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Coronavirus Response
Email updates for member hospitals and health systems

CHA’s Coronavirus Response newsletter provides news and updates on state and federal guidance, recommendations, and advocacy on behalf of hospitals and their patients. 

News for April 6

Executive Order on Telehealth Services

Gov. Newsom issued an Executive Order on April 3 that makes the following changes related to telehealth services:

  • Suspends the requirement to obtain oral or written consent from a patient for telehealth services
     
  • Allows health care providers to use video chats and other applications to provide health services consistent with federal HIPAA guidelines and waivers
     
  • Suspends penalties for privacy breaches related to telehealth services, as well as penalties for late notifications
     
  • Lengthens the time frame — from 15 to 60 days — for notifying the California Department of Public Health (CDPH) and patients of telehealth-related breaches. This may cause confusion because CDPH waived the breach notification requirements on March 20 in AFL 20-26. Because HIPAA breach notification requirements are not suspended, CHA recommends notifying CDPH at the same time the patient is notified, to the extent staff is able to do so.


Certain CNA Requirements Waived

CDPH has temporarily waived certain certified nursing assistant (CNA) requirements and suspended regulatory enforcement of the following for nursing assistants and CNAs:

  • Allows a CNA whose certificate expired within the past two years or whose certificate will expire during the emergency to work without renewing; facilities must check CDPH’s online verification page to verify employment eligibility.
     
  • Allows a CNA certificate to be renewed without continuing education units. The units may be completed at any time during the two-year recertification period and may be completed online or by distance learning.
     
  • Allows a CNA student to provide patient care prior to having a test for tuberculosis infection.
     
  • Allows a licensed vocational nurse or registered nurse with a license issued by another state or foreign country, whether active or expired within the last two years, to work as a CNA immediately upon submission of an application to CDPH.
     
  • Waives the requirement to submit a Live Scan until 30 days after the emergency ends.
     
  • Allows a CNA student to continue to work during the emergency for more than three months after starting employment, even if training requirements are not completed. The CNA may render services only at the competency level confirmed by the training program on a competency checklist to be issued by CDPH.
     
  • Extends the time frame for a CNA to notify CDPH of a change of address. They must notify CDPH as soon as practicable, but no later than 30 days after the emergency ends.

Reduced Clinical Care Requirement for Nursing Students

The Department of Consumer Affairs has reduced the direct clinical patient care requirement for obstetrics, pediatrics, and mental health/psychiatric nursing students from 75% to 50%. Special accommodations may be made for geriatric and medical/surgical hours, too.

Executive Order Expanding Child Care for Essential Workers

Gov. Newsom signed an Executive Order April 4 that will facilitate child care for children of essential critical infrastructure workers. The order allows the California Department of Education and California Department of Social Services flexibility to waive certain programmatic and administrative requirements, which will expand eligibility for child care and prioritize essential workers — including health care professionals, emergency response personnel, law enforcement, and grocery workers. Guidance from the departments will be issued April 7.


Daily Updated Statewide, County Hospital Data

CDPH has publicly released new hospital data sets using data the department collects and data from the CHA COVID-19 Tracking Tool. Data include a daily statewide update of hospital status, aggregated to the county level, depicting total confirmed cases, total deaths, positive and suspected positive COVID-19 patients, as well as Intensive Care Unit positive and suspected positive COVID-19 patients. These are posted to the California Health and Human Services Agency’s Open Data Portal.

Webinar: Preparing Perinatal Units to Respond to COVID-19

The California Maternal Quality Care Collaborative — a multi-stakeholder organization committed to ending preventable morbidity, mortality, and racial disparities in California — will host a webinar April 10 at noon (PT) on “Preparing your Perinatal Unit to Respond to COVID-19.” The webinar will be presented by a team from UC Davis, who will explain the protocols and guidelines being implemented at UC Davis Medical Center to care for pregnant women and infants who test positive or may have been exposed to COVID-19. The webinar will also include a Q&A session with the panelists. Details and registration information are here.

New Resources

  • Summary of employment law issues: The AHA has issued a summary of the various employment law issues raised in recent federal legislation related to COVID-19.
     
  • Online compendium for addressing the needs of Medicaid populations: The Center for Health Care Strategies has compiled a compendium of resources aimed at reducing the impact of COVID-19 on Medicaid populations, particularly those at the highest risk. Resources include key guidance, reference materials, and tools.

Next CDPH Call: April 7, 8-9 a.m. (PT)

Dial: (844) 721-7239

Passcode: 7993227
The phone number and passcode are the same each week. We encourage you to add this information to your calendars. Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org.

FAQs on CHA Website

CHA’s Coronavirus Response web page features updates and guidance in a Q&A format by subject area. Topics include staffing, testing, licensing and certification, persons under investigation, human resources, supplies, pharmacy, vulnerable populations, telehealth, and more. The site also includes links to detailed information on federal funding opportunities, Federal Emergency Management Agency reimbursement, resource requests, and more.

News for April 3

CHA Issues Summary of Interim Rule Providing Regulatory Flexibilities
CHA has issued a members-only summary — prepared by Health Policy Alternatives — on the Centers for Medicare & Medicaid Services (CMS) interim final rule providing hospitals and health care providers with additional regulatory flexibilities during the COVID-19 public health emergency. The policies are intended to support the health care system in absorbing and managing surges of COVID-19 patients, including the increased use of telehealth to reduce exposure and preserve personal protective equipment, increased workforce flexibility, and the reduction of administrative burdens. The interim final rule does not include provisions of the recently passed Coronavirus Aid, Relief, and Economic Security (CARES) Act. CMS is working on additional regulations and waivers to update its policies accordingly.

CMS Issues Guidance to Nursing Homes, State and Local Governments

CMS, in consultation with the Centers for Disease Control and Prevention (CDC), has issued guidance to state and local governments, as well as nursing homes, to help mitigate the spread of COVID-19 in nursing homes. The recommendations build on and strengthen recent guidance from CMS and CDC related to effective implementation of long-standing infection control procedures.

Anthem Suspends Prior Authorization and Cost Sharing

Anthem announced on March 27 that its health plans will suspend prior authorization requirements for patient transfers, as well as for use of medical equipment critical to COVID-19 treatment; will cover respiratory services for acute treatment of COVID-19 along with in-network and out-of-network coverage for COVID-19 laboratory testing; and that it will temporarily adjust handling and monitoring of claims and audits. This week, Anthem also announced it will waive cost sharing for COVID-19 treatment received through May 31, and provide post-discharge support to Medicare members with complex care needs following hospitalization.

‘Care for the Caregiver’ Webinar Offers Help for Those on the Front Lines

The Hospital Quality Institute, CHA, and your Regional Associations are partnering with BETA Healthcare Group to present “Care for the Caregiver,” a complimentary webinar designed to provide “psychological first aid” to health care workers navigating through the COVID-19 pandemic.

It includes practical and straightforward tools to help employees create a peer support model and engage in empathic conversation with patients, family, loved ones, and members of the care team. Staff will learn to serve as peer responders for their co-workers, who are dealing with unprecedented stress. Additionally, through video enactment, participants will learn emotional first aid techniques for those experiencing moral injury related to caring for patients with COVID-19. The webinar will be offered from 9 a.m. to noon (PT) on three different dates: April 7, 14, and 21 and is available and applicable to all hospital employees. Details and registration information are available here.

AHA Asks for Federal Loan Program for Hospitals

The American Hospital Association (AHA) today urged the Department of Treasury and the Federal Reserve to quickly implement a loan program for mid-size businesses and to ensure access to the program for hospitals. The AHA letter says loan eligibility should extend to hospitals of all ownership types, including municipal, county, and other public hospitals. AHA also urges a minimum no-payment period of 12 months after a loan is made, and a maximum term of up to 10 years.

The Joint Commission Suspends Surveys Until End of May

Following its March 17 announcement that regular surveys would be suspended until further notice, The Joint Commission has now notified providers that surveys and reviews will remain on hold until the end of May.

FAQs on CHA Website

CHA’s Coronavirus Response web page features updates and guidance in a Q&A format by subject area. Topics include staffing, testing, licensing and certification, persons under investigation, human resources, supplies, pharmacy, vulnerable populations, telehealth, and more. The site also includes links to detailed information federal funding opportunities, Federal Emergency Management Agency reimbursement, resource requests, and more.

News for April 2

Hospital Data Submission
The CHA COVID-19 Tracking Tool has reached sufficient utilization, so hospitals can now stop other data submission to the California Department of Public Health (CDPH) — including to the District Office — as long as they continue to submit via the CHA tool. Hospitals are still required to report COVID-19 positive patients to the local public health officer.

State Guidance on Public Use of Face Coverings

The CDPH has released guidance on Californians’ use of cloth face coverings to protect against COVID-19 when they must leave their homes. The guidance does not require the use of face coverings, nor is it intended as a substitute for social distancing guidelines. The state does not recommend the use of N95 or surgical masks for anyone who is not a health care worker.

CDC Updates:

  • Decontaminating N95 masks: The Centers for Disease Control and Prevention (CDC) has issued guidelines for decontaminating and reusing N95 masks during crisis situations when shortages exist. Based on these guidelines, a collaborative of researchers at UC San Francisco, UC Berkeley, Stanford, and other universities has published fact sheets and technical reports on three N95 reuse methods: Heat and Humidity, UV-C, and Hydrogen Peroxide Vapor & Hydrogen Peroxide Gas Plasma.
     
  • COVID-19 ICD-10-CM code: Yesterday, the CDC posted official guidelines for the new ICD-10-CM code, which will help capture and report surveillance data for the virus. These are effective April 1 and are to be used through Sept. 30, 2020.

Health Plans Waiving Prior Authorization, Cost Sharing

  • Centene Corp. has announced it will waive prior authorization and member cost sharing for COVID-19 related screening, testing, and treatment for all Medicare, Medicaid, and Exchange members. Centene will also provide additional support to safety-net providers, including assistance in securing small-business loans for behavioral health providers, obtaining personal protective equipment, and providing data and other support.
     
  • UnitedHealthcare has announced it will waive cost sharing through May 31 for COVID-19 testing, treatment, early prescription refills, and telehealth visits for Medicare Advantage, Medicaid, and commercial plan members.
     
  • Cigna and Humana have announced plans to waive cost sharing for COVID-19 testing, early prescription refills, and FDA-approved medications or vaccines when they become available. Cigna is waiving cost sharing until May 31. Humana has not set an end date.

