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Coronavirus Response Newsletter
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 September 15

CDPH Describes Hospital Surge Monitoring Visits, Other Survey Activity
The California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 20-69, which outlines the survey activities the department will conduct for both hospitals and skilled-nursing facilities. 

CDPH is monitoring the daily COVID-19 data reporting that hospitals complete. Based on the data, if CDPH determines a hospital is at risk of surging, the hospital will receive a check-in phone call about its surge plan, any urgent needs, and whether it needs assistance from CDPH. If a hospital is considered at high-risk, CDPH may conduct a surge monitoring visit to evaluate the hospital’s surge preparedness and infection control practices. CDPH has prepared the Hospital Surge Monitoring Checklist for hospitals to self-assess their surge preparedness and compliance with infection control requirements.

Regarding survey activity for hospitals, CDPH will also:

  • Prioritize complaints and facility-related incidents
  • Conduct federal revisit surveys for hospitals that were cited an immediate jeopardy violation
  • Conduct limited state licensing survey activities, including initial licensing, change of service, and change of location surveys

Finally, CDPH recommends hospitals use the Centers for Medicare & Medicaid Services (CMS) Infection Control Checklist in QSO-20-20-All to conduct a voluntary self-assessment of their infection control plans and protections.

CDPH Requires Weekly Testing of All Skilled-Nursing Facility Staff
CDPH has issued AFL 20-53.3, updating its guidance for testing health care personnel and residents at skilled-nursing facilities. The revised AFL clarifies and aligns with the CMS interim final rule on testing, and Centers for Disease Control and Prevention guidance and terminology. Among the important updates:

  • Skilled-nursing facilities without positive COVID-19 cases are required to test all health care personnel weekly.
  • Those with a positive COVID-19 case are required to implement response-driven testing, as described in the AFL.
  • Use of point-of-care antigen test instruments and associated requirements
  • Test reporting requirements

The AFL also clarifies policies for testing newly admitted/readmitted residents and residents previously diagnosed with COVID-19, and quarantine for newly admitted residents.

New Resources for COVID-19 Supplemental Paid Sick Leave Law, Effective Sept. 19
The labor commissioner has released a notice to be used to advise employees of their right to COVID-19 supplemental paid sick leave beginning Sept. 19. While the law requires employers to post a notice and directs the Labor Commissioner to make a sample notice available, it appears that the Labor Commissioner is taking the position that its notice must be used — which would not preclude an employer from also issuing its own notice to employees.

The Department of Industrial Relations has also updated its website to incorporate frequently asked questions about both the food sector supplemental paid sick leave that was adopted in April and the newly adopted COVID-19 supplemental paid sick leave (note that some errors exist in the new FAQs, and CHA has requested they be addressed).

Because the COVID-19 supplemental leave obligations are based, in part, on existing California’s paid sick leave law, the FAQs applicable to that law may also be helpful. For example, one common question is whether COVID-19 supplemental leave may be paid in the pay period after the leave was taken. The new law incorporates existing Labor Code 246(n), which allows an employer to pay for the time off “no later than the payday for the next regular payroll period after the sick leave was taken.” The FAQs note that the existing paid sick leave law “requires that an employer provide payment for sick leave taken by an employee no later than the payday for the next regular payroll period after the sick leave was taken. This does not prevent an employer from making the adjustment in the pay for the same payroll period in which the leave was taken, but it permits an employer to delay the adjustment until the next payroll. For example, if you did not clock in for a shift and therefore were not paid for it but utilized your paid sick leave, your employer would have to pay you not later than the following pay period and account for it in the wage stub or separate itemized wage statement for that following regular pay period.”

It should be noted that the COVID-19 supplemental paid sick leave is in addition to current paid sick leave obligations, and not all aspects of existing law apply to the new COVID-19 supplemental paid sick leave.

Guidance Addresses Rapid Antigen Tests
CDPH has released guidance on the use of rapid antigen tests for COVID-19 in symptomatic individuals. The guidance includes information on performing, processing, interpreting, and appropriate use of the tests. Tests currently given emergency use authorization by the Food and Drug Administration (FDA) include:

  • Quidel Sofia SARS Antigen FIA Assay
  • BD Veritor System for Rapid Detection of SARS-COV-2
  • LumiraDX SARS-COV2 Antigen Test
  • Abbott BinaxNOW COVID-19 Ag CARD

Antigen tests offer many advantages — fast turnaround, easy point-of-care use, identification of current viral infection, and lower cost. However, the tests’ drawbacks include lower sensitivity (more false negatives) and intended use limited to individuals suspected of COVID-19 within five to 12 days of symptom onset (number of days varies by manufacturer).

Recommendations for Non-Emergency Transportation of SNF Residents

CDPH has issued AFL 20-70, which recommends that skilled-nursing facilities coordinate with their non-emergency medical transportation and non-medical transportation providers, in accordance with the Department of Health Care Services guidance.


Next CDPH Call for Health Care Facilities: Sept. 22, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227

Summary of Sept. 15 CDPH Call
CDPH has provided a summary of its most recent weekly call with health care facilities.

Upcoming CMS Calls

CMS will host its Lessons from the Front Lines call on Friday — a joint effort between CMS Administrator Seema Verma, FDA Commissioner Stephen Hahn, MD, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experiences, ideas, strategies, and insights with one another related to their COVID-19 response. CMS will also host five other calls next week. Details are as follows:

  • Lessons from the Front Lines: Sept. 18 at 9:30 a.m. (PT)
    Dial: (833) 614-0820
    Passcode: 4446447
    Audio Webcast
  • Hospitals: Sept. 22 at 2 p.m. (PT)
    Dial: (833) 614-0820
    Passcode: 2409459
    Audio webcast
  • Home Health & Hospice: Sept. 22 at noon (PT)
    Dial: (833) 614-0820
    Passcode: 1169237
    Audio webcast
     
  • Nursing Homes: Sept. 23 at 1:30 p.m. (PT)
    Dial: (833) 614-0820
    Passcode: 5839938
    Audio webcast
     
  • Dialysis Organizations: Sept. 23 at 2:30 p.m. (PT)
    Dial: (833) 614-0820
    Passcode: 7026727
    Audio webcast
     
  • Nurses: Sept. 24 at noon (PT)
    Dial: (833) 614-0820
    Passcode: 5872398
    Audio webcast

News for September 1

County Re-openings Begin This Week
County re-openings began this week, with new criteria for both loosening and tightening restrictions, based on what has been learned about how COVID-19 spreads. Effective Aug. 31, the state is using a four-tiered designation — widespread, substantial, moderate, and minimal — to determine the level of reopening indoor businesses within each county. This replaces the previous county watch list.

