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 Revises New Hospital Relicensing Survey

The California Department of Public Health (CDPH) Licensing and Certification (L&C) program earlier this year implemented a new general acute care hospital relicensing survey, intended to evaluate facility compliance with statutory and regulatory requirements addressed in Title 22 and the Health and Safety Code. CDPH has reissued the relicensing survey protocol with several changes.

Focused on quality of care, the survey will consist of a review of nursing and pharmacy as well as identified past compliance concerns. L&C will review three years of past compliance, including deficiencies and associated plans of correction — all of which could be areas of emphasis during the survey. Hospitals should be prepared to provide a full list of services and locations to the survey team, including outpatient services, and should review all past compliance issues (including 2567s, plans of corrections, etc.) as well as every complaint, entity-report incident and breach of medical information reported. To help hospitals better understand the survey process, CHA hosted a webinar, available for purchase, on the upcoming changes and has developed the California Hospital Survey Manual. Hospitals are encouraged to review information about the survey on the CDPH website.

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!

Recording

Responding to Licensing and Certification Deficiencies Webinar
New CDPH penalties, working with surveyors, plans of correction, appeal process

Webinar Recorded Live on May 21, 2014

Overview

You’ve received a licensing violation. You may have been expecting it from a recent survey, or it may have come as a complete surprise. One thing is for certain, survey activity — and subsequent violations — will be more common now that California Department of Public Health (CDPH) has issued new regulations for hospital penalties, including non-immediate jeopardy violations.

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
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.

General information

Emergency Department Toolkit
Behavioral health resources for the emergency department

Special resource toolkit developed by CHA’s EMS/Trauma Committee and the Center for Behavioral Health.  Designed to help staff provide support to patients in the ED with psychosis and/or substance abuse disorders, this toolkit provides access to articles, policies, management techniques, assessment tools and more. Click the topic tabs below to access resources and information.

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.

Recording

Advanced Decision Making for EMTALA Webinar
EMTALA principles, case scenario learning, surveyor compliance tips

Webinar Recorded Live on November 14, 2014

Overview

Whether you are a sending or receiving hospital, many factors must be considered when dealing with a potential EMTALA situation. Knowing the right thing to do isn’t easy, especially in a stressful or busy emergency department.

Recording

Minors Health Care — The Basics of Consent, Privacy and More Webinar
Learn about the rules, exceptions to the rules, practical solutions to common problems

Webinar Recorded Live on October 29, 2014

Overview

This scenario plays out in hospitals every day: grandmother, teacher, neighbor or concerned friend brings a minor to the hospital. No parent in sight. Now what?

Can you treat the minor? Whose consent do you need? Who should you talk to about the minor’s treatment options? These are all too common questions that often challenge the most seasoned health care providers.

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

Board of Pharmacy Releases Waivers for Facilities Undergoing Construction
Hospitals unable to comply with new regulations must submit request by Jan. 1

The California Board of Pharmacy released finalized hospital sterile compounding regulations (Title 16, California Code of Regulations, Section 1735) on Sept. 13. The regulations, which go into effect Jan. 1, allow for a construction waiver request to be made by hospitals needing a delay in compliance due to physical construction, alterations or improvements necessary to meet requirements. The waiver is for a delay, not an exemption, from compliance with the new compounding structural requirements. Pharmacies must submit their waiver request in writing. Questions should be emailed directly to the Board of Pharmacy at compounding.waivers@dca.ca.gov.

CHA News Article

New App From OSHPD Provides Facilities Development Information
Includes hospitals and skilled-nursing facilities

The Office of Statewide Health Planning and Development (OSHPD) Facilities Development Division (FDD) has released the FDD App, now available exclusively for Android devices. Through the app, users may search and view information for hospital and skilled-nursing facilities in California including site plans, basic building information and seismic ratings for the buildings. The app includes a database of projects where users may view their current status, as well as web links commonly used by OSHPD/FDD office and field staff. A version of the app for Apple devices is in development.