Professional Licensure – Renewal/Reactivation of Licenses

The Department of Consumer Affairs has waived examination and continuing education requirements for certain health care professionals whose licenses expire between March 31 and June 30, 2020. The waiver applies to physicians, nurses, pharmacists, mental health professionals, physician assistants, respiratory therapists, clinical lab scientists/bioanalysts, optometrists, dieticians, physical therapists, occupational therapists, speech-language pathologists, perfusionists, and other professionals licensed under Division 2 of the Business and Professions Code. This waiver does not apply to certified nursing assistants, paramedics, or emergency medical technicians, as they are licensed/certified by other state agencies. Licensees must submit their required renewal form on time and must satisfy any waived exam or continuing education requirements by Oct. 1, unless an additional extension is issued.

The department also waived continuing education requirements and fees for health care professionals licensed in the past five years who want to reactivate or restore a retired, inactive, or canceled license. This includes renewal, delinquency, penalty, late, or any other fees. The waivers do not apply to licenses that were surrendered or canceled for disciplinary reasons. A reactivated or restored license is valid until Oct. 1 or when the State of Emergency ends, whichever is sooner. The licensee must comply with any other reactivation or restoration requirements, including submitting required forms or notices to their licensing agency.

BRN Approval for Nursing Students

The Board of Registered Nursing has announced that during a pandemic, nursing services may be provided by unlicensed persons, including student nurses. The board has developed a chart showing the types of services student nurses can provide depending on the coursework they’ve completed.

SNF Transfer and Continuity of Care

CDPH has issued guidance clarifying the expectation for transfer and continuity of care for skilled-nursing facility (SNF) residents with suspected or confirmed COVID-19, including admission following hospitalization. CDPH specifies that SNFs may not require a negative test result as a criteria of admission for patients who have no clinical concern for COVID-19, and that patients with confirmed or suspected COVID-19 can be accepted as long as the facility can follow infection prevention control recommendations from the CDC. Patients under investigation should not be transferred to SNFs. Hospitals and SNFs should consult the local health department when considering the transfer of a patient with confirmed or suspected COVID-19.

HIPAA Enforcement Discretion

The federal Health and Human Services Office for Civil Rights announced it will exercise enforcement discretion for violations of certain provisions of the HIPAA privacy rule related to uses and disclosures of protected health information during the COVID-19 public health emergency.

Hospital Presumptive Eligibility Flexibilities Approved

The Department of Health Care Services (DHCS) has approved immediate enrollment flexibilities for hospital presumptive eligibility (HPE) providers, in order to limit potential exposure to COVID-19. Enrolling providers can use telephonic signatures for HPE applications, noting in the case file “COVID-19 protocol.” Providers may also obtain an authorized representative form for the applicant, allowing an individual acting on behalf of the applicant to provide the required information to assist with enrollment. Questions about HPE flexibilities or processes should be sent to DHCSHospitalPE@dhcs.ca.gov.

Crisis Standards of Care Resources

The American Hospital Association has published a summary document, “Caring with Limited Resources during the COVID-19 Crisis: A Compilation of Resources for Your Team.” This document includes ethical guidance, clinical resources, capacity planning tools, information on communication and palliative care, and more.

Recordings of CMS Calls

The Centers for Medicare & Medicaid Services has been hosting regular calls with a variety of clinicians, hospitals, other facilities, and states to keep stakeholders updated on COVID-19 efforts. Recordings of the calls, along with transcripts, are available here.

COVID-19 California Tracker

This dashboard of COVID-19 cases in California provides county-level data on confirmed cases and deaths over time and mapped statewide.

Summary of This Week’s CDPH Call

CDPH has provided this summary of the call it held with health care providers on March 31.

FAQs on CHA Website

CHA’s Coronavirus Response web page features updates and guidance in a Q&A format by subject area. Topics include staffing, testing, licensing and certification, persons under investigation, human resources, supplies, pharmacy, vulnerable populations, telehealth, and more. The site also includes links to detailed information federal funding opportunities, Federal Emergency Management Agency reimbursement, resource requests, and more.

News for April 1

Grant Money Available to Local Hospitals

The Assistant Secretary for Preparedness and Response (ASPR) is authorized to distribute $50 million in grants to state hospital associations with the direction that they distribute the funds within 30 days to local hospitals. $4.1 million has been allocated to CHA to distribute to hospitals in California. CHA must formally apply for the funds and will do so by the April 3 deadline. Once the application is approved, it is expected that ASPR will distribute the funds to CHA by mid-April. CHA will then send a letter to each hospital with their grant amount and instructions for participating in the program. Hospitals will need to complete federal forms before CHA can distribute the checks.

Hospitals Recommended to Report Data to HHS and CDC

In a letter sent to hospitals on March 29, Vice President Mike Pence requested hospitals that conduct in-house COVID-19 testing to report their data daily to the U.S. Department of Health and Human Services (HHS). This reporting would be in addition to the daily reports hospitals submit on bed capacity and supplies to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network COVID-19 Patient Impact and Hospital Capacity Module. CHA recommends hospitals submit this data at the federal level, as well as on the CHA COVID-19 Tracking Tool for the state. It is CHA’s understanding that Federal Emergency Management Agency (FEMA) officials will base their decisions on the allocation of resources from the Strategic National Stockpile on data they have received from hospitals.

CHA Issues Summaries of Recent Federal Legislation

CHA has issued a members-only summary — prepared by Health Policy Alternatives — that provides details of two recently enacted laws in response to the COVID-19 pandemic: The Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act. The summary includes all aspects of the legislation, including health care and non-health care related provisions. Members can view the summary here.

Social Media Movement Claims COVID-19 Is a Hoax

CHA has received reports from local law enforcement of a social media movement — #filmyourhospital — that is designed to prove the COVID-19 pandemic is a hoax. Supporters are encouraged to openly confront hospital staff while filming and demand to see evidence of the pandemic. The videos are then uploaded to social media. Based on descriptions from around the country, #filmyourhospital adherents will ignore requests to leave the hospital and will often accuse staff of engaging in a conspiracy. Their behavior may require a response from on-site security or even law enforcement.

FAQs on CHA Website
CHA’s Coronavirus Response website features updates and guidance in a Q&A format by subject area. Topics include staffing, testing, licensing and certification, persons under investigation, human resources, supplies, pharmacy, vulnerable populations, telehealth, and more. The site also includes links to detailed information on federal funding opportunities, FEMA reimbursement, resource requests, and more.

News for March 31

Expanding the State’s Health Care Workforce
Gov. Newsom’s Executive Order issued yesterday, intended to expand California’s health care workforce, includes several items of interest to hospitals:

  • Clarifies staffing ratios are waived for hospitals and nursing homes
     
  • Allows the California Department of Public Health (CDPH) to waive licensing and certification, along with scopes of practice, for certified nursing assistants, home health aides, nursing home administrators, and hemodialysis technicians
     
  • Addresses radiology technician licensure
     
  • Waives credentialing and privilege requirements for doctors in hospitals
     
  • Allows hospitals to use emergency medical technicians in the hospital or other health care setting
     
  • Allows the Emergency Medical Services Authority (EMSA) to suspend any licensing, certification, or training requirements for EMS personnel. EMSA has released this policy to implement these provisions.
     
  • Allows the Department of Consumer Affairs to waive licensure and certification requirements for licensed health care professionals. The department is currently working on the following five directives and will establish a waiver request form and website for future waiver requests:
     
    • Extending renewals for licensees whose renewal is due March 31-June 2020
    • Reinstating of canceled licenses
    • Allowing nursing students and other trainees to work in hospitals
    • Removing supervision ratios for nurse practitioners/physician assistants (still requires some form of supervision)
    • Waiving the 36-month post-graduation training requirements to allow residents to work in hospitals


CHA Submits Staffing Waiver Requests to State Agencies

Yesterday, CHA submitted — and CDPH approved — a request for waiver of all licensing and staffing requirements of Chapters 2 and 2.4 of Division 2 of the Health and Safety Code, most of which were previously granted to hospitals in All Facilities Letter 20-26. This includes waiving nurse staffing ratios. The waiver of requirements in Chapter 2 is retroactive to March 20, and the waiver of requirements in Chapter 2.4 (which relate to skilled-nursing facilities) takes effect March 30. CDPH had requested this letter for administrative purposes, following the Executive Order. As a result, the waiver of nurse staffing ratios remains in place.
 

Also yesterday, CHA submitted waiver requests to the Department of Consumer Affairs to allow registered nurses, temporary licensees, interim permitees, advance practice nurses, physician assistants, and respiratory care practitioners to continue to practice nursing even if their license or permit has expired. In addition, CHA has requested waivers of requirements for standardized procedures, patient-specific protocols, ratio of physicians to other practitioners, written practice agreements, and physician supervision level (general vs. direct).
 

Federal Funding Opportunities for Hospitals
CHA has prepared this overview of direct funding opportunities available to hospitals and health systems from recent legislation, including the Coronavirus Aid, Relief, and Economic Security (CARES) Act and guidance issued March 28 by the Centers for Medicare & Medicaid Services (CMS).
 

2020 Seismic Safety Milestone Deadline Extensions

The Office of Statewide Health Planning and Development (OSHPD) is granting extensions, upon request, to the construction milestones individual hospitals established with OSHPD as part of their 2020 seismic safety extensions, if hospitals need additional time due to their response to COVID-19. Note the extensions are not automatic; hospitals must request additional time and work with OSHPD to develop new milestones. 
 

Regulatory Enforcement of Certain SNF Requirements Suspended
The California Department of Public Health has notified skilled-nursing facilities (SNFs) that it will temporarily waive regulatory enforcement of a range of SNF licensing, staffing, services, and space conversion requirements.
 

Updated Guidance, Recommendations for CMS Waivers
CMS has issued several memos that provide guidance for and responses to frequently asked questions about waivers and flexibilities allowed during the COVID-19 emergency. This includes guidance for Emergency Medical Treatment and Labor Act requirements, as well as infection control and prevention in hospitals, psychiatric hospitals, critical access hospitals, dialysis facilities, and outpatient settings. There are FAQs for patient triage, placement, limits to visitation, and availability of 1135 waivers. Details and links to the CMS documents are here.

Lessons Learned from a Washington Hospital
Evergreen Health in Washington, where the state’s first COVID-19 patients were treated, has shared two documents: an article from The Hospitalist on how COVID-19 transformed the ground-zero hospital and lessons learned from Evergreen Health’s direct experience.