Individual county status is available here. Currently, 87% of the state is at the most restrictive level (widespread). In those counties, hair salons and barbershops can reopen, as well as retail and shopping centers at 25% of capacity. Schools in the widespread tier may apply for waivers. To move to less restrictive tiers, counties must be on the same tier for at least three weeks and demonstrate two weeks straight of “stability” to move forward. As the reopening progresses, it is expected that cases will again rise, with hospitalizations increasing beginning in late September.

CDPH Clarifies Costs, MOUs for Urgent Staffing Resources
The California Department of Public Health (CDPH) has released revised All-Facilities Letter (AFL) 20-46.2 regarding health care facility requests for urgent staffing resources. Hospitals and skilled-nursing facilities experiencing staffing shortages are directed to report the shortage as an unusual occurrence to CDPH. Additionally, they may seek staffing from their Medical Health Operational Area Coordinator, which can fulfill it or request it from the state. The state has been deploying Health Corps, California Medical Assistance Teams (CalMATs), and contracted staffing to health care facilities, upon request.

Previously, the AFL stated that facilities were required to reimburse the state for all costs associated with staff deployed to the facility. The revised AFL clarifies that is still the case for Health Corps staff and state contracted staff. However, it is only the case for CalMATs after 72 hours. The AFL now includes links to the hourly rates for Health Corps and CalMAT and contracted staff.

In addition, the AFL specifies that facilities need to enter into a memorandum of understanding (MOU) with the state and has provided copies of the MOUs for Health Corps, CalMAT, and contracted staff. It also clarifies that deployments will be made for limited durations; previously it stipulated that deployments would be made in 72-hour increments.

Legislature Passes Supplemental Leave Bill
On Aug. 28, a bill — which subsequently passed — was introduced in the Legislature  to require employers not covered by other supplemental leave laws to provide such leave. Senate Bill 822, a budget trailer bill, was the result of negotiations between the Administration and CalChamber so, as a result, CalChamber did not take a position. The Governor had previously stated he wanted to “fill the gap” in supplemental paid sick leave for employees not covered by the Families First Coronavirus Response Act (FFCRA).

There are many details in the bill, which takes effect 10 days after the Governor signs it. Therefore, hospitals should immediately evaluate it and prepare for prompt implementation. Some important details include:

  • It requires employers with more than 500 employees and health care employers that opted out of the FFCRA to provide two weeks of supplemental paid sick leave to employees if they are quarantined/isolation by a public health order or their health care provider, or directed not to report to work by their employer because of concerns about potential COVID-19 transmission.
  • It provides a method to calculate the amount of leave available for part-time and per diem employees.
  • Employers that have already provided two weeks of supplemental COVID-19-specific leave, as far back as March 4, are not required to provide an additional amount of leave.
  • Like FFCRA and California paid sick leave, the supplemental paid sick leave under state law must be paid at the “regular rate” up to a maximum of $5,110 for the two-week period. The bill, however, allows an employer that already provided leave at the base rate to simply make up the difference in the rate, rather than requiring the employer to provide two additional weeks.
  • It sunsets either on Dec. 31 or later if the FFCRA supplemental leave provisions are extended.

News for August 28

Governor Announces New Partnership to Improve Testing Efficiency and Capacity
Gov. Newsom has announced a new partnership with PerkinElmer to create a lab that will double the state’s capacity of daily testing, increasing it to over 250,000 tests per day. The partnership is also expected to decrease the average turn-around time to 24-48 hours (it now stands at about five to seven days), as well as drive down costs, which now average around $150-$200 per test. Other details include:

  • The lab will be in Valencia.
     
  • All hospitals will be eligible to use the lab.
     
  • The lab will allow for COVID-19 and flu testing simultaneously.
     
  • The lab is scheduled to open Nov. 1.
     
  • Details are being worked out through the state testing task force, of which CHA is member.


In addition, as previously reported, the original agreement for PerkinElmer platform rental is still available through the state. However, hospitals must perform nucleic acid purification and have high production systems, such as ABI 7500 Fast DX, to produce 6,000 to 8,000 tests per month. Interested hospitals should contact Robert Nakamura at Robert.Nakamura@cdph.ca.gov for more information.

State Issues Guidance for Licensed and License-Exempt Child Care Providers

The California Department of Social Services has issued guidance on waivers for licensed and license-exempt child care providers who would like to “provide child care beyond the current conditions that qualify for child care facility licensure or exemption, and for licensed providers, waivers of licensing standards.” The waivers provide short-term solutions for license-exempt providers, licensed facilities, and temporary employer-sponsored child care during the COVID-19 emergency. This would allow providers such as the YMCA to support distance learning during school hours.

Specific guidance is also available for small cohorts/groups of children and youth, and for case and contact management within child care facilities.

The guidance applies to groups of children and youth in controlled, supervised, and indoor environments operated by local educational agencies, non-profits, or other authorized providers, including, but not limited to, public and private schools; licensed and license-exempt child care settings; organized and supervised care environments, i.e., “distance learning hubs”; recreation programs; before and after school programs; youth groups, and day camps.

DHCS Announces New COVID-19 Uninsured Group Program and Web Portal

The Department of Health Care Services (DHCS) has launched a COVID-19 Uninsured Group portal to process applications for the COVID-19 Uninsured Group program. The COVID-19 Uninsured Group program replaces the Presumptive Eligibility (PE) for COVID-19 Program and provides temporary, no-cost diagnostic testing and testing-related services. It also provides treatment services — including all medically necessary care, which includes associated office, clinic, and emergency room visits related to COVID-19. The program is available to uninsured individuals determined eligible by a qualified provider, based on preliminary applicant information.

With the new program and portal, qualified providers should note two changes:
 

  • Need information on citizenship/immigration status: An individual’s status will be requested and verified when they apply for the new COVID-19 Uninsured Group. However, an individual’s status will have no bearing on their ability to receive care or on a provider to receive reimbursement for COVID-19 testing and treatment services.
     
  • Periods of PE: Previously, an individual’s eligibility period ended on the last day of the following month in which they applied, which could be up to 60 days, and DHCS allowed two periods of PE, instead of one, in a 12-month period. With this new program, an individual’s eligibility period ends on the last day of the 12th month from the date of their PE application or the end of the public health emergency, whichever occurs sooner.


CMS Updates FAQs on Provider Relief Fund Payments, Cost Reports

The Centers for Medicare & Medicaid Services has revised its COVID-19 frequently asked questions (FAQs) on Medicare fee-for-service billing to address questions related to the Coronavirus Aid, Relief, and Economic Security Act Provider Relief Fund and the Small Business Administration’s (SBA) Paycheck Protection Program payments.