CHA News Article

OSHPD Construction Seminars Begin Next Week

The Hospital Building Safety Board and the Office of Statewide Health Planning and Development, Facilities Development Division, will host their 2016 educational seminar on Oct. 12 in Anaheim and Oct. 18 in Sacramento. Titled “Lessons Learned During Construction,” the seminar is designed for anyone involved in hospital construction including owners, designers, inspectors and contractors. This year’s program will focus on lessons learned from before construction begins to post-closure of a hospital construction project. CHA encourages all hospitals to plan for at least one representative to attend one of the scheduled seminars. Questions may be directed to hbsbsupportstaff@oshpd.ca.gov.

CHA News Article

Registration Open for OSHPD Construction Seminars
Focus is on lessons learned during construction

Registration is now open for the “Lessons Learned During Construction” educational seminars hosted by the Hospital Building Safety Board and the Office of Statewide Health Planning and Development (OSHPD). The program is designed for anyone involved in hospital construction including owners, designers, inspectors and contractors. This year’s seminars, to be held Oct. 12 in Anaheim and Oct. 18 in Sacramento, will focus on lessons learned from before construction begins to post-closure of a hospital construction project. CHA encourages all hospitals to plan for at least one representative to attend one of the scheduled seminars. Questions may be directed to OSHPD’s Facilities Development Division at FDD.Seminar@oshpd.ca.gov.

CHA News Article

The Joint Commission Makes Major Changes to Plans for Improvement
Hospitals should correct deficiencies as soon as possible

Starting Aug. 1, The Joint Commission (TJC) will no longer accept plans for improvement for its Life Safety requirements. All life safety deficiencies identified by TJC must be corrected within 60 days; hospitals should work to correct these deficiencies as soon as possible because many California building requirements take longer than 60 days to complete. In some cases, hospitals may be eligible for a waiver through the Centers for Medicare & Medicaid Services regional offices. To help expedite the state approval process for hospitals, the Office of Statewide Health Planning and Development (OSHPD) will offer field review or rapid review. If necessary, OSHPD deputy division chiefs — Chris Tokas, Northern California or Gordon Oakley, Southern California —will work to assist hospitals. Hospitals in need of assistance should contact the OSHPD FDD administrative office at (916) 440-8381. For questions related to this change, contact TJC Department of Engineering at (630) 792-5900

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

FEMA Releases Data Snapshot of Hospital Fires

The Federal Emergency Management Agency (FEMA) has released the attached snapshot providing information on hospital fires from 2012-14. According to the agency, an estimated 5,700 medical facility fires were reported each year during that period, and nearly 20 percent (1,100) happened in hospitals. Per year, the fires were estimated to cause fewer than five deaths, 25 injuries and $5 million in property loss. The majority of hospital fires — 60 percent — were confined to cooking pots. Confined fires are smaller fires that rarely result in death, serious injury or large content losses. Fires in trash bins, incinerators or compactors composed 10 percent of hospital fires, while 3 percent were fuel burner or chimney fires. Nonconfined fires, which are generally larger structure fires, made up 27 percent of hospital fires. Additional statistics are available at www.usfa.fema.gov/data/statistics/.

CHA News Article

DHS Bulletin Addresses Global Threat Environment

The Department of Homeland Security (DHS) has issued the attached National Terrorism Advisory System bulletin, reflecting continued concern about homegrown violent extremists. The bulletin also describes the government’s counterterrorism efforts and how DHS is partnering with the private sector to provide risk assessments and coordinate enhanced security measures with business owners and operators. While there is no current, specific threat, DHS urges Americans to remain vigilant and aware of their surroundings, particularly during the holidays.

CHA News Article

CMS Publishes Medicare, Medicaid Emergency Preparedness Final Rule
Attached memo provides implementation details

The Centers for Medicare & Medicaid Services (CMS) has released the attached memorandum providing information on implementation of its recently issued emergency preparedness conditions of participation. The rule becomes effective Nov. 15; affected facilities have one year to reach full compliance. CMS is preparing interpretive guidelines as well as surveyor training, both of which are anticipated to be ready in spring of 2017. The memo also provides links to a variety of resources, as well as a frequently asked questions document.