News for March 30

Governor Signs Executive Order to Add Health Care Workers to Staff 50,000 Additional Beds

Gov. Newsom today issued an Executive Order intended to expand California’s health care workforce and recruit health care professionals with an active license, public health professionals, medical retirees, medical and nursing students, or members of medical disaster response teams in California. Interested health care professionals are encouraged to visit healthcorps.ca.gov.

CMS Announces New Waivers

The Centers for Medicare & Medicaid Services (CMS) has announced new regulatory flexibilities — including waivers and an interim final rule — to support the health care system in increasing capacity to absorb and manage surges of COVID-19 patients. Under CMS’ temporary new rules, hospitals may transfer patients to outside facilities, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories, while still receiving hospital payments under Medicare. In addition, new guidelines allow health care systems, hospitals, and communities to set up testing and screening sites exclusively for the purpose of identifying COVID-19 positive patients and describe circumstances in which hospital emergency departments can test and screen patients for COVID-19 at drive-through and off-campus test sites. CMS also announced a number of other changes to expand the workforce, reduce administrative burden, and further promote telehealth services. CHA is reviewing the waivers and regulations and will provide members with additional details in the coming days.

President Signs Federal Economic Relief Legislation

On Friday, the House passed the Senate’s  Coronavirus Aid, Relief, and Economic Security (CARES) Act, and the President signed it. The legislation includes several measure of importance to the hospital community; the American Hospital Association has provided additional detail and insight.  

Noridian COVID-19 Hotline

California’s Medicare administrative contractor, Noridian, has established a COVID-19 hotline to help hospitals with questions on provisional billing privileges and enrollment flexibilities afforded by the COVID-19 waivers for health care facilities and providers. The hotline is also available to assist with questions on Medicare Part A, B, and durable medical equipment accelerated payments related to COVID-19. The hotline is open from 6 a.m. to 5 p.m. (PT); the phone number is (866) 575-4067.

Updated Information on Reporting Cases to Local Public Health

In the March 29 edition of Coronavirus Response, it was stated that hospitals that complete the CHA COVID-19 Tracking Tool no longer need to report COVID-19 cases to their local public health officer. This information has changed. The California Department of Public Health (CDPH) released an update to All Facilities Letter 20-31 on March 29 clarifying that, while hospitals completing the CHA COVID-19 Tracking Tool are exempt from reporting COVID-19 cases to their CDPH district office, they must continue to report confirmed cases to their local public health officer.

Reminders About Non-Discrimination in Medical Treatment

The Departments of Health Care Services, Public Health, and Managed Health Care have issued guidance reminding health care providers and payers that rationing care based on a person’s disability status is impermissible and unlawful under both federal and state law. The federal Health and Human Services  Office of Civil Rights issued a similar reminder on Saturday. 

Telehealth Toolkit for Long-Term Care Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) has issued an electronic toolkit for telehealth and telemedicine for long-term care nursing home facilities. CMS has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a health care facility. Most of the toolkit is directed toward providers who may want to establish a permanent telemedicine program, but it also includes information that will help in the temporary deployment of a telemedicine program.

Next CDPH Call: March 31, 8-9 a.m. (PT)  
Dial: (844) 721-7239  

Passcode: 7993227 
The phone number and passcode are the same each week. We encourage you to add this to your calendars. Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org.

News for March 29

To support hospitals and health systems as they prepare and care for patients potentially exposed to and diagnosed with novel coronavirus, CHA has created a web page as a repository of information and is distributing this regular email update.

Definition of Health Care Provider for Federal Paid Sick Leave and Family Care Leave
The Department of Labor has issued FAQs defining a health care provider for the purpose of employees who may be exempted from paid sick leave or expanded family and medical leave by their employer under the Families First Coronavirus Response Act.

Employers with fewer than 500 employees and all public employers are covered by this law. The act gave the department authority to define health care providers and further gave employers discretion for whether to provide these benefits to them. The department adopted a very broad definition that includes anyone employed at the following: a doctor’s office, hospital, health care center, clinic, post-secondary educational institution offering health care instruction, medical school, local health department or agency, nursing facility, retirement facility, nursing home, home health care provider, any facility that performs laboratory or medical testing, pharmacy, or any similar institution, employer, or entity. This includes any permanent or temporary institution, facility, location, or site where medical services are provided that are similar to such institutions.

Cal/OSHA Allows for Surgical Masks When Respirator Supplies Are Insufficient
Cal/OSHA has updated its guidance on COVID-19 for health care facilities with respect to respirator use. It states that surgical masks may be used for low-hazard tasks involving patient contact when the respirator supply is insufficient for anticipated surges, or when efforts to optimize the efficient use of respirators does not resolve the respirator shortage. Hospitals will still receive complaint letters, but a certification that they have a shortage of N95 respirators, despite reasonable efforts to obtain additional respirators and implementing strategies to maximize existing respirator supplies, will serve as a response.

CMS Expands Medicare Advance Payment Program
The Centers for Medicare & Medicaid Services (CMS) yesterday announced an expansion of the accelerated and advance payments program for Medicare-participating heath care providers. These payments provide emergency funding and address cash flow issues based on historical payments when there is a disruption in claims submission or processing. A fact sheet is available here.

CDPH Allows CHA Tracking Tool to Replace Daily Reporting of COVID-19 Patients
The California Department of Public Health (CDPH) has issued an All Facilities Letter allowing hospitals that complete the CHA COVID-19 tracking tool daily to stop reporting COVID-19 positive and suspected patients to CDPH and their local public health officers.

Home Health and Hospice Waiver Request
CHA, in conjunction with the Washington State Hospital Association, filed a third waiver request with CMS, relating to home health and hospice services.

For operational or policy questions related to COVID-19, email us at info@calhospital.org. If you are being forwarded this email and would like to receive it directly, contact Christina Devi at cdevi@calhospital.org to be added to the distribution.

News for March 27

$50 Million for Hospitals to Flow Through State Associations
The U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR) is making available $50 million to hospitals through the Hospital Preparedness Program to help them during the COVID-19 public health emergency. The funds are to be distributed through the state hospital associations via a formula based on the COVID-19 risk population. Each state will get a specific allocation to distribute; we don’t yet know what CHA’s allocation will be. CHA will apply next week, and ASPR has promised to distribute the funds by early April. Once received, CHA will distribute the funds to hospitals as quickly as possible.

Updated COVID-19 FAQs on CHA Website
Recognizing hospitals’ need to get the most relevant COVID-19 information quickly and easily, CHA’s Coronavirus Response website now features updates and guidance in a Q&A format, organized by subject. Topics include staffing, testing, licensing and certification, persons under investigation, human resources, employee safety, supplies, pharmacy, vulnerable populations, and federal and state funding. The site also includes links to detailed information about resource requests, Federal Emergency Management Agency reimbursement, and more. In the coming days, look for a comprehensive list of state and federal waivers, flexes, and enforcement discretions.

OSHPD Suspension of Penalties for Late Data Submissions
The Office of Statewide Health Planning and Development has announced it will temporarily suspend penalty assessments for late reporting of data from March 4 (when the Governor declared a State of Emergency) through May 1. This suspension period may be extended beyond May 1.

Accreditation Data Submission Optional
Given the changing environment due to COVID-19, The Joint Commission has announced that data submission for accreditation (ORYX) and certification (with standardized measures) will be optional for Q4 of 2019 and Q1 and Q2 of 2020. ORYX contacts will receive notification this week; next week a formal announcement with additional information will be available on the website under the “Measurement” tab.

Guidance for Delivering Beneficiary Notices
The Centers for Medicare & Medicaid Services urges providers treating patients with suspected or confirmed COVID-19 to be diligent and safe while issuing beneficiary notices to beneficiaries receiving institutional care. Current delivery instructions provide flexibilities for delivering notices to beneficiaries in isolation.

Optimizing PPE and Equipment
The Centers for Disease Control and Prevention’s Strategies to Optimize the Supply of PPE and Equipment are displayed in an easy-to-read table format in this summary document by the New Jersey Hospital Association. 

AHA Advances 100 Million Mask Challenge
The American Hospital Association has taken on a critically important initiative from Providence, headquartered in Washington State with several hospitals in California, to bring to national scale the 100 Million Mask Challenge. This initiative is designed to facilitate new relationships between providers in need of surgical masks and manufacturers with the capacity to produce them. The AHA-led initiative will, over time, expand its scope to meet the growing and ongoing challenges, and supports hospitals’ first priority: to ensure the safety and well-being of our caregivers on the front lines.

News for March 26

CMS Issues Waivers for California Health Care Facilities
In response to CHA’s request, the Centers for Medicare & Medicaid Services (CMS) today issued a waiver for all California health care facilities. Included are waivers for hospitals related to EMTALA, verbal orders, reporting requirements, patient rights, sterile compounding, discharge planning, medical staff, medical records, and physical environment. Additional waivers are included for skilled-nursing facilities, home health, and hospice.

Senate Passes Sweeping Economic Relief Package
Last night, the U.S. Senate passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act; the House is scheduled to vote on it tomorrow. The President is expected to sign the measure, which includes several measures of particular importance to the hospital community. See more details here.

CLIA Program Flexibilities
CMS has issued an FAQ describing flexibilities under the Clinical Laboratory Improvement Amendments program that are available during the COVID-19 public emergency — including remote review and reporting by pathologists, clarification of proficiency testing requirements, and alternate specimen collection — and responding to other questions about COVID-19 testing requirements.

CDPH Requests Waivers for Space, Staffing Requirements
The California Department of Public Health has requested statewide waivers from CMS, including flexibility regarding use of space, staffing and program requirements. CHA will inform members when CMS responds.

The Centers for Disease Control and Prevention Updates

Condition Code Approved for COVID-19 Services
The National Uniform Billing Committee (NUBC) has approved the use of the “DR” condition code for services related to COVID-19 — including services where the patient ultimately tests negative. NUBC provides guidance on how to ensure institutional claims appropriately flag COVID-19 related care, as well as for coding the testing services provided at off-campus facilities, such as parking lots.

Announcement of Medical Resources That May Not Be Hoarded
The federal Secretary of Health and Human Services has announced that certain health and medical resources — including ventilators, PPE, and similar items — are subject to penalties if they accumulated beyond the reasonable demands of business, personal, or home consumption, or for resale in excess of prevailing market prices. Penalties for violation include a fine of up to $10,000 or imprisonment for up to one year, or both.

