Emergency Physician Fair Pricing Policies law, the IRS financial assistance requirements for tax-exempt hospitals, and other related laws.

The third edition provides more comprehensive information than ever and has been updated to address:

  • IRS clarifications of hospital financial assistance policies and related requirements
  • IRS clarifications of community health needs assessments and community benefits plans
  • Details on new requirements for the provider list that must be given to patients
  • How the IRS will address minor omissions and errors in hospitals’ policies and operations
CHA News Article

CDC Announces New Community Health Improvement Navigator Framework and Tool
Website designed as one-stop-shop of tools and resources

The Centers for Disease Control and Prevention (CDC) recently launched a new website to support hospitals, health systems, public health and other community organizations interested in improving the health of their communities. Called the Community Health Improvement Navigator (CHI Navigator), the site is also intended for tax-exempt hospitals complying with the IRS final rule on community health needs assessments for charitable hospitals. 

CHI Navigator was designed as a one-stop-shop of expert-vetted tools and resources for individuals who lead or participate in CHI work within hospitals and health systems, public health agencies and other community organizations, to assist with:

Overview

Clinical Care

Clinical care touches every aspect of hospital operations. Policies and procedures surrounding clinical care are of the utmost importance in meeting regulatory, legal and licensing requirements. CHA has numerous area-specific groups — including specialty centers and committees — that address the many aspects of clinical care. Some areas of clinical care are subject to rapid changes in public policy and regulations, creating additional challenges for hospitals. In addition to providing representation and advocacy to address these challenges, CHA focuses on the unique needs of certain facilities, and the services and programs they offer their communities.

Education event

Consent Law Seminar
End of Life Option Act, labor and delivery, decision-making process, new laws and updates

Five Locations:
May 3, Fresno; May 10, Pasadena
; May 11, Irvine;
May 25, San Ramon; June 1, Sacramento

Managing risk in a hospital is hard. In many situations, the laws aren’t clear or conflict — but a decision has to be made anyway. The annual Consent Law seminar is the one educational program that will expand your knowledge and critical thinking to help you make tough decisions with confidence. As an added bonus, all attendees take home a free copy of CHA’s 2016 Consent Manual.

CHA News Article

End of Life Option Act Webinar Now Available

On Nov. 19, CHA hosted a webinar explaining the End of Life Option Act signed into law by Gov. Brown on Oct. 5. The Act will allow individuals who have a terminal illness and who meet certain qualifications to ask their physician for a prescription for medication to end their life. Because the bill was introduced in a special legislative session, it will become effective 90 days after the session is closed; that date is still uncertain.

The webinar provided an overview of the legislation, discussed the impact on hospitals and medical staffs, and explained the requirements that must be met by the individual to be able to request aid-in-dying medication, and by the physician to prescribe it. Hospitals are encouraged to begin work now to determine whether they will participate in activities under the Act, and to develop policies and procedures whether they choose to participate or not.

Recording

The End of Life Option Act Webinar
Understanding the law, considerations for developing and implementing policies

Webinar recorded live April 18, 2016

The End of Life Option Act is one of the most important bills the Governor signed into law this year. Individuals who have a terminal illness and meet certain qualifications may now ask their physician for prescription medication to end their life. The law is complicated and not without controversy.

CHA News Article

Budget Gives CDPH New Investigation Timelines
Also adds L&C positions to address survey activities

The 2015-16 state budget provides the California Department of Public Health’s (CDPH) Licensing and Certification (L&C) Division with 237 additional positions to assist with its workload, including addressing “past failures to complete its survey workload and close/complete complaint investigations.” In addition, the budget increases hospital fees and adjusts the timelines for CDPH to complete investigations of skilled-nursing facilities (SNFs).

Many provider fees were increased in the budget to correspond to the associated survey activity within each type of provider (hospital, clinic, etc.). Hospitals and SNFs will likely experience increased survey and investigation activities as L&C will have additional staff to complete this work. In addition, providers fees may increase in coming years as the L&C workload continues to increase.

Overview

Construction / Renovation

In the area of construction and renovation, CHA assists hospitals by reviewing and commenting on proposed regulations, attending all Hospital Building Safety Board (HBSB) meetings, nominating hospital representatives to the HBSB Board and serving as liaison between hospitals and the Office of Statewide Health Planning and Development’s (OSHPD) Facility Development Division when issues need to be resolved.

CHA News Article

HVAC Guidance Available for ORs, Sterile Processing Departments

An HVAC task force, whose members include the American Hospital Association’s American Society for Healthcare Engineering (ASHE), has issued the attached interim guidance to help health care facilities maintain appropriate temperature and humidity control in operating rooms and sterile processing departments while it works to achieve consensus on conflicting standards. Among other actions, the task force said it plans to explain the conflicting standards to accreditors and state licensing agencies and ask them to work with health care organizations to establish a plan for resolving variance.

In addition to ASHE, task force members include the American Society of Heating, Refrigerating and Air-Conditioning Engineers; Association for the Advancement of Medical Instrumentation; Association for Professionals in Infection Control and Epidemiology; Association of periOperative Registered Nurses; and the Facility Guidelines Institute. 