The FAQs provide guidance on reporting Provider Relief Fund payments, uninsured charges reimbursed through the COVID-19 Uninsured Program administered by Health Resources and Services Administration, and SBA loan forgiveness amounts. They also address that Provider Relief Fund payments should not offset expenses on the Medicare cost report. The questions appear under the “Cost Reporting” section of the FAQs, beginning on page 98 of the Aug. 26 updated version.

New Waiver of Pharmacy Testing Restrictions

The Department of Consumer Affairs (DCA) has waived restrictions on pharmacies, pharmacists, and pharmacy technicians relating to ordering, collecting specimens for, and performing COVID-19 tests. Corresponding guidance describes the authority and permissible practices. The waiver supersedes DCA waiver 2014. A complete list of current waivers is available on the DCA website.

Board of Pharmacy Extends PPE Waiver
The Board of Pharmacy has extended a previously approved limited waiver on the use of personal protective equipment in certain compounding aseptic isolators or compounding aseptic containment isolators. The extension is effective through Sept. 29.

CDPH Issues Guidance on COVID-19 Transmission in SNFs
The California Department of Public Health (CDPH) has revised All Facilities Letter (AFL) 20-22.4, which provides guidance on limiting transmission of COVID-19 in skilled-nursing facilities. The AFL updates visitation guidance to require facilities to permit ombudsmen to enter regardless of whether there is a COVID-19 outbreak.

Next CDPH Call for Health Care Facilities: Sept. 1, 8-9 a.m. (PT)

Dial: (844) 721-7239

Passcode: 7993227

Summary of Aug. 25 CDPH Call

CDPH has provided a summary of its most recent weekly call with health care facilities.

News for August 25

COVID-19 Data Reporting to Become a Medicare Condition of Participation

The Centers for Medicare & Medicaid Services (CMS) has issued an interim final rule revising regulatory requirements related to the COVID-19 public health emergency. Among the provisions finalized, CMS establishes new requirements in the hospital and critical access hospital Conditions of Participation that require hospitals to report certain COVID-19-related data elements to the Department of Health and Human Services (HHS) on a daily basis. Currently, hospitals have the option of voluntarily reporting this data either directly to HHS through its TeleTracking portal or through CHA’s COVID-19 Tracking Tool, which the California Department of Public Health then submits to HHS on hospitals’ behalf.

Under the final rule, hospitals that fail to consistently report data throughout the duration of the public health emergency could be subject to termination from the Medicare and Medicaid programs.

The final rule also includes new requirements for long-term care facilities by revising infection-control regulations to require nursing homes to routinely test staff for COVID-19. CMS recommendations for the frequency of staff testing will be based on the degree of community spread, to be announced shortly through guidance, that indicate the facility may be at increased risk for COVID-19 transmission. Facilities that do not comply with the new requirements will be cited for non-compliance and may face enforcement sanctions based on the severity of the noncompliance, such as civil money penalties in excess of $400 per day, or over $8,000 for an instance of noncompliance. CMS also announced that additional Provider Relief Funds will be allocated to nursing homes to offset the cost of increased testing.

CMS Launches On-Demand Training Program for SNFs
CMS has developed a new COVID-19 training program for front-line nursing home staff and management. Based on input from CMS nursing home inspections and the Centers for Disease Control and Prevention, the scenario-based training includes five modules for skilled-nursing facility (SNF) staff and 10 for SNF management. More information about the program is available here.

KIND Foundation Offers Non-PPE Donations to Health Care Workers
The foundation for the company that makes KIND bars has created the Frontline Impact Project (FIP) to support health care workers with non-personal protective equipment (PPE) donations. Hospitals are encouraged to request items in whatever quantity they need — orders as small as 25 items and as large as 30,000 items have been fulfilled. Typically, hospitals make requests in one or more categories, including food, beverages, gum/mints, housing, skin care, hygiene, sanitizer, virtual fitness, and mental health. In addition to public and private hospitals, institutions eligible for donations include assisted living facilities, nursing homes, community health care centers, outpatient clinics, and emergency medical services squads.
 

How it works:

  • Requests are submitted through FIP’s website, with submitters providing a reference for vetting to ensure the institution’s legitimacy. Departments or units within a larger institution are encouraged to work with their internal procurement team before submitting so that FIP can efficiently fulfill requests and help as many people as possible.
     
  • The system matches requesting institutions with relevant donors, and the donors subsequently deliver the products or services directly.
     
  • To ensure ample supply, FIP continually recruits corporate partners to donate non-PPE items.


Questions can be directed to frontline@thekindfoundation.org.

News for August 21

State Remdesivir Allotment Increases
The California Department of Public Health (CDPH) reports a significant increase in the state allotment of remdesivir, from initial allocations of 12,000-14,000 vials per week to 40,000 last week. This week, 60,000 vials are available for distribution. Due to the increase, CHA encourages all hospitals to purchase their full allocation. If your hospital wishes to purchase additional dosages above its designated allotment, let your MHOAC know immediately, so any unused vials are kept in the state.

As a reminder, CDPH uses the CHA COVID-19 Tracking Tool information to make the initial county allotments on Thursdays, then county and hospital redistribution occurs on Fridays for hospitals that chose not to purchase their designated allotments.

More detailed guidance on California Commercial Remdesivir Allocation can be found here.

CMS Revises Guidance on Add-on Payment for COVID-19 Patients
The Centers for Medicare & Medicaid Services (CMS) has revised its guidance on the add-on payment for COVID-19 patients. The guidance states that effective with admissions occurring on or after Sept. 1, claims eligible for the 20% increase in the Medicare Severity-Diagnosis Related Group weighting factor for cases with a COVID-19 diagnosis will also be required to have a positive COVID-19 laboratory test documented in the patient’s medical record.

Positive tests must be demonstrated using only the results of viral testing (i.e., molecular or antigen), consistent with Centers for Disease Control and Prevention guidelines. The test may be performed either during the hospital admission or up to 14 days prior to the hospital admission. CMS notes that a test performed by an entity other than the hospital can be manually entered into the patient’s medical record to satisfy this documentation requirement. Hospitals should carefully review the guidance and educate staff on documentation policies to ensure outside test results are properly documented in the medical record.  

The claims processing system will continue to apply the increase if ICD-10-CM diagnosis code U07.1 (COVID-19) is on the claim. If the diagnosis has been coded consistent with ICD-10-CM coding guidelines, but the hospital cannot document a positive COVID-19 test, the hospital may inform its Medicare Administrative Contractor (MAC) prior to claims submission and the MAC will note the claim with an internal processing code. This will result in the 20% increase not being applied. If the increase is applied and the hospital cannot document a positive COVID-19 test upon post-payment medical review, the additional payment will be recouped.