News for March 25

Emergency Medi-Cal Provider Enrollment

The Department of Health Care Services (DHCS) released a provider bulletin today, outlining the requirements and procedures for emergency Medi-Cal provider enrollment. These special exceptions were recently approved by the Centers for Medicare & Medicaid Services, as a result of the DHCS request for an 1135 waiver approved on March 23.

Telehealth Allowable by Out-of-State Physicians

The Emergency Medical Services Authority has set up a quick process for hospitals to be able to use health care practitioners licensed in other states for telehealth services.

Board of Pharmacy Updates

  • Inventory reconciliation: The Board of Pharmacy (BoP) has waived a specific provision of pharmacy law to change inventory reconciliation from every three months to at least once every six months.
     
  • Mobile pharmacies: In response to Governor Gavin Newsom’s declaration of a state of emergency, the BoP will permit the employment of mobile pharmacies or clinics that satisfy certain requirements to ensure continuity of patient care during the COVID-19 public health crisis.

Other Resources, Information

  • For individuals with behavioral health needs: The Substance Abuse and Mental Health Services Administration is continuously updating its website with guidance, resources, and information to assist in the management of individuals with behavioral health conditions posed by COVID-19. The website contains information to assist individuals, providers, communities, and states with both substance use disorder and mental health needs.
     
  • PACE organizations: The California PACE Association – representing the state’s Programs of All-inclusive Care for the Elderly (PACE) organizations – has posted an overview of what PACE programs are doing to respond to COVID-19 and its impact on older adults, people with disabilities and complex care needs, and their caregivers.

News for March 24

CMS Approves First 1135 Medicaid Waiver for California

Yesterday, the Department of Health Care Services received the approval from the Centers for Medicare & Medicaid Services (CMS) in response to its 1135 Waiver requests submitted last week. Additional 1135 Waiver approvals will be reported through Coronavirus Watch as they are received.

CDC Guidance for Discharging COVID-19 Patients

The Centers for Disease Control and Prevention (CDC) has released guidance that suspected COVID-19 patients can be discharged whenever clinically indicated, even without negative tests. The guidance recommends 72 hours to have passed since resolution of fever and improvement in respiratory symptoms, and seven days to have passed since symptoms first appeared.

FEMA Releases Advisory

A new COVID-19 pandemic advisory from the Federal Emergency Management Agency (FEMA) describes actions FEMA is taking, how community-based testing sites will be managed, and information about the Defense Production Act.

The Joint Commission Offers Toolkit

The Joint Commission has posted a comprehensive toolkit on its website, including a short video on proper doffing technique, federal guidance and FAQs on a variety of topics, recommendations for creating surge capacity, and other resources.
 

Other Guidance and Updates

  • CMS COVID-19 MS-DRG assignment: CMS has issued a corrected announcement about the Medicare Severity-Diagnosis Related Group (MS-DRG) Grouper to recognize the new ICD-10-CM diagnosis code, U07.1, for COVID-19. The ICD-10 MS-DRG Grouper software package to accommodate this new code, Version 37.1 R1, is effective for discharges on or after April 1, 2020.
     
  • Adult day health centers: The California Department of Public Health has issued updated guidance on gathering and visitation in these facilities. 

News for March 23

Next California Department of Public Health (CDPH) Call: March 24, 8-9 a.m. (PT)
Dial: (844) 721-7239 

Passcode: 7993227
Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org.

FDA Releases Guidance to Mitigate Ventilator Supply Disruption
The Food and Drug Administration today released updated guidance to provide flexibility around and expand the availability of ventilators and other respiratory devices to treat patients during the public health emergency.

Major Disaster Declaration Provides Additional Assistance

On Sunday, California secured a declaration of a major disaster from the President. It will provide additional assistance, including, but not limited to: mass care and emergency assistance, crisis counseling, disaster case management, disaster unemployment assistance, disaster legal services, and Disaster Supplemental Nutrition Assistance.

Governor Defines Essential Critical Infrastructure Workers
For the health care/public health sector, Gov. Newsom’s list of essential critical infrastructure workers during the statewide stay-at-home order includes those working in direct patient care as well as all support functions. FAQs are available with the Executive Order and definition of essential critical infrastructure workers.

Executive Order Waives More Staffing Ratios
To further increase health care capacity in clinics, adult day health care, hospice, and mobile clinics, Gov. Newsom on Saturday issued an Executive Order that waives staffing ratios at those facilities. Previously, the CDPH had issued a statewide waiver, which suspends staffing ratios at hospitals until June 30, 2020.

CHA Sends New Blanket Waiver Request to Centers for Medicare & Medicaid Services (CMS)
CHA has submitted to CMS, on behalf of all hospitals and health systems, a second request for waivers that immediately suspend all hospital and critical access hospital Conditions of Participation, regulatory deadlines, and audit activity in response to the unprecedented circumstances of the COVID-19 pandemic.

Locating Testing Swabs
The Health and Human Services Agency directs hospitals experiencing shortages of testing swabs to these manufacturers:

Covered California Extends Special Enrollment
Covered California has announced it will extend its special enrollment period through June 30 to help people get coverage in light of COVID-19.

CMS Prioritizes Survey Activity
CMS will prioritize survey activity by authorizing modification of timetables and deadlines for the performance of certain required activities, delaying revisit surveys, and exercising enforcement discretion for three weeks. During the three-week timeframe, the following types of surveys will be prioritized and conducted:

  • Complaint and facility surveys that are triaged at the immediate jeopardy level
  • Targeted infection control surveys using a streamlined review checklist to minimize the impact on provider activities, while ensuring providers are implementing actions to protect the health and safety of individuals to respond to the COVID-19 pandemic
  • Voluntary self-assessments of infection control plans

CMS will not conduct standard surveys for long-term care facilities, hospitals, home health agencies, intermediate care facilities for individuals with intellectual disabilities and hospices. This includes the life safety code and emergency preparedness elements as well as revisits that are not associated with immediate jeopardy.

CMS has also announced that it:

  • Waived the rule requiring a three-day qualifying stay for Medicare
  • Will provide relief from timeframes for Minimum Data Set (MDS) assessments and transmission, and delayed release of MDS 3.0 v1.18.1, which had been scheduled for Oct. 1, 2020.
  • Issued FAQs on provider enrollment relief under 1135 waivers

CHA and Our Health California Call-to-Action
While Congress considers new legislation to help states prepare for a patient surge, CHA activated its Our Health California digital community of more than 1 million Californians to help ensure critical funds for hospital care. More than 10,000 advocates across the state have emailed House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy, urging them to support funding for life-saving supplies, production of more protective equipment and ventilators, and expanded treatment capacity.

OSHPD Suspends Reporting Penalties
The Office of Statewide Health Planning and Development has notified CHA that it will temporarily suspend penalty assessments for late data reporting and will notify impacted health facilities by letter.

Board of Pharmacy Waivers
The Board of Pharmacy has issued new waivers allowing:

  • Sterile compounding pharmacies whose licenses expire on or before May 1, 2020, to have their licenses renewed without being subject to certain renewal requirements if the facility is in a hospital or satellite location
  • Hospital pharmacies to obtain drugs and devices from out of state for one month during the COVID-19 disaster

Support for Placement of People Experiencing Homelessness
The Department of Social Services reminds health care providers that a regional or local Continuum of Care (CoC) — a planning body that coordinates housing and services funding for people experiencing homelessness — can help during this time to support the placement of unsheltered individuals and families. A list of local CoCs and contact information is available here.

Other New Guidance

  • For 340B hospitals: The Health Resources and Services Administration has posted about the administration of the 340B program, addressing 340B patient definition, telehealth services, new 340B registrations particularly for child-sites and contract pharmacies, group purchasing organization prohibition for disproportionate share hospitals, and 340B audits.
  • FAQs on testing: The FDA has issued FAQs on diagnostic testing, including a 24-hour hotline and list of commercial labs.
  • Asymptomatic staff in skilled-nursing facilities (SNFs): CDPH has revised its guidance from last week on SNF preparation for COVID-19 to reflect an Executive Order by the Governor stating that asymptomatic health care workers may continue working during the period of this COVID-19 emergency, provided those health care workers are taking precautions to prevent transmission.
  • Adult day health centers: CDPH has issued guidance for mitigating and preventing transmission of COVID-19 in adult day health centers.

Process for sterilizing and reusing N95 masks: Nebraska Medicine has published its decontamination procedure for reusing N95 masks, involving the delivery of ultraviolet germicidal irradiation to used N95 FFRs. The Centers for Disease Control and Prevention National Institute for Occupational Safety and Health is currently reviewing these methods.

News for March 21

Updates from the California Department of Public Health (CDPH)

  • COVID-19 Mitigation Playbook: CDPH has issued a new COVID-19 Mitigation Playbook. Notably, the playbook recommends that, “Health care facilities need to enact surge plans now to create overflow space for screening, triage, isolation, and transfer/discharge, including conversation of outpatient space for inpatient use and using non-patient areas for patient care.” It also includes detailed information on the following key topics:
     
    • Novel Coronavirus (COVID-19)
    • Pandemic Response Phases
    • Containment to Mitigation Continuum
    • Health Care System Mitigation: Key Considerations
    • Facility Capacity Management
    • Emergency Medical Services
    • Health Care Workforce
    • COVID-19 Patients and the Health Care Worker
    • Supply Chain
    • Infection Control
    • Public and Patient Outreach
    • Laboratory Testing
    • Medical Counter Measures
  • Guidance on Testing Sites: CDPH has also issued guidance to support health care providers and laboratories in determining COVID-19 testing prioritization. The guidance notes that testing is now available in a number of public health, commercial, and hospital laboratories in California, but broad scale testing is not available at this time.

News for March 20 

In response to the many issues related to COVID-19 response that CHA has been working through with the California Department of Public Health (CDPH) over the past few weeks, today CDPH issued an unprecedented statewide waiver of almost all regulatory requirements for hospitals until June 30, 2020. Hospitals are not required to submit individual requests for program flexibility. There are a few exceptions:

  1. Hospitals must continue to report adverse events and unusual occurrences.
     
  2. Hospitals must report substantial staffing or supply shortages that jeopardize patient care.
     
  3. Hospitals must act in the best interest of patients.
     
  4. Hospitals must follow their disaster response plan.
     
  5. Hospitals must follow infection control guidelines from CMS and CDC.
     
  6. Hospitals must comply with local public health department directions.

This waiver does not apply to federal laws or to state laws that are not within the jurisdiction of CDPH. For information on federal waivers click here

News for March 20 

Hospitals Relieved of Most Regulatory Requirements Through June 30

In response to the many issues related to COVID-19 response that CHA has been working through with the California Department of Public Health (CDPH) over the past few weeks, today CDPH issued an unprecedented statewide waiver of almost all regulatory requirements for hospitals until June 30, 2020. Hospitals are not required to submit individual requests for program flexibility. There are a few exceptions:

  • Hospitals must continue to report adverse events and unusual occurrences.
     