CHA News Article

Redesigned Radiation Treatment Resource Launched

The Department of Health and Human Services (HHS) has launched a redesigned online radiation treatment resource. The first major redesign of the Radiation Emergency Medical Management (REMM) website since it launched in 2007 is available at www.remm.nlm.gov. Intended to help health care professionals find reliable guidance to help diagnose and treat patients who have been exposed to radiation, the site provides information about radiation injuries and access to interactive clinical tools and data. Physicians and medical staff also can download a majority of the information from the website to use during an emergency if the Internet is not accessible, and a smartphone app containing REMM information is available for the Apple and Android platforms. The REMM site is a collaboration of the HHS Office of the Assistant Secretary for Preparedness and Response and the National Library of Medicine, part of the National Institutes of Health. More information is available at www.phe.gov/Preparedness/news/Pages/remm.aspx.

CHA News Article

OSHPD, Hospital Building Safety Board to Offer Hospital Construction Seminars

OSHPD has announced a one-day seminar titled “Building Relationships for a Successful Project,” intended to educate architects, engineers, hospitals, contractors and others on leveraging relationships to encourage successful project outcomes. The program will be offered on two dates: Oct. 21 in Anaheim and Oct. 27 in Concord. Attendees are encouraged to register soon, as space is limited. 

CHA News Article

Governor Signs CHA-Sponsored Bill on Medical Waste Management

Gov. Brown has signed SB 225 (Wieckowski, D-Fremont), a bill sponsored by CHA to clarify and streamline requirements of the Medical Waste Management Act. The bill took effect immediately upon signature by the Governor on Sept. 28. The bill:

  • Clarifies the definition of biohazard bag.
  • Requires a hazardous waste transporter of medical waste to maintain a tracking document, as specified, for the purpose of tracking medical waste from the point when the waste leaves the generator facility until the waste receives final treatment.
  • Requires the tracking document to be maintained only by hazardous waste transporters, and not by generators transporting waste.
  • Revises the container labeling requirements for specified medical wastes from “HIGH HEAT OR INCINERATION ONLY” TO “HIGH HEAT” or “INCINERATION ONLY.”

Details about the new law can be found at http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB225.

CHA News Article

FCC Moves to Allow Unlicensed Devices to Operate on Channel 37

Last week, the Federal Communications Commission (FCC) proceeded with rules that could jeopardize patient safety by allowing unlicensed devices to operate on the same frequencies as hospitals’ Wireless Medical Telemetry Service (WMTS). The FCC adopted rules that include smaller protection zones than those suggested by the American Hospital Association and supported by CHA. Although the FCC’s rules allow for increasing the size of the protection zones on a hospital-by-hospital basis to help ensure that WMTS interference will not occur, the hospital community remains concerned that it will. Last month, CHA urged members of the California congressional delegation who serve on the U.S. House Energy and Commerce Committee to sign a letter from Rep. Bob Latta (R-OH) that urged the FCC to delay for at least three months its consideration of the rules, to allow more time for a consensus resolution to the issue.

Overview

Emergency Preparedness
Is your hospital prepared?

Visit CHA’s Emergency Preparedness website at calhospitalprepare.org

About

Through the Office of the Assistant Secretary for Preparedness and Response, Office of Preparedness and Emergency Operations, Hospital Preparedness Program (HPP) grant, CHA has created a web site specifically devoted to Emergency Preparedness at www.calhospitalprepare.org.

   
CHA News Article

CDC Updates Maps on Zika Mosquito Potential Locations

The Centers for Disease Control and Prevention (CDC) has released new maps of the United States that show the potential location of the two species of mosquitoes associated with Zika virus transmission. The updated maps show where these mosquitoes are now or have been previously found within the continental United States, based on data gathered by CDC and its state and local partners, but do not show the numbers or density of mosquitoes within each area. While these maps do not indicate the risk of potential disease spread or risk of infection, they can help individuals and health care providers assess potential health risks and take appropriate precautions.

CHA News Article

Heightened Awareness Advised for Health Care Providers After Brussels Attack

Following Tuesday’s terror attack in Brussels, the Department of Homeland Security urges health care providers to increase awareness of activities that prompt suspicion or raise security concerns. The department stressed that early recognition and reporting of potential terrorist activity is the first line of defense against those who intend harm. Health care providers are encouraged to:

CHA News Article

Institute of Medicine Is Now Health and Medicine Division

The Institute of Medicine — the division of the National Academies of Sciences, Engineering, and Medicine that focuses on health and medicine — has been renamed the Health and Medicine Division. This new name builds on the heritage of the institute’s work in medicine, while emphasizing its increased focus on a wider range of health matters. Any questions about the division’s name change should be directed to Clyde Behney, executive director, at cbehney@nas.edu.

CHA News Article

Homeland Security to Fund Innovative Critical Infrastructure Projects
Webinar for applicants is Monday

The Department of Homeland Security (DHS) has announced that it will fund 10 regional innovation projects to develop technologies, tools, processes and methods that strengthen the security and resilience of the nation’s critical infrastructure. The Security and Resilience Challenge Initiative seeks applications from non-federal partners within the critical infrastructure community that address physical and/or cyber threats. DHS will host a webinar March 21 at 8:30 a.m. (PT) to provide details on the application process, selection specifics and other questions from interested applicants. To join the webinar, dial in using (888) 469-3352 and passcode 6081104, and link to the webinar at https://share.dhs.gov/nipp_challenge_21march2016/.