HHS Emergency Directive Expands Access to Childhood Vaccines
Under an emergency directive issued Aug. 19 by the U.S. Department of Health and Human Services, state-licensed pharmacists and supervised interns in all 50 states will be allowed to order and administer childhood vaccinations for children ages 3 to 18. The vaccinations must adhere to the CDC’s recommended immunization schedule. The emergency directive is a third amendment to the Declaration under the Public Readiness and Emergency Preparedness Act to increase access to lifesaving childhood vaccines and decrease the risk of vaccine-preventable disease outbreaks as children across the United States return to daycare, preschool, and school.

Resurgence of Candida auris in Health Care Facilities Related to COVID-19
CDPH has released a Health Advisory alerting providers of the increasing number of Candida auris (C. auris) cases reported in Southern California in recent months. CDPH notes that personal protective equipment conservation strategies and cohorting COVID-19 patients might be contributing to this resurgence of C. auris. As a result, CDPH recommends health care facilities:

  1. Assess C. auris and other multidrug-resistant organism (MDRO) status for all patients and residents upon admission, by reviewing medical records and screening high-risk individuals
     
  2. When cohorting patients by COVID-19 status, consider C. auris and other MDRO status during room placement
     
  3. Do not reuse or extend use of gloves or gowns between patients with different or unknown C. auris or other MDRO, and COVID-19 status
     

CDPH also advises health care facilities to report any cases of C. auris or unusual or highly-resistant organisms to their local health department and CDPH at HAIprogram@cdph.ca.gov.

AFL Provides Guidance to SNFs on Emergency Resident Transfers
CDPH has issued All Facilities Letter (AFL) 20-67, which provides guidance to skilled-nursing facilities on the evacuation and transfer of residents in emergency situations during the COVID-19 pandemic. In additional to reviewing existing regulations regarding disaster preparedness, the AFL provides recommendations on preparing for and carrying out emergency transfers of residents during the public health emergency.

Rural Crosswalk Details CMS Flexibilities to Fight COVID-19
CMS Office of Minority Health has released Rural Crosswalk: CMS Flexibilities to Fight COVID-19. This resource documents all current COVID-19-related waivers and flexibilities issued by CMS that impact Rural Health Clinics, Federally Qualified Health Centers, Critical Access Hospitals, rural hospitals generally, and long-term care facilities. It also describes the significance of each provision for these facilities.
The Rural Crosswalk is divided into six sections:

  • Telehealth
     
  • CMS Hospitals Without Walls
     
  • Patients Over Paperwork
     
  • Workforce
     
  • Payment
     
  • Additional guidance

Next CDPH Call for Health Care Facilities: Aug. 25, 8-9 a.m. (PT)
Dial: (844) 721-7239

Passcode: 7993227

News for August 18

Letter to CDPH Makes Recommendations on Post-Hospital Access to SNFs

CHA has sent a letter to the California Department of Public Health (CDPH) regarding post-hospital access to skilled-nursing facilities (SNFs). In the letter, CHA makes several recommendations, including:

  • Developing and issuing statewide guidance on SNF admission practices and policy, in the form of an All-Facilities Letter
     
  • Requiring SNFs to submit admissions and capacity data as part of their daily reporting
     
  • Developing a SNF Access Task Force by convening representatives from hospitals, SNFs, local health departments, and others to review and develop sound practices and policies for safe hospital-to-SNF care transitions

HHS Delays Release of Provider Relief Fund Reporting Requirement Details
The U.S. Department of Health and Human Services (HHS) has announced that additional details on data reporting requirements for Provider Relief Fund payments over $10,000 are being refined and will not be released by Aug. 17, as previously announced. Providers will be given the detailed Provider Relief Fund reporting instructions and a data collection template with the elements required in advance of the reporting system being made available – targeted for Oct. 1. Providers should continue to check the HHS Provider Relief Fund website for the latest updates.

Summary of Aug. 18 CDPH Call
CDPH has provided a summary of today’s weekly call with health care facilities.

Upcoming CMS Calls

The Centers for Medicare & Medicaid Services will host several calls this week and next:
 

Lessons from the Front Lines: Aug. 21 at 9:30 a.m. (PT)
Dial: (833) 614-0820
Passcode: 5956858
Audio webcast

Hospitals and Health Systems: Aug. 25 at noon (PT)
Dial: (833) 614-0820
Passcode: 6782346
Audio webcast

Home Health and Hospice Providers: Aug. 25 at noon (PT)
Dial: (833) 614-0820
Passcode: 6782346
Audio webcast

Nursing Homes: Aug. 26 at 1:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 5718509
Audio webcast

Dialysis Organizations: Aug. 26 at 2:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 1834329
Audio webcast

Nurses: Aug. 27 at noon (PT)
Dial: (833) 614-0820
Passcode: 1556623
Audio webcast

News for August 14

CDPH Making Calls, Conducting Visits to Support Hospitals

The California Department of Public Health (CDPH) is calling and conducting visits to hospitals that it has identified through a new internal hospital dashboard. Triggers for a call or visit are if a hospital: 1) has a patient surge and is at 85% capacity for med/surg and ICU beds, 2) has made a request for urgent staffing resources or personal protective equipment (PPE) to its Medical Health Operational Area Coordinator, or 3) is located in a county with significant COVID-19 spread. CDPH continues to review these metrics and is considering iterating on them to better focus on hospitals experiencing surges and most likely to experience them.

CDPH’s goal with these calls and visits is to provide support to hospitals that are currently experiencing, or may soon experience, patient surges or staffing or PPE resource needs. In addition, if CDPH has not yet conducted an infection control survey of the hospital on behalf of the Centers for Medicare & Medicaid Services (CMS), it will do so.

The Governor’s Executive Order of March 15 directs CDPH and Cal/OSHA staff to focus on providing technical assistance and support to health care facilities. It also limits agencies’ enforcement activity to allegations of the most serious violations impacting health and safety. CDPH is still operating under this Executive Order.

CDPH is also following current CMS guidance, issued June 1, which authorizes state survey agencies like CDPH to conduct these surveys: immediate jeopardy, focused infection control, and initial certification. That guidance also authorizes CDPH to conduct complaint investigations that are triaged as non-immediate jeopardy-high and revisit surveys of any facility with removed immediate jeopardy (but still out of compliance).

CHA has requested that CDPH release an All-Facilities Letter to communicate with hospitals about its survey activity, including its new internal hospital dashboard and calls and visits. This is currently under consideration by CDPH.