CHA News Article

Hospitals to Participate in ‘Great ShakeOut’ Drill Oct. 20

This year’s Great California ShakeOut drill will be held Oct. 20 at 10:20 a.m. to help Californians prepare for the next big earthquake. Hospitals can participate in a variety of ways, depending on their organization’s time and resources. The ShakeOut drill has occurred every third Thursday of October since 2008. Many providers are already actively engaged in the ShakeOut, and CHA encourages all hospitals and systems to participate each year. To register and begin planning for the Great California ShakeOut drill, visit www.shakeout.org/california/index.html. Those participating in the drill can find messaging resources, in English and Spanish, at www.shakeout.org/messaging/.

CHA News Article

CHA Conference Convenes Disaster Planners to Advance Hospital Readiness

More than 750 people attended CHA’s Disaster Planning for California Hospitals conference in Sacramento (see photo gallery), where emergency management professionals and community and government partners demonstrated their dedication to “drive readiness in dynamic times.”

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 Courses Available for Emergency Response to Radiation Incidents

In partnership with the Oak Ridge Institute for Science and Education (ORISE), the Radiation Emergency Assistance Center/Training Site (REAC/TS) provides emergency response advice and consultation for the National Nuclear Security Administration’s Office of Emergency Response as well as a number of continuing education classes geared toward health care professionals. Medical personnel, emergency planners, public health professionals and others will learn about the medical management of radiological/nuclear incidents through didactic and hands-on education. An additional course accredited by the American Academy of Health Physics is available for health physicists, medical physicists, radiation safety officers and nuclear medicine personnel.

The REAC/TS course brochure for October 2016 – September 2017 is available on the ORISE website, and online registration is now available. Courses are held at the REAC/TS Facility in Oak Ridge, TN. REAC/TS is also available to conduct one or two-day training programs at hospital locations. For more information, contact reacts@orau.org or call (865) 576-3131.

Post

CDC releases toolkit to reduce risk of Legionella

The Centers for Disease Control and Prevention (CDC) released a new toolkit to prevent Legionnaires’ disease outbreaks. The toolkit builds off of ASHRAE 188: Legionellosis: Risk Management for Building Water Systems.

The toolkit provides an easy-to-understand interpretation of ASHRAE Standard 188, as well as worksheets, checklists and scenarios of common water-quality problems. It also contains special sections and considerations for health care facilities.

CHA News Article

Air Resources Board to Host Event Focused on Enforcement, Compliance for Truck Fleets

The California Air Resources Board (ARB) has announced dates for its 2016-17 “One Stop Truck” events, which offer compliance assistance, as well as information and resources for clean technology options. At each event, participants will be able to take advantage of one-on-one regulatory and financial incentive assistance, participate in a number of breakout sessions including funding options for on-road trucks and an enforcement inspection demo, and interact with industry vendors and local agencies. More information is available online, along with registration and vendor information.

Recording

Meeting New Requirements for Sterile Compounding Webinar
Learn about new and upcoming state regulations and federal standards, and how to comply

Webinar Recorded Live June 28, 2016

Overview

The California State Board of Pharmacy (BoP) and United States Pharmacopeia (USP) Convention are planning changes that will significantly impact hospital pharmacy compounding of hazardous and non-hazardous medications and facility structures.

CHA News Article

Toolkit Aims to Help Hospitals Reduce Food Waste

Practice Greenhealth has released a new “Less Food to Landfill” toolkit, intended to support the U.S. Department of Agriculture’s and Environmental Protection Agency’s shared goal to reduce food waste by 50 percent by 2030. The “Less Food to Landfill” goal aims to feed hungry people, reduce waste and reduce methane gases by not landfilling food waste. Experts have found that hospitals can reduce pre-consumer food waste by 50 percent, resulting in a 2-6 percent savings on annual food purchases. In addition to providing step-by-step guidance and best practices, the toolkit facilitates goal-setting, standardized tracking and setting up a safe food donation program. The toolkit and other related resources can be found at https://practicegreenhealth.org/topics/less-waste/less-food-landfill.