  • Hospitals must report substantial staffing or supply shortages that jeopardize patient care.
     
  • Hospitals must act in the best interest of patients.
     
  • Hospitals must follow their disaster response plan.
     
  • Hospitals must follow infection control guidelines from CMS and CDC.
     
  • Hospitals must comply with local public health department directions.

This waiver does not apply to federal or state laws that are not within the jurisdiction of CDPH. For information on federal waivers click here.
 

Governor’s Stay at Home Order Prioritizes Health Care Resources

Gov. Newsom issued a stay at home order to protect the health and well-being of all Californians and to establish consistency across the state in order to slow the spread of COVID-19. According to the order, the healthcare delivery system shall prioritize services to serving those who are the sickest and shall prioritize resources, including personal protective equipment, for the providers providing direct care to them.


DHCS Requests Second 1135 Waiver Request From CMS

Yesterday, the Department of Health Care Services (DHCS) submitted its second 1135 Waiver request to the Centers for Medicaid & Medicare Services (CMS), seeking temporary relief of existing federal requirements — service authorization and utilization controls, program eligibility, telehealth, administrative activities, targeted payment rates, and request for flexibility with IMD exclusion.
 

Board of Pharmacy Issues Staffing Ratio Waiver

The Board of Pharmacy has authorized a waiver of the ratio of pharmacists to pharmacy technicians to allow for one additional pharmacy technician for each supervising pharmacist under the following conditions:

  • The pharmacy documents the need for the ratio modification due to the COVID-19 public health emergency. Examples of documentation may include, but are not limited to, an increased prescription volume or limitation on staff availability because of quarantine.
  • The supervising pharmacist, exercising their professional judgment, may refuse to supervise the additional pharmacy technician and tell the pharmacist-in-charge of this determination. When making such a determination, the supervising pharmacist must specify the circumstances of concern with respect to the pharmacy and patient care implications. Under such circumstances, the ratio may not increase. See other Board of Pharmacy waivers here.

Additional Guidance, Resources

  • Undocumented individuals urged to seek care: The U.S. Customs and Immigration Services has urged everyone, including undocumented individuals, with symptoms that resemble COVID-19 to seek necessary medical treatment or preventive services, noting that treatment or preventive services will not negatively affect any future “public charge” analysis. The public charge rule does not restrict access to testing, screening, or treatment of communicable diseases, or vaccines to prevent vaccine-preventable diseases.
  • Uninterrupted substance use disorder treatment through telehealth: The Substance Abuse and Mental Health Services Administration has shared guidance to ensure that substance use disorder treatment services are uninterrupted through the use of telehealth technology and telephonic consultations. The guidance clarifies that the prohibitions on use and disclosure of patient identifying information would not apply in these situations to the extent that, as determined by the provider, a medical emergency exists.
  • State behavioral health FAQs: DHCS has updated its FAQs for narcotic treatment programs to reflect recent federal guidance, including the ability to prescribe new patients buprenorphine through telemedicine in lieu of an in-person visit; flexibility to apply for blanket waivers to allow 14-28 days of take-homes and home delivery of methadone; and clarification that the U.S. Department of Health and Human Services Office for Civil Rights will use enforcement discretion regarding HIPAA violations when providers use telehealth in good faith. DHCS has also updated its FAQs for driving under the influence programs.
  • State-level data on COVID-19 cases: The Kaiser Family Foundation has released a new, regularly updated tool for tracking coronavirus policy actions, along with data on current cases and deaths and state-level data on health coverage and provider capacity.
  • New FAQs on Medicaid/CHIP, catastrophic health plan coverage: CMS yesterday updated its FAQs for state Medicaid and Children’s Health Insurance Program agencies, answering questions related to flexibilities related to managed care, benefits, financing, Section 1115 demonstrations, and Section 1135 Waivers offered as part of the Pesident’s declaration of a national emergency.

News for March 19

Developments in Telehealth

  • HIPAA enforcement discretion: In conjunction with recent Centers for Medicare & Medicaid Services (CMS) telehealth waivers, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights has announced it will exercise enforcement discretion and waive penalties for HIPAA violations against providers that serve patients through technologies such as FaceTime or Skype, during the COVID-19 public health emergency. This discretion applies to telehealth provided for any reason, not just related to COVID-19.
     
  • Telemedicine visit enough for controlled substance prescription: The Drug Enforcement Administration (DEA) has allowed that, as long as the COVID-19 public health emergency remains in effect, DEA-registered practitioners may prescribe for patients for whom they have not conducted an in-person medical evaluation, provided all of the following conditions are met:
    • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.
    • The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
    • The practitioner is acting in accordance with applicable state and federal law.

Elective Surgeries
CMS has released recommendations outlining factors that should be considered for postponing elective surgeries and non-essential medical, surgical, and dental procedures — including patient risk factors; availability of beds, staff, and personal protective equipment; and the urgency of the procedure.

Gubernatorial and State Actions

  •  $150 million to protect Californians experiencing homelessness: Of the $500 million for COVID-19 recently approved by the Legislature, Gov. Newsom has authorized $150 million through emergency actions to fund programs to people experiencing homelessness, including $100 million directly to local governments for shelter support and emergency housing, and $50 million to purchase travel trailers and lease rooms in hotels, motels, and other facilities to provide immediate isolation placements throughout the state. Gov. Newsom also issued an Executive Order providing flexibility to local governments to spend their emergency homelessness funding on combatting COVID-19 and its impacts on the homeless population.
     
  • Executive Order protecting safety-net services: Gov. Newsom issued an Executive Order delaying eligibility re-determinations for 90 days for Californians who receive public assistance benefits through Medi-Cal, CalFresh, CalWORKS, Cash Assistance for Immigrants, and In-Home Supportive Services.
     
  • Statewide COVID-19 public awareness campaign: The state has launched a public awareness campaign to provide information on what Californians can do to further prevent the spread of the virus. The campaign includes a new website, www.covid19.ca.gov, and public service announcements from Dr. Sonia Angell, California Department of Public Health director and state health officer, and California Surgeon General Dr. Nadine Burke Harris.
     
  • Insurers directed to maintain health care access, including prescription refills: The state Department of Insurance has directed health insurance companies to submit emergency plans detailing how they will ensure continued access to medically necessary health care services for the duration of the declared COVID‑19 state of emergency — including allowing for 90-day prescription drug refills, suspending refill waiting periods for all drug tiers, and maximizing telehealth.

Defense Production Act
President Trump has invoked the Defense Production Act to enable expanded production of personal protective equipment and ventilators. The Executive Order requires companies to accept and prioritize contracts from the government over performance of any other contracts or orders, and gives the HHS Secretary authority to determine the proper nationwide priorities and allocation of health and medical resources.

CDC Report on U.S. COVID-19 Hospitalizations
About 80% of deaths and 45% of hospitalizations for COVID-19 in the U.S. are among adults aged 65 or older, according to a report released yesterday by the Centers for Disease Control and Prevention. The report also says that an estimated 21% to 31% of U.S. COVID-19 patients between Feb. 12 and March 16 were hospitalized, with 5% to 12% admitted to an intensive care unit.

Webinar Recording Available
CHA held a members-only webinar yesterday to help hospitals and health systems implement the most current rules on worker safety relative to COVID-19. A recording is now available.

Updated Guidance & Recommendations

  • For skilled-nursing facilities: CDPH has issued an All Facilities Letter with recommendations to help skilled-nursing facilities prepare for COVID-19 patients.
     
  • New COVID-19 ICD-10-CMS code April 1: CDC has announced it will implement a new ICD-10-CMS diagnosis code specific to COVID-19 (U07.1) effective April 1, rather than October 1 as previously announced. The code is not retroactive, and more guidance on usage will be released soon.
     
  • Infection control guidance for Programs of All-Inclusive Care for the Elderly (PACE) organizations: CMS yesterday released COVID-19 infection control guidance for PACE organizations, noting that there may be circumstances where a PACE organization needs to implement strategies that do not fully comply with program requirements. CMS notes it will take those situations into consideration when conducting oversight activities.

Rural Health Webinar
CDC will host a webinar for rural partners March 23 at 10 a.m. (PT). It will feature guidance for public health practitioners, health care providers, and others working to protect the health of rural communities. View more information and register here.

News for March 17

Announcements by the Governor

There are three key provisions from the Governor’s directive last night that are critical for hospitals’ continued workforce and operations:

  • The guidance from the state this weekend that directed individuals over 65 to home-isolate does not apply to health care workers. See full guidance.
     
  • Health care workers who are asymptomatic and have been exposed to a COVID-19 positive patient can continue to work during this period of emergency, according to the Governor’s executive order. See full executive order.
     
  • The executive order provides enforcement relief for hospitals, directing the Department of Social Services, the California Department of Public Health, and the Division of Occupational Safety and Health (Cal/OSHA) to focus enforcement activities where there are allegations of the most serious violations impacting health and safety and to focus on providing technical assistance and support. This is intended to protect from Cal/OSHA enforcement those hospitals that move to use droplet precautions for all but aerosol-generating procedures to address COVID-19, following the World Health Organization guidance.

CHA’s Medicare 1135 Request
CHA has submitted a blanket waiver request to the Centers for Medicare & Medicaid Services (CMS) asking for additional waivers for all California hospitals. Several other states and the American Hospital Association have done the same. CMS has confirmed receipt and responded that it is considering the hospital associations’ requests.

Blanket Waivers, Telehealth Expanded

  • CMS today announced its third set of blanket waivers, this one regarding telehealth. See FAQs and a fact sheet. As a reminder, all hospitals can operate under these blanket waivers automatically — no request is needed. The Office of Inspector General also issued a policy statement allowing hospitals flexibility to waive cost-sharing obligations for telehealth services and a related fact sheet.
     
  • In addition, the Department of Health Care Services yesterday submitted a request to CMS for additional section 1135 waiver flexibilities for the Medi-Cal program, seeking temporary relief of existing administrative requirements to rapidly increase access to medical services.

Return to Work Criteria for Health Care Workers
The Centers for Disease Control and Prevention has issued guidance for determining when health care workers with confirmed or suspected COVID-19 should return to work, including restrictions and practices to follow after they return to work.