Additional information is available at www.thenihs.org. Questions about proposals can be directed to cip@hhs.gov.

CHA News Article

CDPH Emergency Preparedness Office to Host Medical Surge Webinar

The California Department of Public Health (CDPH) will host a webinar addressing preparation for a medical surge on March 9 at 1 p.m. (PT). The webinar will provide an overview of the 15 ‘til 50 program, which is designed to enable hospital staff to receive a surge of 50 or more patients within 15 minutes after notification of a mass casualty incident. Participants will receive the 15 ‘til 50 toolkit containing videos, slide decks, checklists and a planning guide, among other items. To register, visit http://www.cdphready.org/. More information is available in the attached flier. 

Overview

Environmental Health & Safety

CHA assists hospital environmental health and safety (EH&S) officers and other hospital personnel regarding compliance with the many — and frequently overlapping — state and federal EH&S requirements, including those related to  managing medical, hazardous and low-level radioactive waste. CHA also monitors EH&S legislation and regulation on behalf of hospitals and acts as their liaison with government agencies.  

CHA News Article

New Prop. 65 Website Geared Toward Consumer Education

The California Office of Environmental Health Hazard Assessment (OEHHA) recently established a new website to provide the public with information on chemicals, products and locations often associated with Proposition 65 warnings, which emphasize exposure to chemicals that cause cancer, birth defects or other reproductive harm. The OEHHA website offers information on laws and regulations, frequently asked questions, fact sheets and other resources.

CHA News Article

State Clarifies Regulatory Status of Certain Hazardous Waste Containers
Provides interpretation of EPA letter affecting California generators

The California Department of Toxic Substances Control (DTSC) recently published the attached letter clarifying the regulatory status of pharmaceutical-related hazardous waste generated by health care facilities in California — specifically, the impact of previous EPA guidance on California generators. While federal regulations allow hospitals to factor in only the weight of the RCRA P-listed hazardous waste residue when determining generator status and completing the hazardous waste manifest, the DTSC letter clarifies that California hospitals must consider the weight of P-listed waste containers in addition to the residue, unless the containers are properly cleaned — a time-consuming and costly process.

CHA News Article

New Guidance Focuses on Cybersecurity Risks for Medical Device Manufacturers

The U.S. Food and Drug Administration (FDA) issued draft guidance Jan. 15 outlining important steps medical device manufacturers should take to continually address cybersecurity risks to keep patients safe and better protect the public health. The draft guidance, which recommends that manufacturers implement a structured and systematic comprehensive cybersecurity risk management program and respond in a timely fashion to identified vulnerabilities, is part of the FDA’s ongoing efforts to ensure the safety and effectiveness of medical devices in the face of potential cyber threats.

CHA News Article

Upcoming Call to Focus on Helping Hospitals Create Sustainability Internships

Greenhealth Academy will host a call Jan. 19 to share strategies for implementing sustainability initiatives in the hospital setting. Presenters will review Practice Greenhealth’s new sustainability intern toolkit and share tips for establishing sustainability intern positions. The call will also include strategies for energy and water conservation as well as solid waste reduction. Registration is available online

CHA News Article

Proposed Air Toxics Risk Assessment Methodology Could Affect Hospitals

CHA has been participating in meetings with the Office of Environmental Health Hazard Assessment (OEHHA), local air management districts and other businesses regarding guidance OEHHA issued on  March 6 — the revised Air Toxics Hot Spots Program Guidance Manual for Preparation of Health Risk Assessments. The guidance includes changes to air toxics risk assessment methodology that will increase facility risk estimates by 150-300 percent or more compared to the prior methodology, without any increases in actual facility emissions. The guidance would also require a number of hospitals and other businesses to provide written risk notification to their neighbors even though the hospital may have significantly reduced its diesel particulate matter (dpm) emissions. CHA is concerned that the OEHHA guidance lacks direction and information on how air districts should communicate expected increases in the facility risk estimates to the public.

Overview

Finance

Hospital finance is complicated, and California hospitals operate in a challenging environment. Hospital executives are faced with the task of developing financial strategies that contain costs yet allow for the provision of health care to the state’s large uninsured population.

CHA News Article

Governor Releases 2016-17 State Budget

Today, Gov. Brown released his state budget plan for the 2016-17 fiscal year, a few days ahead of schedule. The Governor proposes allocating much of this year’s $170 billion budget to schools, some to the developmentally disabled and several billion to the rainy day reserve, staying consistent with his past budgets. Tax revenues continue to come in well ahead of projections, but the Governor remains cautious in his budgeting. In his press conference, he emphasized the possibility of another economic downturn and the importance of funding the rainy day fund.