HHS Announces $1.4 Billion in Aid for Qualifying Children’s Hospitals

The U.S. Department of Health and Human Services has announced an additional $1.4 billion in funding for almost 80 free-standing children’s hospitals nationwide. The funding is part of the Coronavirus Aid, Recovery and Economic Security Act and the Paycheck Protection Program and Health Care Enhancement Act, which allocated $175 billion for to hospitals and other health care providers. The payment allocations by state are available here. Distribution of the funds will begin next week.

Qualifying free-standing children’s hospitals must either be an exempt hospital under the CMS inpatient prospective payment system or be defined as a Children’s Hospital Graduate Medical Education facility by the Health Resources and Services Administration. Eligible hospitals will receive 2.5% of their net revenue from patient care.

Department of Consumer Affairs Extends Waivers

The Department of Consumer Affairs has extended, until Oct. 11, waivers that:

  • Eliminate the cap on the number of physician assistants, nurse practitioners, and certified nurse midwives that a physician may supervise
     
  • Modify the requirement for a physician assistant to have a practice agreement with a specific physician under certain circumstances. Physician supervision is still required, but that supervision can be provided by any physician; no written practice agreement is required.
     

Details of these waivers and a list of all current waivers are available on the DCA website.

Next CDPH Call for Health Care Facilities: Aug. 18, 8-9 a.m. (PT)

Dial: (844) 721-7239

Passcode: 7993227

Summary of Aug. 11 CDPH Call

CDPH has provided a summary of its most recent weekly call with health care facilities.

News for August 11

CDPH Director Steps Down, Acting Director and Acting Health Officer Announced

On Aug. 9, the California Health and Human Services Agency confirmed that California Department of Public Health (CDPH) Director and State Public Health Officer Sonia Angell resigned her post. Sandra Shewry, who was vice president at the California Health Care Foundation and previously director of the Department of Health Care Services will serve as acting CDPH director. Dr. Erica Pan will serve as acting public health officer. On June 29, she was appointed deputy director, Center for Infectious Diseases, and state epidemiologist at CDPH, and was previously the Alameda County interim public health officer.

HHS Announces Opportunity to Apply for Provider Relief Fund General Distributions by Aug. 28
The federal Department of Health and Human Services (HHS) has announced an additional opportunity for hospitals to apply for Provider Relief Funds. Specifically, providers who missed the June 3 deadline to apply for funding equal to 2% of their total patient care revenue (from the $20 billion portion of the $50 billion Phase 1 general distribution) and certain providers who experienced a change in ownership — making them previously ineligible for Phase 1 funding — will be eligible to apply for financial relief. Eligible providers must submit information to HHS’ Provider Relief Fund portal by Aug. 28 to be considered for additional funding of up to 2% of their reported total revenue from patient care. Previous Phase 1 general distribution payments will be taken into account when determining the amount of the Phase 2 general distribution payment.

State Testing Task Force Seeks Eligible Hospital Labs for PerkinElmer Testing Opportunities
The state of California and PerkinElmer have entered into a contract to provide equipment (liquid handlers, extraction robots, PCR machines) and reagents for COVID-19 testing at hospitals, with the goal of expanding testing capacity for underserved populations. The equipment and supplies will be provided at no charge to hospitals that meet these eligibility requirements:

  • The hospital must conduct at least 8,600 tests per month.
     
  • The hospital would be required to perform nucleic acid purification followed by setting up and running PCR on a machine such as an ABI 7500 Fast DX.
     
  • The hospital would be financially responsible for performing the tests, including setting them up and running them.
     
  • The hospital must be a public or nonprofit facility.


Interested hospitals should contact Robert Nakamura at Robert.Nakamura@cdph.ca.gov.

Federal Updates Require Additional Data Submission Changes
Due to updates from HHS, another round of changes will be made to the CHA COVID-19 Tracking Tool on Aug. 13. The point of contact at each hospital or health system will receive an email tomorrow, Aug. 12, with details on the fields that have been modified.

CDPH Revises Visitor Limitations Guidance on Clinical Experience, Doulas
On Aug. 7, CDPH released revisions to the visitor limitations guidance for hospitals and skilled-nursing facilities in All-Facilities Letter (AFL) 20-38.4, with two main changes:

  • In addition to new nurses, the guidance now also encourages facilities to permit other professionals to enter for purposes of obtaining their clinical experience.
     
  • Recommends that a doula, in addition to one support person for labor and delivery patients, be permitted if prior arrangements have been made with the hospital and the doula complies with hospital personal protective equipment and infection control guidelines.


This AFL is advisory and not binding for facilities. However, visitors may point to it as CDPH’s recommendations for facilities.

 

News for August 7

CHA Letter to HHS Secretary Addresses Problems With State Testing Policies, Practice
This week, CHA sent a letter to Health and Human Services Secretary Dr. Mark Ghaly addressing the patchwork of testing policies across jurisdictions in California. The lack of uniform policies has created confusion for providers, avoidable utilization of scarce testing supplies, and uneven reimbursement practices. CHA’s letter asks the state to take five steps to ameliorate these problems:

  • Convene a second testing task force whose sole focus is setting testing goals, policies, and priorities.
     
  • Quickly refine the state’s testing prioritization guidance in light of critical testing supply shortages.
     
  • Drive alignment between state guidance and county public health orders regarding testing.
     
  • Align state regulations about payer financial responsibility with state testing prioritization.
     
  • Leverage the state’s purchasing power to expand the availability of testing supplies.

Cal/OSHA Updates Respirator Guidance, Again
On Aug. 6, Cal/OSHA released updated guidance on COVID-19 for Health Care Facilities: Severe Respirator Supply Shortages, which modifies the earlier June 12 guidance in three significant ways:

  • It does not include the extended re-use strategy whereby an employee is provided five or seven N95s that are rotated in use under specified conditions.
     
  • While it allows hospitals to continue to disinfect N95s, it requires hospitals to store them for “future shortages.”
     
  • It does not include the option for hospitals to provide facemasks for routine care of COVID-19 patients or persons under investigation.

These changes are premised on Cal/OSHA’s perspective that, “While supply chains for obtaining respirators are not fully restored, the supply of respirators for hospitals and other employers involved in patient care has improved to a point that prioritization of respirators for high hazard procedures and some other optimization strategies are not currently necessary.” The state stockpile is considered part of that supply, although there have been mixed results in fit testing the N95s provided by the state (see next article).

In addition, the guidance provides minor relief with respect to fit testing. Cal/OSHA did not follow Fed/OSHA in allowing for postponing of fit testing but will allow hospitals to postpone fit testing for 90 days. Cal/OSHA has adopted some other modifications to fit-testing protocols but did not adopt all the modifications authorized by Fed/OSHA.