The Joint Commission Suspends Surveying
The Joint Commission announced it has suspended all regular surveying as of March 16. In some cases — such as high-risk situations — a limited number of surveys may continue. Additional details on which surveys will be processed will be released soon.

Reminder

  • CHA webinar tomorrow: CHA will host a complimentary, members-only webinar March 18 from 11:30 a.m. to 1 p.m. (PT). The webinar will focus on untangling employee safety regulations and guidance around coronavirus as community transmission increases.

News for March 16

CHA Webinar: March 18, 11:30 a.m.-1 p.m. (PT)
CHA will host a complimentary, members-only webinar March 18 from 11:30 a.m. to 1 p.m. (PT). The webinar will focus on untangling employee safety regulations and guidance around coronavirus as community transmission increases.

New White House Guidance
Today’s updated guidance from the White House urges people to stay home and avoid groups larger than 10 for the next 15 days, avoid eating at restaurants, not visit nursing homes or long-term care facilities, and more.

Centers for Disease Control and Prevention (CDC)

The CDC on March 15 issued a recommendation that, for the next eight weeks, organizers (whether groups or individuals) cancel or postpone in-person events of 50 people or more throughout the U.S. The recommendation does not apply to the day-to-day operation of organizations such as schools, institutes of higher learning, or businesses.

Department of Health Care Services (DHCS) Updates

The DHCS website now includes:

Guidance for Nursing Homes and Older Adults

  • Federal guidance: The Centers for Medicare & Medicaid Services has issued revised guidance on protecting nursing home residents, directing nursing homes to significantly restrict visitors and nonessential personnel, and to restrict communal activities inside nursing homes.
  • California Department of Aging (CDA): CDA has posted several updates on its home page, including links for area agencies on aging, community-based adult services and more; as well as for older adults and people with disabilities.

Other New Developments

  • The California Dental Association has issued an announcement strongly recommending that dentists practicing in California suspend nonessential and nonurgent dental care for the next 14 days.
     
  • A JAMA-published paper details Italy’s early experience with critical care utilization during the COVID-19 outbreak.

Reminder

CHA how-to guide on requesting licensing program flexibility: CHA has prepared an overview for requesting program flexibility from CDPH, including links to the CDPH forms for requests to suspend both state licensing regulations and statutes.

News for March 15

Governor Announces More Statewide Changes
Gov. Newsom held a press conference today to provide status updates on the state’s response to protect the most vulnerable Californians as coronavirus spreads. Among the most significant announcements is a limitation on hospital visitors, largely reserving visits for end-of-life patients. In addition, the state will recommend that people 65 and older, and those who have chronic conditions, home isolate. We expect the state to issue guidance on both recommendations very soon and will forward it in an upcoming issue of Coronavirus Watch.

CDPH Changes to Program Flexibility Process
CDPH has centralized its program flex response process in Sacramento. Hospitals should now send program flexibility requests to CDPH by emailing chcqdutyofficer@cdph.ca.gov. The Sacramento office will inform the hospital’s district office of all flexes every night.

In addition, CDPH has updated its Form 5000 A, and CHA has updated its how-to guide for requesting program flexibility.

CMS Call Tomorrow for Hospitals
The Centers for Medicare & Medicaid Services (CMS) will hold a call for hospitals tomorrow, March 16, at 9 a.m. (PT) — and subsequently every Monday at 9 a.m. (PT) — about the national emergency. To participate: Dial: (888) 455-1397, Participant Passcode: 5854574

New Section 1135 Waivers
The U.S. Department of Health and Human Services today issued additional blanket waivers (backdated to March 13) – in addition to the blanket waivers issued on Friday. Hospitals do not need to request an individual waiver to be relieved from compliance with these laws to the extent described in these lists. If a blanket waiver is insufficient to meet your needs, you can submit a request to operate under an individual waiver. CHA has updated its how-to guide on requesting federal individual waivers here.

Other New Developments

  • Information on possible clinical treatment: A member has shared this information about a possible clinical treatment. Note, this is not FDA-approved. Supportive research findings are here and here.
  • The California Employment Development Department has waived the one-week waiting period for state disability insurance and unemployment, making those benefits available on the first day an employee is unable to work due to quarantine or a positive COVID-19 test, or if an employee loses their job due to COVID-19.
  • A new JAMA article on mitigation strategies recommends droplet precautions and offers operational recommendations for hospitals.

Next CDPH Call: March 17, 8-9 a.m. (PT)
CDPH will send call-in information through the California Health Alert Network. CHA will also share the information, once available, through Coronavirus Watch. Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org.

News for March 13

CHA Advocacy
Testimony before state Legislature: CHA President & CEO Carmela Coyle testified yesterday before a California Senate Budget Subcommittee, asking for four rapid decisions from the state:

  • Move to droplet precautions
  • Allow asymptomatic health care workers who have been exposed to a COVID-19 positive patient to continue to work
  • Institute a statewide, rather than county-by-county, strategy
  • Allow access to the Strategic National Stockpile for personal protective equipment

At the same hearing, Susan Fanelli, CDPH chief deputy director, noted that CDPH will request access to the Strategic National Stockpile, stand up a statewide call center, and receive $41.9 million from the federal supplemental bill.

Requests of California congressional delegation: Also yesterday, CHA sent a letter to the California congressional delegation asking for their swift action on:

  • Clarifying guidance for health care personnel exposure to COVID‐19
  • Moving to droplet precautions
  • Removing a provision of the Families First Coronavirus Response Act
  • Urging presidential action for a federal declaration that will allow for 1135 waivers of Medicare, Medicaid, and Children’s Health Insurance Program requirements
  • Activating the National Disaster Medical System Definitive Care Reimbursement Program

Federal Guidance & Resources

President Trump today declared a national emergency, which will allow federal funding for response efforts and flexibility in requirements for health care providers. Here is CHA’s summary of key provisions.

The Centers for Medicare & Medicaid Services (CMS) has issued:

  • For Medicare Advantage and Part D plans, a memorandum requiring additional flexibilities of them
  • For state Medicaid and Children’s Health Insurance Program agencies, a COVID-19 FAQ that covers a range of topics and issues and notes that states can expand the groups for which hospitals can make presumptive eligibility determinations.
  • For Medicare providers, a fact sheet with information on pricing on Centers for Disease Control and Prevention (CDC) and non-CDC tests.

The CDC has issued:

The FDA has:

  • Established a COVID-19 Hotline (1-888-463-6332) for laboratories that have questions related to the development, authorization and validation of COVID-19 tests. The hotline can also assist the FDA in connecting laboratories to manufacturers.

News for March 12

Latest Developments
Today, the Governor issued a new Executive Order. Of note:

  • Commandeering power for quarantine, isolation, and treatment sites (#8 in the Executive Order): Gives the state the power to commandeer hotels (and other places of temporary residence), medical facilities, and other facilities to quarantine, isolate, or treat individuals with COVID-19 or who have had a high-risk exposure to COVID-19.
  • Unemployment insurance could be available sooner (#2 and #3 in the Executive Order): Allows the Employment Development Department to waive the one-week waiting period for unemployment insurance. CHA requested this for any health care workers who have at-home isolation in advance of the original Executive Order last week that declared a State of Emergency.
  • Scope of practice for paramedics can be augmented (#4): Allows the Emergency Medical Services Authority (EMSA) director to “implement additions to local optional scopes of practice for paramedics without first consulting with a committee of local EMS medical directors named by the EMS Medical Directors Association of California.”
  • Suspends state law on who can conduct testing in public health labs and licensed labs. (#9)

CHA how-to guide on requesting licensing program flexibility: CHA has prepared an overview for requesting program flexibility from CDPH, including links to CDPH forms, for requests to suspend both state licensing regulations and statutes.

Link to CHA webinar: CHA hosted a webinar Wednesday on how hospitals and health systems can best care for their communities in response to coronavirus. The webinar can be viewed here.

CDPH guidance for long-term care facilities: CDPH has issued an All Facilities Letter for long-term care facilities.

CDPH recommendations for older adults, other compromised individuals: CDPH has issued a press release with recommendations for older adults, people with compromised immune systems, and those with serious chronic medical conditions. Recommendations include staying home as much as possible.

Interim CDC guidance on infection prevention and control: The Centers for Disease Control and Prevention (CDC) has updated its Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. It does not expressly move to droplet precautions but states that airborne isolation rooms should be reserved for patients undergoing aerosol-generating procedures.

State guidance on gatherings, social distancing: On March 11, CDPH released recommendations for canceling or postponing, during the month of March, large gatherings of 250 or more people, small gatherings where people are not six feet apart, and limiting gatherings to no more than 10 people for those who are most at-risk for COVID-19 (i.e., older adults).

The World Health Organization (WHO) pandemic designation: The WHO Director-General made remarks today about why the organization made the decision to designate COVID-19 as a pandemic.

CDPH updating numbers regularly: These are online here, including a map of the counties where community transmission is occurring, currently: Yolo, Sacramento, Solano, San Francisco, San Mateo, Santa Clara, and Riverside.

Centers for Medicare & Medicaid Services (CMS) guidance: CMS has released updated guidance for nursing home providers, guidance aligning with the CDC’s recommendations on the use of N95 respirators, and EMTALA guidance.

Recap of March 10 CDPH call: CDPH hosted a call for health care providers on March 10, including state-specific status updates. See details here, under the “CDPH Updates” tab.

Next CDPH Call: March 17, 8-9 a.m. (PT)
CDPH will send call-in information through the California Health Alert Network. CHA will also share the information, once available, through Coronavirus Watch. Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org.

News for March 9

Latest Developments
Hospitals urged to complete survey on surge capacity: CDPH has issued an All Facilities Letter (AFL) asking hospitals to immediately complete a statewide resources survey on surge capacity. The AFL also reminds hospitals to contact their Medical Heath Operational Area Coordination (MHOAC) with resource requests related to COVID-19.

Recap of March 6 CDPH call: CDPH hosted a call for health care providers on March 6, including state-specific status updates. See details here.

Details on requesting licensed out-of-state health care personnel: Requests should be made to the Emergency Medical Services Authority (EMSA), and should include documentation that the health care provider is requesting additional practitioners; a roster of names with demographics and licenses; and attestations that the practitioners are licensed and in good standing. EMSA anticipates putting out a policy and template for requests this week.