Recording

Hospital Presumptive Eligibility Program Webinar
A vital tool for providing potentially-eligible individuals with on-the-spot Medi-Cal coverage

Webinar Recorded Live on June 19, 2014

Hospitals can play an important role in reducing the number of uninsured through the Hospital Presumptive Eligibility (HPE) program. The HPE program will allow all hospital Medi-Cal providers — including any clinic on a hospital’s license — to provide potentially-eligible individuals with temporary, full-scope Medi-Cal benefits.

General information

Video Describes Vital Role Nonprofit Hospitals Play in Their Communities

In opposition to AB 975 (Wieckowski/Bonta), CHA has embarked on a comprehensive public advocacy campaign to increase awareness of the importance of not-for-profit hospitals and the diverse array of community benefit programs they provide throughout California.  A new video (below) describes the vital role nonprofit hospitals play in the communities they serve. 

AB 975 would establish a “guilty until proven innocent” presumption for hospitals that report an operating margin of more than 10 percent.Under current law, nonprofit hospitals are required to invest their funds int

Overview

Health Care Reform

Our nation’s health care system has entered a new era with the enactment of federal health care reform. This landmark legislation is resulting in many changes in how health care is financed and delivered for years to come. For nearly two decades, CHA has been at the forefront in advocating for meaningful health care reform — and we will continue to help shape the future of hospital care far into the future. CHA’s vision of an “optimally healthy society” is now a reality within reach.

CHA News Article

County Medical Services Program to Offer New Primary Care Benefit May 1

The County Medical Services Program (CMSP) — which provides limited-term health coverage for uninsured low-income, indigent adults who are not otherwise eligible for other publicly-funded health programs in the 35 primarily rural California counties participating in CMSP — has announced that, beginning May 1, eligible members will not be charged a copay or share of cost for medical services, and prescription medications will require a $5 copay. This new primary care benefit will be provided to eligible members in aid code 89 (legal residents) and aid code 50 (undocumented), in addition to their CMSP standard benefit that has a monthly share of cost. The new benefit aims to assist these CMSP members in obtaining access to a specified set of primary care and/or specialty care services, including medical office visits, various diagnostic tests and prescription medications, with little or no beneficiary cost. This change — along with a number of changes to CMSP eligibility that the CMSP Governing Board approved on a two-year pilot project basis — is designed to reach more of the remaining uninsured.

CHA News Article

Report Identifies Characteristics of Uninsured Men

The Kaiser Family Foundation (KFF) has released a report, Characteristics of Remaining Uninsured Men and Potential Strategies to Reach and Enroll them in Health Coverage, that provides information on remaining nonelderly uninsured men ages 19-64. The report provides national estimates of their eligibility for Affordable Care Act (ACA) coverage options, and discusses strategies for reaching and enrolling them into health coverage. It also notes that, although the number of uninsured adults ages 19-64 declined significantly in 2014, more than 27 million nonelderly adults in the U.S. remained uninsured at the start of 2015, based on analysis of 2015 Current Population Survey data. More than half of these adults, or nearly 15 million, were nonelderly uninsured men.

CHA News Article

DHCS to Host Behavioral Health Forum April 25

The California Department of Health Care Services (DHCS) will host a Behavioral Health Forum on April 25 from 9:30 to 11 a.m. (PT) via webinar. The webinar will include an update on the Certified Community Behavioral Health Clinics (CCBHC) demonstration, including the CCBHC planning process and upcoming stakeholder engagement opportunities. In October 2015, California was awarded a CCBHC planning grant to support the state in soliciting and certifying clinics to become CCBHCs; establishing a prospective payment system rate for Medi-Cal reimbursable services; and preparing an application to participate in the two-year CCBHC demonstration program. On April 11, Governor Brown signed Assembly Bill 847, which provides DHCS with the additional funds necessary to embark on the CCBHC planning grant process. Registration is available online; meeting materials will be posted on the DHCS website in advance of the meeting.

CHA News Article

CACHI Proposals Due April 29

The California Health and Human Services Agency and Community Partners are soliciting proposals for up to six accountable communities for health (ACHs) under the Accountable Communities for Health Initiative (CACHI). During its three-year span, CACHI will assess the feasibility, effectiveness and potential value of a more expansive, connected and prevention-oriented health system. Grant proposals are being accepted for the initiative’s first year, and should identify a set of short- and medium-term goals related to a specific health issue, such as a chronic condition like diabetes, cardiovascular disease or asthma. Proposals should be submitted online by noon on April 29. More information is available at www.communitypartners.org/cachi

CHA News Article

CACHI to Host Upcoming Webinar

The California Accountable Communities for Health Initiative (CACHI) will host a webinar March 24 at 3 p.m. (PT) on CACHI governance issues. As previously reported, the CACHI will assess the feasibility, effectiveness and potential value of a more expansive, connected and prevention-oriented health system, and seeks proposals to support up to six Accountable Communities for Health through the CACHI. This webinar will feature a report (available on the CACHI website) from ChangeLab Solutions, which will also provide an overview of issues that applicants may want to consider. Registration is available online. The CACHI has also posted a new FAQ document addressing a number of questions about the program.

Overview

Health Information Management & Technology

Hospitals are moving away from paper-based records to electronic medical records and electronic health records to retain patient-care data. Electronic formatting facilitates data capture in a “real-time” environment, and allows many users to access the data at the same time.