CHA submitted various concerns about the June 12 guidance. Unfortunately, those concerns were not addressed in the updated guidance. CHA will continue to advocate for a reasonable approach to balancing the obligations of the Aerosol Transmissible Disease Standard with the reality of the continued shortage of N95 respirators. Please contact Gail Blanchard-Saiger with any operational issues you are facing or expect to face in light of this new guidance.

Hospitals See Mixed Results With State-Issued Respirators
Numerous hospitals have recently received BYD N95 respirators from the state stockpile and, as a result, some questions have arisen. First, there is a question about whether there are limitations on their use. Because these respirators are NIOSH-approved but not yet approved by the Food and Drug Administration, they can be used for respiratory protection but not used in exposure settings where the performance of a surgical mask to maintain a sterile field is required (see the Centers for Disease Control and Prevention’s FAQ “Can we use an N95 that has not been cleared by the FDA in a patient setting?”).

There have also been varying reports about fit-testing with the BYD N95s. While some hospitals have seen relatively high success, others have had a very low success rate, leading them to stop using the respirators. If your hospital is experiencing an unacceptable fit-testing success rate, please contact Gail Blanchard-Saiger so that CHA can monitor the situation and assist where possible.

CDPH Launches New Online Process for SNF COVID-19 Mitigation Surveys
The California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 20-63.1, which announces the launch of a new online process for surveys and investigations in skilled-nursing facilities (SNFs). A phased implementation of the Risk and Safety Solutions (RSS) Inspect began today and will be used to conduct COVID-19 mitigation surveys. SNFs will access their Statements of Deficiencies and submit their plans of correction via the RSS Inspect website.

SNFs are advised to enroll in the RSS system by Aug. 31 and may authorize three facility-based users. The AFL includes additional information on user enrollments and go-live dates for the new systems for each part of the state.

Summary of CDPH Calls
CDPH has provided summaries of its July 28 and Aug. 4 weekly calls with health care facilities.

Next CDPH Call for Health Care Facilities: Aug. 11, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227

Upcoming CMS Calls
The Centers for Medicare & Medicaid Services will host several calls next week, one for hospitals and health systems and others for home health/hospice providers, dialysis organizations, nursing homes, and nurses. Call details are as follows:

Hospitals and Health Systems: Aug. 11 at 2 p.m. (PT)
Dial: (833) 614-0820
Passcode: 3498643
Audio webcast

Home Health and Hospice Providers: Aug. 11 at noon (PT)
Dial: (833) 614-0820
Passcode: 5097566
Audio webcast

Nursing Homes: Aug. 12 at 4:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 7857618
Audio webcast

Dialysis Organizations: Aug. 12 at 2:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 1027088
Audio webcast

Nurses: Aug. 13 at noon (PT)
Dial: (833) 614-0820
Passcode: 7844289
Audio webcast 

News for August 4

State Unified Support Teams, Leadership Arrive in the Central Valley

The state has begun deploying unified support teams into eight Central Valley counties: Stanislaus, San Joaquin, Merced, Madera, Fresno, Kings, Tulare, and Kern. The state teams include leadership from the Governor’s Office of Emergency Services, the California Department of Public Health (CDPH), the Department of Food and Agriculture, the Business, Consumer Services and Housing Agency, Cal/OSHA, and the Department of Social Services.
In his Aug. 3 press conference, Gov. Newsom described the teams as being modeled after the state’s strike team approach in Imperial County. A July 27 press release that focused on $52 million in funding for the Central Valley said the teams’ work “could include an evaluation and improvement in testing, contact tracing, disease investigation, data management, public education and surge planning for local health care systems. The teams will review data and look at outbreaks in factories and congregate settings such as long-term care facilities, high-density housing developments and agricultural workplaces where individuals may be exposed to COVID-19.”

CHA is aware that top leadership (e.g., chief deputy directors, deputy directors) from various state departments are in the Central Valley counties this week to view the situation on the ground and assess issues around surge, patient flow, and alternate care sites. They plan to visit a number of health care facilities, including hospitals.

Update on Federal COVID-19 Data Reporting

The U.S. Department of Health and Human Services (HHS) has updated its COVID-19 reporting guidance once again with several changes to be implemented beginning Aug. 5. On Aug. 3, CHA was notified by TeleTracking that HHS will make changes only to the definitions of certain fields on Aug. 5, and no fields will be added or removed. To address those changes, CHA is working with CDPH to update the data dictionary for the CHA COVID-19 Tracking Tool and will publish the updated version here before the morning of Aug. 5.

Federal Judge Invalidates Paid Leave Exemption for Health Care Workers

On Aug. 3, a federal judge invalidated the U.S. Department of Labor regulations that created a broad exemption for health care providers who would otherwise be covered by the Families First Coronavirus Response Act’s paid leave provisions. The act, which went into effect on April 1, created two new paid leave laws that apply to California employers with fewer than 500 employees and all public employers. The law contains an optional exemption for health care providers. On April 1, the Department of Labor issued emergency regulations, adopting a broad definition of health care provider to include anyone working in a hospital, doctor’s office, long-term care facility, and other health care-related workplaces. However, a federal judge has now concluded that the department exceeded its authority in applying such a broad definition, and has invalidated that portion of the regulations. The judge did not provide a replacement definition for “health care provider,” so it is not clear how employer responsibilities related to the health care exemption are impacted. It is likely that the department will appeal the decision.

Provider Relief Fund Payments May Be Available for Providers Who Had a Change in Ownership

The Department of Health and Human Services (HHS) has announced that, beginning the week of Aug. 10, providers that experienced change-in-ownership challenges may submit their revenue information, along with documentation proving a change in ownership, to be considered for a Provider Relief Fund payment. The deadline for submitting information and documentation is Aug. 28. HHS relied on 2019 Centers for Medicare & Medicaid Services (CMS) payment data to determine automatic payments for $30 billion of the $50 billion Phase 1 Medicare general distribution.

Accordingly, some providers or provider practices that experienced a change in ownership in 2020 missed out on payments, as the payments were distributed to the previous owners. Prior owners are required to return the payments to HHS if they cannot attest to providing diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 on or after Jan. 31. CHA will provide members with additional information on the application process when available.

CDPH Updates Testing Recommendations for SNFs, Launches New Web Page

CDPH has issued All Facilities Letter (AFL) 20-53.2, which provides updated recommendations for testing of skilled-nursing facility (SNF) residents and health care personnel. The AFL updates testing and isolation guidelines, as well as health care personnel return-to-work criteria, to reflect recent changes in Centers for Disease Control and Prevention (CDC) guidance. Of note, this includes clarifications on SNF admissions from hospitals, specifically:

  • Results for asymptomatic patients tested in the hospital do not have to be available prior to SNF transfer.
     