New guidance/information has been issued on:

Reminder: Upcoming webinar
CHA will host a complimentary members-only webinar on March 11 from 2 to 3:30 p.m. (PT). The webinar will emphasize how hospitals and health systems can best care for their communities in response to coronavirus. Register here.

News for March 6

Latest Developments

The Centers for Disease Control and Prevention (CDC) updates guidance on health care worker exposure: Updated guidance from the CDC states that facilities could consider allowing asymptomatic health care workers who have had exposure to a COVID-19 patient to continue working after consultations with their occupational health program.

State announces no cost-sharing for tests, disability claims available for affected workers: CDPH issued a press release yesterday announcing that:

  • All commercial and Medi-Cal health plans regulated by the Department of Managed Health Care (DMHC) will eliminate cost-sharing for medically necessary testing. DMHC has issued an All-Plan Letter to health plans. CHA had requested a letter to health plans reminding them of their coverage obligations to enrollees suspected or confirmed to have COVID-19.
  • The California Department of Insurance issued a bulletin with similar direction providing cost free medically necessary testing of its enrollees.
  • Individuals who are unable to work because they have or have been exposed to COVID-19 may file a disability insurance claim.

The Centers for Medicare & Medicaid Services (CMS) issues new procedure code for testing, fact sheets on coverage: CMS announced yesterday that it has developed a second procedure code that can be used by laboratories to bill for certain COVID-19 diagnostic tests. The announcement also includes links to fact sheets explaining Medicare, Medicaid and Children’s Health Insurance Program, and individual and small group market private insurance coverage for services related to COVID-19.

Hardening preparation checklist: The North Carolina Health Care Association has shared a practical checklist on preparing and/or hardening — focused on patients, facilities, and staff — to help avoid overwhelming surge and mitigate impact.

Reminders
CDPH weekly provider call: CDPH will hold its weekly provider call on March 10 from 8 to 9 a.m. (PT). CDPH will send call-in information through the California Health Alert Network. CHA will also share the information, once available, through Coronavirus Watch. Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org.

CHA to host webinar: CHA will host a complimentary members-only webinar on March 11 from 2 to 3:30 p.m. (PT). The webinar will emphasize how hospitals and health systems can best care for their communities in response to coronavirus. Register here.

Reminder

CHA to host webinar: CHA will host a complimentary members-only webinar on March 11 from 2 to 3:30 p.m. The webinar will emphasize how hospitals and health systems can best care for their communities in response to coronavirus. Register here.

News for March 2

CDPH has also posted a summary of its February 25 call with health care providers.

Latest Developments

Possible community transmission expands: Confirmed cases of the virus were reported in Santa Clara County — including additional possible cases of community transmission — as well as among health care workers in Solano and Alameda counties. CHA is working with member hospitals and health systems and state public health officials to ensure an appropriate, coordinated response.

CDPH receives test kits from the CDC: CDPH announced it has received new test kits to begin diagnostic testing at state public health laboratories and will receive an additional shipment of kits to test up to 1,200 people.

CDC issues information on potential use of stockpiled N95 respirators: On Saturday, the CDC posted information about the potential to use stockpiled N95 respirators beyond the manufacturer-designated shelf life, indicating some of the respirators have continued to perform adequately.

CDPH releases new guidance for outpatient clinics: CDPH has released All Facilities Letter 20-15, with new infection control recommendations for outpatient health care facilities.

News for February 28

Latest Developments

CDC expands criteria for persons under investigation: The CDC has expanded its criteria for persons under investigation to include patients requiring hospitalization who have traveled to: Iran, Italy, Japan, and South Korea.

CHA issues key messages on how hospitals are responding to novel coronavirus: CHA has developed a set of key messages on how, as novel coronavirus begins to spread, California hospitals are caring for their communities. Members may find these useful in their interactions with local and state officials, community members, and news media.

Gov. Newsom and state health officials hold press conference: On Thursday, the Governor held a press conference on the state’s preparedness and other efforts as the novel coronavirus has reached the point of community transmission. Gov. Newsom, California Health and Human Services Agency Secretary Mark Ghaly, MD, MPH, and CDPH Director and State Health Officer Sonia Angell, MD, emphasized that the state is:

  • Prioritizing the expansion of laboratory testing. The Centers for Disease Control and Prevention (CDC) has committed to sending additional testing kits within a few days, which will augment the state’s current supply of 200
  • Expecting testing criteria to be expanded by the CDC, possibly to include individuals who have pneumonia without a clear source of infection
  • Confident in the state’s resources to address this public health challenge
  • In ongoing coordination with federal agencies
  • Focused on supporting local health departments throughout the state
  • Appreciative of hospitals that have taken on an unanticipated clinical load
  • Encouraging people to use telemedicine and other technology resources, if possible, before going to a hospital or other health care provider, and to call ahead

CDC releases interim guidance on coding: The CDC has announced it will implement a new diagnosis code for COVID-19 effective October 1 and has issued interim coding guidance to use until then.

News for February 10

CDC releases health care worker guidance: The CDC released guidance on health care worker exposure, discussing exposure risk as high, medium, or low and recommending excluding from work for 14 days those who are high or medium risk. It also discusses exposure risk and recommendations for personnel who interact with a person under investigation, as well as those who triage patients in the emergency department. Finally, it reiterates that guidance about community and travel-associated exposure applies to health care personnel. 

CDC guidance on health care workers minimizing risk of exposure: On February 7, the CDC released guidance on how health care personnel can limit their risk of exposure. This brief document includes reminders such as using standard precautions, contact precautions, and airborne precautions and eye protection when caring for patients with confirmed or possible novel coronavirus. It also includes guidance on environmental cleaning and disinfection, which indicates management of laundry, food service utensils, and medical waste should be performed in accordance with routine procedures.

Supply updates:

The CDC, taking steps to make sure there are enough supplies and appropriate guidance to prevent spread of disease, released guidance on personal protective equipment usage.

The World Health Organization has issued a situation report on the supply of personal protective equipment, encouraging manufacturers to increase production and distribute supplies to countries most in need.

The state’s emergency cache of N95 respirators and pediatric surgical masks has been activated. If your hospital needs additional masks or other emergency supplies, submit a 213 Resource Request to the Medical and Health Operational Activity Coordinator and they will help obtain it through your county, region, or the state. Hospital disaster preparedness coordinators are familiar with this process.

CDPH, the Governor’s Office of Emergency Services, and the Emergency Medical Services Authority have formed a multi-agency coordination group to address scarce resource allocation of N-95 respirators.

CDPH has distributed a questionnaire to counties with outstanding resource requests from hospitals and others in order to assess the greatest needs.

The World Health Organization has issued a situation report on the supply of personal protective equipment, encouraging manufacturers to increase production and distribute supplies to countries most in need.

New requirement of airlines: The CDC and Department of Health and Human Services issued an interim final rule requiring airlines to provide phone numbers, email addresses, and home addresses for all passengers arriving from foreign countries into the U.S. “for the purposes of health education, treatment, prophylaxis, or other appropriate public health interventions, including travel restrictions.”

News for February 7

CDPH specimen testing: CDPH has announced it will begin testing specimens for suspected cases February 12. This has previously been limited to the CDC and testing has taken two to seven days. Once CDPH begins testing, it anticipates a turnaround time of two days.

Send emergency contact information: CHA encourages all hospitals to respond to a CDPH request to provide contact information for a designated emergency contact who is reachable and able to respond 24 hours a day. All information provided will be entered into the California Health Alert Network (CAHAN) system, which CDPH uses to send important notifications including emergency alerts, health notifications, information bulletins, and All-Facilities Letters.

CDPH summary: CDPH has released its detailed summary of the February 4 call with CDPH and hospitals.

News for February 6

February 3 Call: American Hospital Association/Centers for Disease Control & Prevention 

On February 3, the American Hospital Association hosted a call with the Centers for Disease Control and Prevention (CDC). The call included status updates, recommendations for hospitals, and a Q&A session. Highlights include:

Update

Chinese outbreak: 17,000 cases currently, with 7-13% considered severe

U.S. cases: 260 patients under investigation in 36 states; 11 confirmed cases; seven people identified in airport screening (none yet confirmed)

Recommendations for hospitals

The CDC is recommending to the public that potentially infected people call ahead to primary care providers and hospitals. When they arrive, the CDC recommends hospitals have them wait in a non-crowded area, away from other people, wearing a mask.

Personal protective equipment (PPE) should be used in airborne isolation rooms, if available, or in a room with the door closed. Airborne and eye protections are recommended. If an airborne isolation room is not available, hospitals are recommended to arrange for transportation to another facility that has one or home.

Stable patients that do not require a hospital stay can be sent home but should assessed on a case-by-case basis with the local public health department. They should also have prescriptions filled for the remaining period of their isolation.

Key questions

Q: If an individual is identified at an airport, to which hospital or military site will they be taken and how and by whom is that determined? Is the receiving facility notified in advance?

A: State authorities, the federal Department of Health and Human Services Assistant Secretary for Preparedness, and the CDC are working together to make these decisions. Health care facilities will be notified if they are being considered.

CDPH Updates

    March 10 CDPH Call With Hospitals

    On March 10, the California Department of Public Health (CDPH) hosted a weekly call with health care providers. Highlights included:

    Status updates

    • COVID-19 is being transmitted to a limited extent in some communities.
    • CDPH is looking at moving to mitigation from containment.
    • CDPH recently distributed a survey on surge capacity and noted that hospitals might also be contacted by its licensing and certification staff if there is a surge in their area.
    • CDPH continues to look at alternate sites for patients with COVID-19, rather than only hospitals.

    Program flexes

    • Section 10 of the Governor’s State of Emergency declaration includes information about health care facilities and what can be waived or flexed. 
    • Facilities can send Form 5000 to their local district office, which will send it to the state’s Medical and Health Coordinator Center. Some situations don’t require a program flex, but rather a consultation (e.g., doesn’t require a waiver of regulation, but something that must be put in policies and procedures). Questions about this process can be emailed to chcqdutyofficer@cdph.ca.gov

    Guidance on droplet precautions

    CDPH anticipates releasing an AllFacilities Letter on droplet precautions tonight.