CHA supports the capture and availability of secure patient-care data through the use of health information technology (HIT) across the continuum of care. CHA believes HIT will serve as a tool to enhance patient safety, promote information for preventative health and reduce health care costs.

CHA News Article

ONC Seeks Comments on Measuring Interoperability of HIT
Comments due June 3

The Department of Health and Human Services (HHS) Office of the National Coordinator (ONC) for Health Information Technology has  issued the attached request for information on measuring interoperability and the exchange of health information. The Medicare Access and CHIP Reauthorization Act of 2015 set an objective to achieve the widespread exchange of health information through the use of interoperable certified electronic health records and directed HHS to establish metrics to determine if that objective has been met. In the request, ONC seeks comments on whether a national survey — such as the American Hospital Association’s Health IT Supplement Survey — is an appropriate data source for measurement, and if ONC should combine that data with the agency’s Medicare EHR Incentive Program data. Comments on the request are due June 3. 

CHA News Article

CMS Releases Measure Specifications for 2017 eCQMs

The Centers for Medicare & Medicaid Services (CMS) has posted its annual update of measure specifications for electronic clinical quality measures (eCQMs) for eligible hospitals and eligible professionals. Providers will use these updated measures to electronically report 2017 quality data for CMS quality reporting programs. The measure specifications are available for download on the CMS website’s eCQM library and the Electronical Quality Improvement Resource Center

CHA News Article

Application Deadline Extended for EHR Hardship Exception
Eligible hospitals and CAHs must apply by July 1

The Centers for Medicare & Medicaid Services (CMS) has extended the application deadline for the Medicare EHR Incentive program hardship exception process to July 1 for eligible professionals, eligible hospitals and critical access hospitals (CAHs). The exceptions apply to the Medicare EHR program 2017 payment adjustments. The previous deadline was March 15 for eligible professionals and April 1 for eligible hospitals and CAHs. The hardship application and instructions are available on CMS’ website

CHA News Article

CMS Provides Updates on IMPACT Act
Comment deadline for post-acute care measure is tomorrow

The Centers for Medicare & Medicaid Services (CMS) will host two upcoming calls on the Improving Post-Acute Care Transformation (IMPACT) Act of 2014 and the standardization of patient assessment data across post-acute care settings, including skilled-nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term care hospitals. Additionally, CMS has announced that the public comment period for “Medicare Spending Per Beneficiary – Post-Acute Care (MSPB-PAC) Resource Use Measures” has been extended to Jan. 29. Information on the measure is available on the public comment website. Comments should be submitted to mspb-pac-measures-support@acumenllc.com by 8:59 p.m. (PT) on Jan. 29.

CHA News Article

President Signs Meaningful Use Blanket Hardship Exemption

In late December, President Obama signed a law creating a blanket hardship exemption for providers from 2015 meaningful use penalties, which were to be assessed in 2017. The law requires hospitals to apply for the hardship exemption by April 1. Eligible professionals must apply by March 15. Previously, the Centers for Medicare & Medicaid Services could only grant such exemptions on a case-by-case basis. CHA will notify members of the steps necessary to apply for the hardship exemption through CHA News as more details become available. 

Overview

Human Resources

California hospitals and health systems employ more than half a million people — from entry-level positions to senior executives. Many health care human resources (HR) departments are responsible for a wide range of issues, such as recruitment, staffing, compensation, benefits, labor/employee relations and employee health. Navigating the complex regulatory environment, while monitoring how it applies to HR in the health care setting, can be a challenging and dynamic task.

Representing hospitals and health systems in California, CHA provides leadership in HR policy on state and federal levels. In addition, CHA advocates on behalf of hospitals and health systems before the federal and state legislatures, federal and state administrative agencies and the public. CHA also provides educational opportunities, such as the annual Labor & Employment Law seminar, to help hospital leaders sharpen their skills and knowledge in health care HR. CHA members also participate on an HR executive e-mail list and receive periodic informational memoranda. 

CHA News Article

New Budget Repeals Requirement for Automatic Health Plan Enrollment of Employees
Applies to employers with 200 or more full-time employees

With the signing of the Bipartisan Budget Act of 2015, President Obama has repealed Section 18A of the Fair Labor Standards Act, enacted as part of the Affordable Care Act (ACA). As originally written, the ACA would have required employers with 200 or more full-time employees to automatically enroll new full-time employees in an employer health plan and to continue enrolling current employees in the health plan offered. Additionally, employers were required to give automatically enrolled employees adequate notice and an opportunity to opt-out of the employer health plan. Because the requirements raised concern about coordination with other ACA provisions, employers were not required to comply until final regulations were issued. With the passage of the Bipartisan Budget Act, the automatic enrollment requirements have now been repealed and employers will not have to comply with them.

Overview

Legal

CHA’s legal department advocates vigorously before the courts on behalf of California hospitals, both as a party in litigation and as amicus curiae in important appellate cases. In addition, the CHA legal department prepares legal memoranda and manuals to help hospitals understand and comply with state and federal laws. The CHA legal department also supports CHA staff in their advocacy efforts before the state legislature and regulatory agencies.