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

Report Examines Efforts to Improve Care Quality, Coordination and Costs Through Provider Collaborations
Highlights efforts of CHA member hospitals, health systems

The California HealthCare Foundation has released a report that examines efforts to improve care quality, coordination and costs through provider collaborations. The report acknowledges that California providers — many of them CHA members — have been particularly active in developing collaborations among themselves and with commercial health plans in response to the Affordable Care Act. Many of these partnerships have been driven by key market factors characteristic of many California communities — most notably, the presence of large providers experienced in managing financial risk for patient care, as well as competitive pressure on both insurers and providers. Most of these initiatives aim to slow the growth of health care spending and improve the coordination and quality of patient care. 

The report describes integration efforts that have proliferated in California since 2013, highlights leading examples from the seven regions studied, discusses collaborators’ key goals and strategies, and explores how market conditions spurred each major type of partnership and influenced their structure.

CHA News Article

Members of Congress Sign Letter Calling for Liver Transplantation Reform

Working with colleagues in New York and New Hampshire, CHA asked members of the California congressional delegation to sign a letter addressed to Secretary of Health and Human Services Sylvia Burwell, urging reform of the current liver distribution methodology.  A total of 68 members of the U.S. House of Representatives, including 27 from California, signed the letter.  

The current methodology — which is based on 58 local donation service areas (DSAs) of varying size, density and health — creates large disparities in access to liver transplantation between patients in different regions of the country. To increase fairness of liver allocation, the signatories of the letter recommend that the Department of Health and Human Services adopt the United Network for Organ Sharing (UNOS) committee’s proposal to condense the 58 DSAs to between four and eight districts. The proposal also specifies that each district would contain at least six liver transplant centers that support a maximum median transplant-volume-weighted transport time between DSAs of no more than three hours. The letter echoes CHA’s beliefs, outlined in a comment letter to UNOS last week in support of their recommendations.

CHA News Article

CHA Comments on Recommendations for Liver Transplant Regions

CHA has submitted the attached comment letter to the United Network for Organ Sharing (UNOS), supporting the Liver and Intestinal Organ Transplantation Committee’s recommendations to reduce geographic and economic disparities in access to liver transplantation. CHA believes the current liver allocation methodology, which operates under 58 local donation service areas (DSAs), is responsible for the unfair disparities that deprive many Californians of life-saving liver transplants.

In the letter, CHA comments on the high barriers Californians face in receiving liver transplantation compared with patients in other areas of the nation, who are arbitrarily favored due to the unbalanced structure of the 58 DSAs. In addition, because Californians suffer from a higher incidence of liver disease, patients wait longer, receive livers when they are sicker and die at substantially higher rates. 

CHA News Article

Senate Finance Committee Issues White Paper on Stark Law Reform

Senate Finance Committee Chairman Orin Hatch (R-UT) released the attached white paper this week calling for reform to the Stark Law, which prohibits a physician from referring Medicare patients to a facility in which that physician has a financial stake. The committee requested comments on the Stark Law last December, and CHA submitted a letter with suggestions on how to improve the law. CHA’s letter, among the nearly 50 that were submitted, formed the basis of Sen. Hatch’s white paper. 

In the white paper, the committee concludes that the Stark Law is costly, burdensome to providers and needlessly complex. Of chief concern to the committee is that technical violations unknowingly committed may result in substantial penalties. The white paper echoes CHA’s comments that the Stark Law prevents desirable changes in health care and delivery payment models, that technical violations should be differentiated from substantial ones, and that it may be best to repeal the law in its entirety.

CHA News Article

DHCS to Host Webinar on Global Payment Program Tomorrow

The Department of Health Care Services (DHCS) will host a webinar on the Global Payment Program (GPP) tomorrow at 3 p.m. (PT); registration is available online. The GPP is a new program under California’s section 1115(a) demonstration waiver – “California’s Medi-Cal 2020 Demonstration,” which is effective Dec. 30, 2015, through Dec. 31, 2020.

The new program aims to improve the way care is delivered to California’s remaining uninsured individuals by establishing a statewide funding pool that combines federal disproportionate share hospital (DSH) and uncompensated care funding and distributing it to select designated public hospitals that meet their goal of moving patients from high-cost, avoidable services to higher value, preventive services. Webinar slides will be posted on the GPP web page prior to the start of the webinar.