    Testing

    • Hospitals have three routes to get COVID-19 test results:
    1. Public health labs: Send the specimen to their local health department. The lab will provide a person under investigation number and either conduct the test  — if it is one of the 18 labs that have Centers for Disease Control and Prevention (CDC) testing kits  — or send the specimen to one of those labs. Additional labs are awaiting test kits.
    2. In-house: Test the specimen themselves with a test that they have developed by “cloning” the CDC’s test.
    3. Commercial labs: Send the specimen to a commercial lab (e.g., LabCorp or Quest), which does not require approval from  the local health department  before testing.
    • Laboratories will now also report COVID-19 cases to CDPH and local health departments; regulations are underway. Any hospital laboratory conducting COVID-19 testing should also report.
    • Any lab that develops its own tests must have the first five negative and first five positive samples tested with a public health lab.

    Webinar for skilled-nursing facilities (SNFs)

    CDPH will provide a webinar for SNFs later this week and will disseminate information for that webinar soon. At a minimum, facilities should plan to cohort multiple patients and suspend communal dining and group activities.

    Health care worker exposure

    The CDC has updated its guidance on health care personnel exposure to remove active verification. Health care personnel should be self-monitoring.

    March 6 CDPH Call With Hospitals

    On March 6, the California Department of Public Health (CDPH) hosted a weekly call with health care providers about novel coronavirus. Highlights included:

    AFL provides guidance for health care facilities

    See March 3 All Facilities Letter (AFL) with key guidance for health care facilities on preparing for COVID-19.

    CMS guidance on licensing surveys

    In accordance with a memo from the Centers for Medicare & Medicaid Services (CMS), CDPH will not conduct re-licensing surveys for Medicare Conditions of Participation, and will instead focus on facility-reported incidents and complaints; will batch and contact through phone and email to minimize impacts to hospitals; and may also conduct offsite investigations. In addition, CDPH will continue to reassess the certification and licensing workload on a case-by-case basis by county.

    CDC updates guidance for health care worker exposure

    Updated guidance from the Centers for Disease Control and Prevention (CDC) stated that facilities could consider allowing asymptomatic health care workers who have had exposure to a COVID-19 patient to continue working after consultations with their occupational health program. Note: The CDC revised this again on March 7, and it now allows this only “after options to improve staffing have been exhausted.”  

    March 3 CDPH Call With Hospitals

    On March 3, the California Department of Public Health (CDPH) hosted a weekly call with health care providers about novel coronavirus. Highlights included:

    Respirator supplies

    Cal/OSHA will be issuing interim guidance on the efficient use of respirator supplies. CDPH and Cal/OSHA will issue FAQs, including how hospitals can request expired N95 masks in the state’s emergency cache.

    Program flexes

    CDPH is open to offering program flexibility related to COVID-19 related to space if the hospital has an immediate need.

    COVID-19 testing

    • Testing is first done at the local public health lab. Based on that result, confirmatory testing then is done at the CDC. This week, 13 laboratories this week will be online for confirmatory testing in California.
    • CDPH will be releasing guidance on electronic reporting of COVID-19 testing. 
    • CDPH notes that patients not requiring hospitalization should not be referred to the emergency department. Options are to either send the patient home or keep the patient in a private room and work with the local health department. 

    Guidance for long-term care

    The Centers for Disease Control and Prevention will be clarifying that long-term care facilities ought to use the same infection control protocol as other health care facilities.

    New weekly call

    The Department of Social Services will be hosting a 10 a.m. call on Wednesdays, beginning March 4, with its licensed facilities (e.g., assisted living, home health agencies, child care).  

    February 25 CDPH Call With Hospitals

    On February 25, the California Department of Public Health (CDPH) hosted a weekly call with health care providers about novel coronavirus. Highlights included:

    Updates

    • CDPH noted that it can take up to a month for a positive patient to complete viral shedding.
    • In addition, CDPH is in the process of approving outpatient clinic guidance and will be releasing it soon.
    • A hearing on whether the Fairview Developmental Center in Costa Mesa can be used for isolation patients will take place March 2.
    • The Centers for Disease Control and Prevention (CDC) is still the only entity authorized to conduct testing.

    CDC guidance

    This past week, the CDC issued an update on the potential for community transmission; travel notices that suggest health care professionals screen for travelers from South Korea, Italy, Japan, and Iran; and a two-page checklist for hospitals to assess their preparedness for patients exposed to coronavirus.

    Supply issues

    Multiple health care providers raised concerns about supplies and asked about flexibility on fit testing for N95 respirators. CDPH responded that it is communicating closely with Cal/OSHA on the issue of fit testing. Additionally, CDPH stated that it ordered 300,000 masks that will be delivered in April, with another 300,000 expected to be delivered in May.

    February 18 CDPH Call With Hospitals

    On February 18, the California Department of Public Health (CDPH) hosted its third call with health care providers about novel coronavirus. Highlights included:

    Updates

    • While risk of individuals contracting novel coronavirus is low, it remains a public health concern.
    • On Feb. 17, a plane arrived at Travis Air Force Base in Fairfield, with approximately 170 U.S. citizens who had previously been aboard the Diamond Princess cruise ship in Japan; 14 of the patients have tested positive for coronavirus and were appropriately managed and quarantined. The State Department and Department of Health and Human Services have issued a statement on repatriation specific to the cruise ship passengers.
    • While there are no antiviral medications available at this time, the Centers for Disease Control and Prevention is available for consultation for any hospitalized case, including clinical consulting on potential medications. 

    Hospital supply issues

    • CDPH’s request to distribute the expired N95 masks it received during the 2009 influenza pandemic was sent to the National Institute of Occupational Safety and Health, which is part of CDC, but was informed that some of the masks did not pass testing. CDPH has ordered more than 300,000 additional masks, estimated to arrive beginning in April.
    • Additionally, CDPH is developing a query of health care facilities to determine how many masks and gowns they have, of which models, and length of available supply. 

    February 11 CDPH Call With Hospitals

    On February 11, the California Department of Public Health (CDPH) hosted its second call with hospitals on novel coronavirus. Highlights included:

    Update

    There are 13 confirmed cases in the U.S. and 13 patients under investigation (PUI) in California, with 26 pending test results.

    Recommendations for hospitals

    Supply issues: Hospitals are reporting supply issues for masks and gowns. While CDPH is working on solutions, hospitals are encouraged to request supplies from their counties, which can request from their regional Medical Health Operational Area Coordinator.

    CDC has issued guidance about conserving supplies while protecting personnel. Isolation room access should be limited to only essential personnel (for instance, not having dietary staff deliver meals), which will allow supplies to be used only for essential personnel.

    Diagnostic testing: Performance issues have been identified with some testing kits sent by the CDC. CDPH hopes to begin using the kits beginning February 12. Use of testing is restricted to patients that meet the CDC’s PUI specimen criteria.

    Infection control guidance: On February 8, CDC released guidance on health care personnel exposure that categorizes personnel into high, medium, and low risk and offers recommendations based on that risk level for exclusion from work.

    For health care personnel with travel or community exposure, the CDC’s travel and community exposure guidance applies. Hospitals should consider excluding from work any personnel who returned from China prior to quarantine date of February 3 if still in the 1- day window.

    Key questions

    Q: Do you recommend reception staff wear masks?

    A: At this time, that has not been a recommendation. Patients with symptoms be provided a mask to limit their secretions.

    Q: Should hospitals report high-, medium-, and low-risk exposures to local public health department?

    A: Any time you have a case, you would be working with your local public health department is concert with CDPH.

    Q: For counties that have increased numbers of confirmed cases, are you considering testing beyond PUI criteria? We think some patients are concealing information and are very close to the criteria. With testing in California soon, could we test beyond PUI criteria?

    A: Local health officers will be able to test beyond PUI criteria at the discretion of the local health officer.

    Q: Do local public health offices package and ship the testing specimens?

    A: These are categorized as Category B, Diagnostic Specimen. If facility has a courier or arrangement with a public health laboratory with courier service, they can use that. Packaging and shipping would take place at the public health laboratory.

    Q: Can anyone carry the specimen?

    A: Any hospital staff can.

    Q: Can hospitals bypass the local health department for testing?

    A: No, hospitals still need to go through the local public health department.

    Q: What PPE should employee health be wearing?

    A: If personnel are asymptomatic, then PPE is not needed.

    Q: Is Hong Kong considered mainland China, which is part of the travel associate exposure guidance?

    A: No, Hong Kong, Macau, and Taiwan are not considered mainland China.

    Q: What about work clearance for those have traveled?

    A: People returning from parts of mainland China, besides Hubei Province, are being screened at the airport and given information on symptoms to watch for. Local public health is following up with these travelers.

    February 4 CDPH Call With Hospitals

      On February 4, the California Department of Public Health (CDPH) hosted its first call to update hospitals on the latest coronavirus developments, guidance, and answer questions. The next call is scheduled for February 11 from 7:45 – 8:45 a.m.

      CHA will send out the call-in information in advance of the call to CEOs, chief medical officers, chief nursing officers, chief operating officers, executive assistants, infection preventionists, human resources executives, quality & patient safety executives and staff, emergency preparedness coordinators, clinical education staff, in-house general counsel, and legal, risk, and compliance staff at CHA member hospitals and health systems.

      Update

      • California cases: So far, six cases have been confirmed — one in Orange County, one in Los Angeles County, two in Santa Clara County, and two in San Benito County. Person-to-person spread has been limited to close family members. The CDPH laboratory has received protocols and test kits, and CDPH is in the process of validating those materials in order to be able to test in California. To date, the only testing has been done by the Centers for Disease Control and Prevention (CDC).

      Recommendations for hospitals

      • Diagnostic testing can only currently be accepted at the CDC. Specimens should be collected as soon as possible after a patient is identified, and local health department contacted.
      • General laboratory guidelines include PPE — gown, laboratory coat, and eye protection. Standard laboratory practices should be observed when handling novel coronavirus specimens.
      • Providers concerned about a potential case of novel coronavirus should immediately contact the local public health department and report all patients who meet CDC Patient Under Investigation criteria to CDPH’s Licensing and Certification Program.

      Key questions

      • Q: What is the turnaround time for testing?
        • A: Two to seven days.
      • Q: Regarding employees who are cohabitants of returnees from China, are there any updates?
        • A: It’s important to work closely with your local health department, which are working closely with CDPH and CDC.
      • Q: What about people who came from China who are asymptomatic?
        • A: Public health messages will be disseminated directing patients to call ahead before showing up at a hospital so proper infection control protocols can be established. 

      Hospitals Encouraged to Complete Preparedness Survey

      On Jan. 27, CDPH issued All Facilities Letter (AFL) 20-10, requesting health care facilities to respond to a survey with information on their capacity to respond to a patient under investigation for novel coronavirus. CHA continues to encourage members to provide this information to CDPH if they have not already. 

      Commands