CHA News Article

Appeals Court Rules on Hospital’s Elder Abuse Liability
May be premised on understaffing in violation of regulations

Last week, a state appeals court reversed a previous decision in Fenimore v. The Regents of the University of California, holding that the trial court improperly sustained the University’s claim that there was no legal basis for the lawsuit. In this case, plaintiffs alleged that the hospital committed neglect as defined in the Elder Abuse and Dependent Adult Civil Protection Act (EADACPA) by allowing the patient to fall minutes after entering the facility, failing to treat his fractured hip for four days and violating state staffing regulations. The Court of Appeal found that the first two allegations were insufficient to support elder abuse liability because they demonstrated no more than mere negligence. However, plaintiffs’ additional allegation that the hospital violated state staffing regulations provided a sufficient basis for finding neglect.

CHA News Article

Appeal Filed in Interdisciplinary Team Consent Case

Both the plaintiff and the defendant in an Alameda County Superior Court case have appealed a new ruling finding unconstitutional a California statute that allows skilled-nursing facilities (SNFs) to use an interdisciplinary team to make medical decisions for patients who lack capacity and have no family or other representative to make those decisions. The decision and the order in the case, California Advocates for Nursing Home Reform (CANHR) v. Chapman (Director of the Department of Public Health), are attached. They are not in effect pending the appeal.

CHA News Article

CDI Issues Permanent Regulations on Network Adequacy
Regulations effective immediately

The California Department of Insurance (CDI) has issued permanent regulations on provider network adequacy that go into effect immediately. The regulations were approved by the Office of Administrative Law and replace the emergency regulations issued in January 2015. The new network adequacy regulations will apply to insurers regulated by the CDI. Plans regulated by the Department of Managed Health Care — typically health care plans such as HMOs and some PPOs — are subject to different network adequacy laws and regulations.

Education event

Consent Law Seminar
End of Life Option Act, labor and delivery, decision-making process, new laws and updates

Five Locations:
May 3, Fresno; May 10, Pasadena
; May 11, Irvine;
May 25, San Ramon; June 1, Sacramento

Managing risk in a hospital is hard. In many situations, the laws aren’t clear or conflict — but a decision has to be made anyway. The annual Consent Law seminar is the one educational program that will expand your knowledge and critical thinking to help you make tough decisions with confidence. As an added bonus, all attendees take home a free copy of CHA’s 2016 Consent Manual.

Recording

The End of Life Option Act Webinar
Understanding the law, considerations for developing and implementing policies

Webinar recorded live April 18, 2016

The End of Life Option Act is one of the most important bills the Governor signed into law this year. Individuals who have a terminal illness and meet certain qualifications may now ask their physician for prescription medication to end their life. The law is complicated and not without controversy.

Overview

Patient Rights

California and federal laws give hospital patients many rights. Hospitals must notify patients of these rights by giving patients a handout and/or by putting posters up in the hospital.

CHA has developed a sample handout that hospitals may use to notify patients of their rights under state hospital licensing regulations, the Medicare Conditions of Participation, and The Joint Commission.

CHA News Article

New Law Establishes Requirements for Post-Hospital Patient Care

Gov. Brown has signed SB 675 (Liu, D-La Canada Flintridge), which requires a hospital to provide an opportunity for each inpatient to identify a family caregiver who may assist in post-hospital care, and to provide an opportunity for the patient and caregiver to participate in the discharge planning process. The hospital must provide information and, when appropriate, instruction about the patient’s post-hospital care needs and medications. The instructions must be provided in a culturally competent manner and in a language that is comprehensible to the patient and caregiver, and must include an opportunity for the caregiver to ask questions. The law also requires hospitals to attempt to notify the patient’s designated family caregiver about the patient’s discharge or transfer to another facility as soon as possible. However, the discharge or transfer does not have to be delayed until notification is accomplished. Hospitals should document all steps required by this law, which becomes effective Jan. 1, 2016.

CHA News Article

New Law Aims to Protect Conservatees’ Rights
Hospitals advised to review conservatorship orders

Gov. Brown has signed AB 1085 (Gatto, D-Glendale), which allows a court to grant a conservator the power to enforce a conservatee’s right to receive visitors, telephone calls and personal mail. The bill also allows the court to direct a conservator to allow specific visitors, telephone calls and personal mail. This bill was introduced as a result of a highly-publicized situation in which radio host Casey Kasem’s second wife allegedly prevented daughters with his first wife from visiting him. The law also requires a conservator to inform certain persons, and an agent under a power of attorney for health care to inform any individuals identified by the patient, of the patient’s death. Hospitals should always get a copy of conservatorship orders for conserved patients and read them to fully understand the authority of the conservator and any limitations. The law takes effect Jan. 1, 2016.

Publication

Principles of Consent and Advance Directives
A handbook on patient consent for treatment and other health care decisions

This handbook guides you through the basic principles of patient consent for health care treatment. In clear, simple terms this publication explains why and when consent is necessary, who may give consent, how consent for minors is different, and procedures that require special consent. It also describes the hospital’s obligations when dealing with complicated issues like advance health care directives, California’s POLST form, refusal of treatment, and end-of-life decisions.