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

CMS to Hold Call on MACRA Final Rule Nov. 15

The Centers for Medicare & Medicaid Services (CMS) will host a call Nov. 15 from 10:30 a.m. – noon (PT) to discuss provisions in the recently released Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule. In the rule, CMS has finalized a number of changes that increase flexibility for the Merit-based Incentive Payment System and for qualifying for incentive payments through participation in advanced alternative payment models. This call is designed for Medicare Part B fee-for-service clinicians, office managers and administrators; state and national associations that represent health care providers; and other stakeholders. Registration is available online. For more resources related to MACRA, visit CHA’s dedicated web page.

CHA News Article

ONC Health Information Technology Certification Program Rules Finalized

The Office of the National Coordinator (ONC) for Health Information Technology has released its final rule implementing new requirements under the ONC Health IT Certification program. The final rule creates a regulatory framework for ONC’s direct review of health information technology certified under the program, including requiring the correction of non-conformities found in health IT certified under the program and suspending and terminating certifications issued to complete EHRs and health IT modules. The final rule also sets forth processes for ONC to authorize and oversee accredited testing laboratories and includes provisions for expanded public availability of certified health IT surveillance results. The regulations will take effect 60 days after publication in the Federal Register.

CHA News Article

Applications Due July 1 for EHR Incentive Program 2017 Hardship Exceptions

The Centers for Medicare & Medicaid Services (CMS) has issued a reminder that hardship exception applications for the Medicare Electronic Health Record (EHR) Incentive program are due July 1. Eligible professionals, eligible hospitals and critical access hospitals may access the instructions and application on the EHR Incentive program website; providers are also encouraged to view the FAQs page. More information is available on the CMS website

CHA News Article

CMS to Host Webinar on Proposed eCQM Changes

The Centers for Medicare & Medicaid Services will host a webinar May 17 at 11:30 a.m. (PT) on provisions of the federal fiscal year 2017 inpatient prospective payment system proposed rule that align electronic clinical quality measure (eCQM) reporting requirements in the inpatient quality reporting and electronic health record incentive programs. The webinar will identify changes proposed for eCQM requirements and provide an overview of how to submit comments on the proposed rule. To register for the webinar, visit https://cc.readytalk.com/r/a74×0biqau5t&eom

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. 

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 For Members

Labor and Employment Law Seminar to Cover Wage and Hour Pitfalls, New Case Law
First program begins Oct. 19 in Sacramento

Hospital human resources and legal professionals who attend CHA’s annual Labor and Employment Law Seminar will learn practical, useful information to help successfully structure policies, procedures and programs that encompass new developments and ensure compliance. Set for Oct. 19 in Sacramento and Oct. 26 in Los Angeles, the seminar opens with an analysis of wage and hour case law, including meal and rest period developments and calculating overtime. Attendees will also learn steps to avoid wage and hour pitfalls related to alternative work schedules, joint employer issues and liability, and more.

CHA News Article

Process to Apply for Functional Affirmative Action Programs Revised
Applies to federal contractors, defined broadly by the OFCCP

The Office of Federal Contract Compliance Programs (OFCCP) has updated its guidance on the process federal contractors may use to apply for and maintain a functional affirmative action program (FAAP). An FAAP is based on a contractor or subcontractor’s business functions or business units, rather than the contractor’s physical locations. A contractor must seek approval and reach an agreement with the OFCCP before it can begin submitting FAAPs. Earlier this month, OFCCP explained the updated guidance in a webinar, which should be available on its website in the coming weeks.

Whenever OFCCP’s rules change, the question of which employers fall under its jurisdiction arises. Historically, employers receiving “federal financial assistance,” such as Medicare and Medicaid, have not been subject to OFCCP’s oversight and enforcement. However, the effect of participation in other federal programs has not been as clear.