  • SNFs may not require a negative test result prior to accepting a new admission.
     
  • If tested at the hospital, two negative tests are not required prior to transfer.
     
  • SNF may consider acute care hospital days as part of the quarantine observation period from the date of last potential exposure for new admissions as long as the following criteria are met:
     
    • SNF is in regular communication with their local health department (LHD) and/or the hospital infection preventionist and occupational health program, and there is no suspected or confirmed COVID-19 transmission among patients or staff at the hospital
    • SNF has verified (via the LHD or hospital) that the hospital is testing all patients upon admission and has designated COVID-19 unit(s) with dedicated staff and minimal cross-over
       
  • Testing and quarantine are not required for residents readmitted after hospitalization, or who leave the SNF for ambulatory care (e.g., emergency department or clinic) visits unless there is suspected or confirmed COVID-19 transmission at the outside facility, or for hospitalized residents that tested positive for COVID-19 and met criteria for discontinuation of isolation and precautions prior to SNF admission or readmission.

CDPH has also established a new COVID-19 SNF web page. The site includes information on CDPH’s six-point plan to support SNFs, links to guidance and recommendations, and a data dashboard, which provides point-in-time data on SNF-reported confirmed COVID-19 cases for both residents and health care workers. 

Waivers Related to Student Nurses Extended
The Board of Registered Nursing/Department of Consumer Affairs has extended – until Dec. 31 – waivers giving student nurses significant flexibility to complete their required clinical hours. These waivers:


CHA has compiled a list of state waivers related to hospital licensing here.

CMS Releases ICD-10 Codes for New COVID-19 Therapies

The Centers for Medicare & Medicaid Services (CMS) has added 12 new ICD-10 procedure codes to identify new therapies for COVID-19, including remdesivir and convalescent plasma, as well as any future therapeutic that does not have a unique name. CMS also released a new ICD-10 Medicare Severity-Diagnosis Related Group (MS-DRG) Grouper software package (Version 37.2) to accommodate the new codes, effective for discharges on or after Aug. 1. The new codes will not affect the MS-DRG assignment.

Upcoming CMS Webinar
CMS will host a webinar Aug. 6 at 1 p.m. (PT) on approaches for remaining current with COVID-19 federal guidance and reporting requirements, as well as the importance of conducting regular outcome and process surveillance. Advance registration is required.
 

News for July 31

CHA Letter Details Concerns With Cal/OSHA Guidance on Respirator Shortages

CHA has submitted a letter to Cal/OSHA with feedback on its June 12 guidance that focuses on severe respirator shortages and certain changes under consideration. The letter expresses hospitals’ concerns with the guidance, which would destabilize rather than enhance employee safety. CHA is urging Cal/OSHA to adopt an approach that allows hospital teams, including infection preventionists, front-line staff, and materials management experts to work together to protect their colleagues and the patients entrusted to them. Our concerns fall into four categories:

  • Clarity of definitions of terms and processes
     
  • Clarity of guidance for alternative options
     
  • Need to address operational/patient safety challenges
     
  • Supply shortages 

More details, including CHA’s recommendations, are available in the letter.

DMHC Issues All-Plan Letter on COVID-19 Testing for Essential Workers

The Department of Managed Health Care has issued has issued a new All-Plan Letter (APL) clarifying its emergency regulations that specify health plans must, during the state of emergency, cover COVID-19 diagnostic testing as a medically necessary basic health care service for all essential workers. The APL states that full commercial health care service plans may not limit the number or frequency of tests for enrollees who are essential workers, regardless of whether they are symptomatic or have known or suspected exposure to COVID-19. Although health plans, per federal law, must provide COVID-19 testing at no cost-sharing for all enrollees with symptoms of or known or suspected exposure to COVID-19, the APL notes that plans may impose ordinary cost-sharing for COVID-19 testing for essential workers who are asymptomatic.

Payment Available to Providers for Counseling on Self-Isolation
The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention have announced that health care providers may be paid for counseling patients about the importance of self-isolation after they have been tested for COVID-19 and before the onset of symptoms. The counseling should include discussion of the immediate need for isolation even before results are available, the importance of informing others in their household that they should also be tested, and a review of symptoms and services available to aid in isolating at home.

CDPH Launches Online Survey Application for COVID-19 SNF Mitigation Surveys
California Department of Public Health (CDPH) has issued All-Facilities Letter (AFL) 20-63, announcing the launch of a new online application called Risk and Safety Solutions Inspect for conducting surveys and investigations in skilled-nursing facilities (SNFs). Effective Aug. 7, CDPH will begin a phased approach for implementing the new application, which will allow facility-authorized users to electronically access their Statements of Deficiencies and submit their plans of corrections. It will initially be used for the COVID-19 mitigation surveys in SNFs and later expanded to include complaint and facility-reported incident investigations, and licensing and certification surveys. It will also be expanded to other health care facility types. SNFs should enroll in the new system by Aug. 31.
 

Updated FAQs on HHS and CMS Policies

The Department of Health and Human Services and CMS this week updated several frequently asked questions on policies related to the COVID-19 public health emergency, including:

Next CDPH Call for Health Care Facilities: Aug. 4, 8-9 a.m. (PT)
Dial: (844) 721-7239

Passcode: 7993227

Upcoming CMS Calls

CMS will host two calls next week for hospitals and health systems. The Aug. 4 “Office Hours” gives providers an opportunity to ask questions of agency officials about CMS’ temporary actions that empower local hospitals and health care systems. The Aug. 7 “Lessons from the Front Lines” will feature CMS and Food and Drug Administration leadership, as well as members of the White House Coronavirus Task Force. Call details are as follows:
 

Office Hours: Aug. 4 p.m. (PT)
Dial: (833) 614-0820
Passcode: 3296947
Audio webcast

Lessons from the Front Lines: Aug. 7 at 9:30 a.m. (PT)
Dial: (833) 614-0820
Passcode: 4695240
Audio webcast

News for July 28

Additional Federal Data Reporting Changes Effective Tomorrow
The U.S. Department of Health and Human Services (HHS) recently changed the definitions of several data fields being collected through TeleTracking. In addition, TeleTracking notified CHA they will be adding nine new fields, removing 24 fields, and renaming three fields, effective tomorrow. As a result, the CHA data dictionary has been updated, and the CHA COVID-19 Tracking Tool will be updated this evening.