Publication

2016 Consent Manual
The trusted resource for consent and related health care law

From basic principles to specific procedures, the Consent Manual is your one-stop resource for all legal requirements related to patient consent for medical treatment, release of medical information, reporting requirements and more. Learn exactly what the law requires and what you need to do to comply.

Resource

Patient Rights Poster
(English)

Download the Patient Rights Poster for free or order a copy for only $2. (Last updated March 2016)

Note: To be legally compliant, poster must be readable and legible therefore this poster should be printed on 11″ x 17″ (tabloid) paper.

Overview

Quality & Patient Safety

CHA is committed to helping hospitals improve quality, reduce medical errors and adverse events, and maximize patient safety.

CHA’s vision is an “optimally healthy society.” CHA’s goal is for “every Californian to have equitable access to affordable, high-quality, medically necessary health care.”

CHA News Article

CMQCC Releases Toolkit to Support Vaginal Birth and Reduce Primary Cesareans

The California Maternal Quality Care Collaborative (CMQCC) has released its Toolkit to Support Vaginal Birth and Reduce Primary Cesareans, which contains key strategies and resources to:

  • Improve the culture of care, awareness and education for cesarean reduction
  • Support intended vaginal birth
  • Manage labor abnormalities and safely reduce cesarean births
  • Use data to drive reduction in cesareans

The free toolkit is available to download on the CMQCC website. Users will be required to either log into their existing CMQCC.org account or create a new one.

CHA News Article

CMS Releases Measure Specifications for 2017 eCQMs

The Centers for Medicare & Medicaid Services (CMS) has posted its annual update of measure specifications for electronic clinical quality measures (eCQMs) for eligible hospitals and eligible professionals. Providers will use these updated measures to electronically report 2017 quality data for CMS quality reporting programs. The measure specifications are available for download on the CMS website’s eCQM library and the Electronical Quality Improvement Resource Center

CHA News Article

New Medical Group Report Card Features Cost and Quality Ratings

California’s Office of the Patient Advocate (OPA) this week released its annual Medical Group Report Card, adding newly available cost information for the first time to the existing quality information for more than 150 medical groups caring for 9 million commercially insured Californians. With the addition of the new cost information, consumers and purchasers can now compare quality and cost information side by side. The result of a partnership between OPA and the nonprofit Integrated Healthcare Association (IHA), the Medical Group Report Card contains clinical measures for breast and colorectal cancer screenings, eye exams and blood sugar control for patients with diabetes, managing osteoporosis in women with a previous fracture and appropriate medication management, among others.

CHA News Article

CMS and AHIP Announce Seven Sets of Clinical Quality Measures

The Centers for Medicare & Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP) last week released seven sets of clinical quality measures in an effort to align quality measures and simplify reporting requirements among payers. The measures — which were developed through a Core Quality Measures Collaborative comprised of health care systems, physicians and provider organizations — are primarily focused on physician quality programs and will inform CMS’ implementation of the Medicare Access and CHIP Reauthorization Act of 2015. This release is the first from the collaborative, which plans to add to and update the current measure sets over time. The core measures sets include accountable care organizations, patient-centered medical homes, and primary care; cardiology; gastroenterology; HIV and Hepatitis C; medical oncology; obstetrics and gynecology; and orthopedics. A fact sheet on the measure sets is available on CMS’ website.  

CHA News Article

CMS Announces Delay in Fourth Quarter 2015 Data

The Centers for Medicare & Medicaid Services (CMS) has announced a delay in the system release of fourth quarter (Q4) 2015 discharge/encounters, including sepsis data and ICD-10 codes. The following applications for inpatient quality reporting (IQR) and outpatient quality reporting (OQR) have been impacted:

  • Hospital Inpatient Population & Sampling
  • Hospital Inpatient Measure Designation
  • CMS Abstraction Reporting Tool (CART)
  • CMS Clinical Warehouse
  • Vendor Authorization

CMS anticipates the Q4 2015 applications will be available in early to mid-March, and there will be no disruptions in service for the February 2016 submission deadlines for hospital IQR, OQR and PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Q3 2015 discharge/encounters. The current IQR, PCHQR and OQR May 2016 deadline remains in place. 

Overview

Reimbursement

California hospitals’ revenue stream is critical to their overall mission of providing care and cures in the communities they serve. While over half of hospitals’ revenue, nearly $30 billion a year, is derived from government-funded programs, including Medicare, Medi-Cal, Healthy Families and county indigent programs – Private Insurance revenues are also significant.

CHA believes that hospitals should be reimbursed adequately to cover the cost of care for enrollees.

CHA News Article

Revised Medicare Ambulance Transports Booklet Available

The Centers for Medicare & Medicaid Services (CMS) has issued the attached materials on the Medicare ambulance transport benefit, including updated information about documentation requirements, coverage, billing and payments, and advance beneficiary notice of noncoverage.  