CHA News Article

CHA Participates in ASHHRA Advocacy Day

On May 15 and 16, CHA participated in the American Society for Healthcare Human Resources Administration (ASHHRA) Capitol Hill visits in Washington, D.C. ASHHRA, a membership group of the American Hospital Association, met with staff for various California congressional representatives – including Sen. Feinstein and Reps. Honda, Davis, DeSaulnier and Hunter – to discuss issues of concern to hospital human resources executives. CHA took the opportunity to thank Rep. Honda for a letter he provided to CHA last year in support of efforts to enact SB 327. A copy of the ASHHRA advocacy white paper and Rep. Honda’s letter are attached.

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 For Members

FDA Identifies Hospitals That Have Not Reported Device Malfunctions

The Food and Drug Administration (FDA) has publicly disclosed multiple hospital violations of the mandatory reporting requirement when a medical device may have caused harm. Hospitals and other health care providers (“device user facilities”) must report to the FDA any event that reasonably suggests that a medical device has or may have caused or contributed to a death or serious injury of a patient. This includes user error; improper or inadequate design, manufacture or labeling; or any other cause of harm related to a device, as well as device malfunction.

CHA News Article

Supreme Court Rules on Providers’ Liability Under False Claims Act
Finds that material misrepresentation may trigger liability

Last week, the U.S. Supreme Court ruled on whether providers may be liable under the False Claims Act for seeking payment while out of compliance with regulatory requirements. In Universal Health Services, Inc. v. United States, a Medicaid beneficiary was prescribed a medicine that ultimately caused her death. After finding that the clinic’s employees were improperly supervised or licensed, her parents filed suit alleging that Universal Health Services had defrauded Medicaid by receiving payments for services rendered, despite being out of regulatory compliance.

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.

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 Nondiscrimination Policies in Effect
Providers must ensure compliance with new federal and state regulations

Several updated nondiscrimination policies took effect this month, requiring health care providers to ensure their programs are compliant. New requirements under Section 1557 of the Affordable Care Act took effect July 18; the U.S.

Publication

Principles of Consent and Advance Directives
UPDATED MAY 2016! A handbook on patient consent for treatment and other health care decisions, including the End of Life Option Act

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, including the new End of Life Option Act effective June 9, 2016.

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.

CHA News Article

CDPH Provides Guidance for Submitting End of Life Option Act Forms

 California’s new End of Life Option Act — which allows terminally ill patients to obtain a prescription from their attending physician for medication to end their life — requires physicians who write such prescriptions to submit specified documentation to the California Department of Public Health (CDPH).  While the Act itself does not specify how the documentation should be submitted, CDPH recently announced those details.

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

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

New Guidance Addresses Infection Control When Reprocessing Endoscopes

The Healthcare Infection Control Practices Advisory Committee (HICPAC) — a federal advisory committee chartered to advise the Centers for Disease Control and Prevention and the Secretary of the Department of Health and Human Services on infection control and related strategies — has released guidance for health care facility endoscope reprocessing systems. To minimize infection risks, all health care facilities should develop a reliable, high-quality system that supports training and competencies, quality measurement and management. HICPAC’s recommendations outline seven essential steps for endoscope reprocessing: pre-cleaning, leak testing, manual cleaning, visual inspection, disinfection or sterilization, storage and documentation. The guidance also addresses the administrative responsibilities and elements of such a program. The Hospital Quality Institute (HQI) Healthcare-acquired Infections Workgroup strongly encourages hospitals to review the committee’s recommendations. Questions about the guidance should be directed to Debby Rogers, CHA vice president, clinical performance and transformation, or Alicia Munoz, HQI vice president, quality and patient safety.

CHA News Article

CMS Releases Measures for Comment

Last week, the Centers for Medicare & Medicaid Services (CMS) released a number of measures (detailed below) under development on which it seeks input. Calls for public comment are posted on the CMS website.

CHA News Article

CMS Releases List of Quality Measures for Future Rulemaking

The Centers for Medicare & Medicaid Services (CMS) has released the attached list of quality measures under consideration for adoption in future Medicare rulemaking as required by the Affordable Care Act. While CMS has not proposed any additional measures for the Hospital Readmissions Payment Penalty program or the Hospital Acquired Conditions program, it has put forward 19 measures for consideration in the Hospital Inpatient Quality Reporting program, three for the Hospital Outpatient Quality Reporting program and two for hospital value-based purchasing. CMS also has proposed a number of measures as required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act for the Post-Acute Care Quality Reporting programs.