CHA News Article

Providers Encouraged to Revalidate Medicare Enrollment Information

CMS has posted deadlines by which providers must submit revalidation applications for their cycle 2 enrollment information. If a due date is listed, providers will need to submit a complete revalidation application by that time. If one is not listed, providers should continue to check back for a due date. Unsolicited revalidation applications submitted six months prior to the due date will be returned. Providers are still encouraged to submit their revalidation via Internet-based PECOS, as it is the most efficient and cost effective way to revalidate. Providers that miss their deadlines will be deactivated and required to submit a new application.

CHA News Article

Appeals Court Reverses Decision on ALJ Delays
Lawsuit on hospitals’ behalf revived

Earlier this week, a federal appeals court issued a ruling that will allow a re-hearing of a lawsuit that would compel the Department of Health and Human Services to adhere to the deadlines for reviewing Medicare claims denials. The lawsuit, brought by the American Hospital Association and several hospitals, was dismissed by a lower court and then appealed. The appeals court declared the backlog of delays for Medicare claims reviews is getting worse and sent the case back to the lower court. The appeals court also noted that the lower court should order HHS to comply with congressionally mandated deadlines if no progress is made toward solving the problem within a reasonable time frame.

CHA sees the court’s decision as confirming HHS has a clear duty to comply with the congressionally mandated deadlines, as well as hospitals’ right to demand compliance.

CHA News Article

Timeliness Date Updated for Resubmission of Certain DRG Claims

The California Department of Health Care Services has extended its deadline for resubmission of diagnosis-related group (DRG) claims over 22 lines. Providers now have until April 1 to resubmit claims meeting certain criteria. For additional information about recent updates to electronic transactions, including specific processing instructions for inpatient claims submitted with more than 22 claim lines, providers should refer to the HIPAA 5010 Medi-Cal Companion Guide Update article.

CHA News Article

DHCS Resolves Processing Issue for Certain DRG Claims
Denied claims with RAD code 9953 may be resubmitted

The Department of Health Care Services (DHCS) has resolved a previously identified claim processing issue that caused diagnosis-related group (DRG) claims with remittance advice details code “9953: APR-DRG — Length of Stay Invalid for Interim Claim” to be erroneously denied. Hospital providers may resubmit previously denied level one or two administrative day claims and rehabilitation claims, provided the claims meet certain criteria. More information on resubmitting claims is available at the DHCS website.

Overview

Workforce

California hospitals are concerned about the need for an adequate supply of highly skilled health professionals to meet the demands for health care services now and in the future. Numerous studies have been completed that validate the need to address critical health professional shortages in nursing and the allied health occupations.  However, efforts to implement recommended strategies have been hindered by a lack of a coordinated statewide effort involving health employers, as well as other necessary partners. 

CHA News Article

Family Medicine and Primary Care Residency Applications Available
Song-Brown program applications due June 3

This year, the Song-Brown program will award $4.13 million to family medicine programs and $2.84 million to primary care residency programs, demonstrating a commitment to increasing the number of family medicine and primary care providers in California.

The applications were released April 26 and are due by 3 p.m. on June 3. Family medicine and primary care hospital residency programs are eligible for the awards and should consider applying. For more information, visit the Song-Brown website

CHA News Article

National Health Service Corps Accepting Applications for Approved Sites
Application webinar to be held April 26

The National Health Service Corps (NHSC) is accepting applications for facilities to become approved NHSC sites. The NHSC provides assistance for qualifying practice sites in recruiting and retaining community-responsive, culturally competent primary care clinicians. Once a facility is approved as an NHSC site, position vacancies will be published on the NHSC Jobs Center and viewed by hundreds of clinicians, including NHSC Scholars and those interested in the loan repayment program.

CHA News Article

Commission to Discuss Health Care Workforce Training Programs
Meeting to be held May 18 in Sacramento

The California Healthcare Workforce Policy Commission (CHWPC) will hold a policy meeting on May 18 to discuss Song-Brown health care workforce training programs, including the family nurse practitioner and registered nurse application criteria and evaluation criteria; allocation of surplus primary care residency funds; nurse mid-wifery programs and more. The Song-Brown Program, which is aided by CHWPC, provides financial support to family medicine, internal medicine, OB/GYN and pediatric residency programs, as well as family nurse practitioner, physician assistant and registered nurse education programs throughout California. CHWPC is a 15-member citizen advisory board that provides expert guidance and statewide perspectives on health professional education issues, reviews applications and recommends contract awards to the OSHPD director. More information is available at www.oshpd.ca.gov/hwdd/song-brown-program.html.

CHA News Article

Song-Brown Webinars Will Address Upcoming Application Release
Family medicine and primary care residency applications to be available soon

This year, the Song-Brown program will award more than $12 million to medical programs that are committed to increasing the number of family medicine and primary care providers in California. Family medicine hospital residency programs are eligible for the funding and should consider applying.

In anticipation of the approaching release date for family medicine and primary care residency applications, the program will conduct several webinars. The webinars will provide an overview of the application, registration and lessons learned, and will address applicant questions. Visit the Song-Brown website for dates, times and links to webinars.

CHA News Article

State Mini Grants Available for Programs Encouraging Health Careers

The Office of Statewide Health Planning and Development announced its Mini Grant Program will be open from Jan. 22 through Feb. 22. The program encourages underrepresented and disadvantaged groups to pursue health careers in California.

Commands