The list of measures will be reviewed by the Measures Application Partnership (MAP), convened by the National Quality Forum (NQF), to provide recommendations to CMS through a process that allows multiple stakeholders the opportunity to weigh in on measure selection before rules are finalized.

CHA News Article

FEMA Releases Data Snapshot of Hospital Fires

The Federal Emergency Management Agency (FEMA) has released the attached snapshot providing information on hospital fires from 2012-14. According to the agency, an estimated 5,700 medical facility fires were reported each year during that period, and nearly 20 percent (1,100) happened in hospitals. Per year, the fires were estimated to cause fewer than five deaths, 25 injuries and $5 million in property loss. The majority of hospital fires — 60 percent — were confined to cooking pots. Confined fires are smaller fires that rarely result in death, serious injury or large content losses. Fires in trash bins, incinerators or compactors composed 10 percent of hospital fires, while 3 percent were fuel burner or chimney fires. Nonconfined fires, which are generally larger structure fires, made up 27 percent of hospital fires. Additional statistics are available at www.usfa.fema.gov/data/statistics/.

CHA News Article

CMS Reports on Antipsychotic Drug Use in SNFs

The Centers for Medicare & Medicaid Services has issued the attached updated data in association with the National Partnership to Improve Dementia Care in Nursing Homes. The data track the percentage of long-stay nursing home residents who receive an antipsychotic medication, excluding residents diagnosed with schizophrenia, Huntington’s disease or Tourette’s syndrome. In the fourth quarter of 2011, 21.9 percent of long-stay nursing home residents in California received an antipsychotic medication; since then, the rate has decreased 40.9 percent to a prevalence of 12.75 percent in second quarter of 2016, compared to a national rate of 16.29 percent. 

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

New Law Requires Patient Notification About Services in Hospital-Based Outpatient Clinics

A new state law, SB 1365 (Chapter 501, Statutes of 2016), will take effect Jan. 1, 2017, requiring hospitals to notify each patient scheduled for a service in an off-site hospital-based outpatient clinic if that service is available in another location that is not hospital-based. The statute defines a hospital-based outpatient clinic as a department of a provider that is more than 250 yards from the main campus. Though there is no standard form available, the notification should include the contact information of someone within the hospital or health system who the patient can call with questions, as well as a directive for the patient to check with their health insurance company for additional information about other locations that may cost less. This law seeks to expand existing law that prohibits health care facilities from referring a patient to, or soliciting payment from a patient on behalf of, another facility in which it has a significant beneficial interest.

CHA News Article

House Passes 21st Century Cures Bill

Yesterday, the House passed, in a 392-26 vote, the 21st Century Cures bill, a $6.3 billion medical innovation package aimed at accelerating the discovery, development and delivery of new cures and treatments through new funding for the National Institutes of Health (NIH) and Food and Drug Administration (FDA). The California delegation voted in favor of the legislation, with the exception of Reps. Barbara Lee (D-CA-13) and Janice Hahn (D-CA-44), who abstained. The measure also included provisions, supported by the American Hospital Association and CHA, to provide some relief for certain hospitals regarding the new site-neutral payment policy for outpatient departments and create a mechanism to adjust readmissions penalties based on a patient’s socioeconomic status. The Senate is scheduled to consider the measure early next week. A summary of the bill’s key provisions is available on the CHA website.

CHA News Article

Noridian Revises Information on Physician Order Authentication Requirements

Medicare administrative contractor Noridian has updated its website with important information about patient order authentication requirements. With input from CHA, the site now reflects the current medical records condition of participation, which allows physician authentication orders to be signed by another practitioner who has responsibility for a patient, rather than only by the ordering physician.

Noridian previously published a response in one of its FAQ documents stating, “Orders may be accepted and put in writing by personnel authorized to do so by applicable State and Federal laws and regulations. The order must be countersigned and dated by the ordering physician within an acceptable timeframe.”

The statement now correctly reiterates, “All orders, including verbal orders, must be dated, timed, and authenticated promptly by the ordering practitioner or by another practitioner who is responsible for the care of the patient only if such a practitioner is acting in accordance with State law, including scope-of-practice laws, hospital policies, and medical staff bylaws, rules, and regulations.”

CHA News Article

Proposed Rule Limits Medi-Cal Managed Care Pass-Through Payments

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule limiting states’ ability to increase or create new pass-through payments for hospitals, physicians or nursing homes under Medicaid managed care contracts. In a May final rule that modernized Medicaid managed care requirements, CMS provided for a 10-year phase out of pass-through payments beginning July 1, 2017. The new proposed rule would impose an annual cap on the pass-through payment amount, equal to the amount included in a state’s Medicaid managed care contracts on or before July 5, 2016. For California, supplemental Medi-Cal managed care payments made through the quality assurance fee (QAF) program would be capped at the state fiscal year 2013-14 QAF payment amounts, beginning on July 1, 2017. CHA  will submit comments outlining its significant concerns about the financial impact of the proposed rule. Comments are due to CMS by Dec. 22. Contact Amber Ott, CHA vice president, finance, with questions or concerns.

CHA News Article

Presentation Available on New Hospital Appeals Settlement Process

Last week, the Centers for Medicare & Medicaid Services (CMS) released additional details about its reopened inpatient status claims settlement. Earlier this week, the agency hosted a call providing more details and answering questions about the new settlement process. The presentation from that call is attached. CMS states it will provide partial payment, equal to 66 percent of the net allowable amount of the claim, for pending administrative appeals of inpatient status denials. Only denied claims with dates of service prior to Oct. 1, 2013, with appeals pending before an administrative law judge or the Departmental Appeals Board, are eligible. In exchange for the partial payment, a hospital must withdraw all of its pending administrative appeals for these inpatient denials. Hospitals cannot choose to settle some claims and continue to appeal others. CMS will make the settlement process available beginning Dec. 1; the deadline for hospitals to submit an Expression of Interest is Jan. 31, 2017.

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

Allied Healthcare Loan Repayment Program Expanded

The Allied Healthcare Loan Repayment program has been expanded to 35 counties participating in the County Medical Services Program (CMSP). Eligible applicants may qualify to receive loan repayment benefits of up to $16,000 in exchange for a one-year service obligation providing direct patient care at a qualified and contracted facility.

The program aims to encourage allied health care professionals to work in underserved areas of California. The program includes over two dozen approved allied health professions; a complete listing of CMSP approved professions is available at www.oshpd.ca.gov/HPEF.

The application cycle closes Nov.18. For questions or assistance with the application process, contact the Health Professions Education Foundation at (916) 326-3640.

CHA News Article

Clinical Laboratories to Receive New Communications From CDPH

The California Department of Public Health (CDPH) has announced that Laboratory Field Services will now distribute All Clinical Laboratories Letters (ACLLs) to facilities licensed or registered by CDPH. The letters will address standards CDPH is imposing, allow the public to observe which California laws are more stringent than federal standards, and specify which accrediting organizations have been approved to conduct inspections. Public comment on an ACLL will be received and considered by the department for 30 days after posting online. Forty-five days after being posted online, ACLLs will become final with the force of regulations. More information, including current ACLLs, can be found at www.cdph.ca.gov/programs/lfs/Pages/AllClinicalLaboratoriesLetters.aspx.

CHA News Article

Children’s Hospitals GME Payment Program Now Accepting Applications

The Health Resources and Services Administration’s Bureau of Health Workforce is accepting applications for the Children’s Hospital Graduate Medical Education Payment program. The program will grant between 55 and 65 awards, totaling approximately $295 million for fiscal year 2017, to freestanding children’s hospitals that participate in an approved graduate medical education program and that have a Medicare payment agreement. Funding will support training for pediatric and other residents in graduate medical education programs at freestanding children’s teaching hospitals.

The application deadline is July 15. For information, technical assistance or to apply, visit the program website.

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.

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