CHA has been working with the California Department of Public Health (CDPH) to prioritize which data elements are of critical importance for daily reporting. Recognizing that hospital resources are stretched thin, CDPH asks that hospitals prioritize daily reporting of data related to COVID-19 positivity rates, occupancy, bed capacity, and anticipated staffing shortages in the coming week. In addition, HHS has asked hospitals to prioritize the following fields, which are used to calculate remdesivir allocations:

  • Previous day’s new adult admissions for confirmed COVID-19
     
  • Previous day’s new adult admissions for suspected COVID-19
     
  • Total adults hospitalized for COVID-19 — suspected and confirmed
     
  • Total hospitalized for COVID-19 — confirmed only
     
  • Total adults in ICU with COVID-19 — suspected and confirmed
     
  • Total adults in ICU with COVID-19 — confirmed
     
  • Remdesivir doses


To help alleviate some of the reporting burden, CHA is working to enhance the CHA COVID-19 Tracking Tool so hospitals and health systems will be able to upload an .XLSX file. Our goal is to complete this update by the end of the week, at which time we will send detailed instructions. Questions can be directed to COVIDTracker@calhospital.org.     

California Hospitals to Receive $10.7 Million in Federal Grant Funds
Later this week, CHA member hospitals will receive a notice about their portion of the Hospital Association COVID-19 Preparedness and Response Activities Grant, which is administered by the Department of Health and Human Services Assistant Secretary for Preparedness and Response. CHA distributed the state’s first allocation, $4.1 million, in May. The second allocation of $10.7 million will be distributed in mid-August.

CHA — with the approval of its board officers — will target most of the funds toward hospitals most impacted by COVID-19 patients. All CHA member hospitals will receive a small grant based on licensed beds. About 25% of CHA member hospitals will receive an additional sum recognizing the relatively higher number of COVID-19 patients they cared for from April 10 to July 8. Questions about compliance forms can be directed to Jen Newman, and questions about the grant in general can be directed to Anne O’Rourke.

Cal/OSHA to Update Guidance About Writing on Decontaminated N95s
Cal/OSHA’s June 12 guidance that, “writing on the filtering material of a filtering facepiece respirator with a permanent marker voids NIOSH approval,” has caused much confusion, as marking the N95 is part of the Battelle decontamination process. However, on July 21 during the CDPH provider call, Cal/OSHA Chief Doug Parker announced that Cal/OSHA has reconsidered that position and will allow marking an N95.

Cal/OSHA will update its June 12 guidance to reflect that change and other updates including an expectation that, while hospitals may be using the Battelle or other decontamination processes, they should not use decontaminated N95s now. Rather, they should store the decontaminated N95s for use in the event of a “severe” shortage. For advocacy purposes, please contact CHA’s Gail Blanchard-Saiger about whether your hospital is currently using decontaminated N95s or storing them for future use.

Emergency Regulations on Communicable Disease Reporting Take Effect Today
CDPH has issued emergency regulations — effective today — requiring health care providers making communicable disease reports to include the patient’s ethnicity, current gender identity, sex assigned at birth, and sexual orientation in the report. This requirement applies to all communicable disease reports, not just those related to COVID-19. The emergency regulations also require laboratories to report race and ethnicity, as well as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within eight hours. An explanatory press release is available here, and the text of the regulation is here.

Update on CDPH Survey Activity
The Governor’s Executive Order of March 15 directs CDPH and Cal/OSHA staff to focus on providing technical assistance and support to health care facilities. It also limits agencies’ enforcement activity to allegations of the most serious violations impacting health and safety. CDPH is still operating under this Executive Order and has no plans to undertake relicensing surveys at this time.

CDPH has told CHA that it is configuring data to create various indicators to proactively identify facilities that may be having patient surges, staffing shortages, or other problems. CDPH staff will call these facilities to ask how they’re doing and find out what CDPH can do to help. These calls, expected to begin in mid-August, are intended to be supportive and provide technical assistance, in line with the Governor’s Executive Order. They are not supposed to be punitive or enforcement oriented.

CDPH is currently conducting surveys on behalf of the Centers for Medicare & Medicaid Services (CMS) where it evaluates hospitals for compliance with federal laws. On March 23, CMS announced general regulatory enforcement discretion for at least three weeks and later extended it indefinitely. The enforcement discretion applies to hospitals, long-term care facilities, home health agencies, hospices, and laboratories. See CHA’s FAQ for more details about CDPH’s limited survey activity on behalf of CMS.

CMS Identifies 230 California SNFs for Initial Distribution of Point-of-Care Tests
On July 22, CMS released a list of 600 skilled-nursing facilities (SNFs) nationwide that will receive the first point-of-care COVID-19 testing devices under a recently announced initiative to improve testing access for SNF residents. The list includes 230 California SNFs located in the identified “hot spots” of Los Angeles, San Francisco, and San Mateo counties. Nursing homes must have a Clinical Laboratory Improvement Amendment Certificate of Waiver to receive a testing device. More information is available in these frequently asked questions.

Members-Only Webinar on Eligibility, Claims Process for Federal COVID-19 Uninsured Program
CHA will hold a members-only webinar on Aug. 7, from 10 to 11:15 a.m. to explain the Health Resources and Service Administration COVID-19 Uninsured Program. The program, launched in early April, provides claims reimbursement for testing and treatment of individuals with COVID-19 who do not qualify for Medi-Cal, Medicare, or other health care insurers. Webinar faculty are representatives from UnitedHealth Group, the program administrator. They will review the process for program participation, claims submission, and reimbursement, as well as how to determine patient eligibility.

Key Messages Available on Nurse Staffing Ratio Waiver Requests
CHA has developed a set of key messages for member hospitals and health systems on the importance of hospitals obtaining waivers to the nurse staffing ratio requirements during the pandemic. The messages include supporting detail for three main points: the demands of COVID-19 have strained California’s health care workforce; the waiver is an important tool that provides relief to a strained workforce and helps to meet patient care needs; and, given the trajectory of COVID-19-positive cases, it is time to return to the statewide waiver that was available to all hospitals through June.

News for July 24

HHS Renews COVID-19 Public Health Emergency

On July 23, the U.S. Department of Health and Human Services renewed the COVID-19 public health emergency. The public health emergency, which was set to expire July 25, extends temporary payment and enforcement flexibilities.

CHA Advocates for More Funding, Support for California Hospitals from Congressional Delegation

CHA today sent a letter to the California congressional delegation urgently requesting additional funding for hospitals and health systems to support expenses incurred as a result the COVID-19 summer surge. In addition to much-needed funds, CHA is requesting a host of important provisions to help secure hospitals’ financial stability over the long term: liability protections, an increase in federal funding for Medicaid, blocking disruptive regulatory changes to Medicaid, providing loan forgiveness for advance Medicare payments, fair treatment of grants to tax-paying hospitals, and other measures.

CHA’s most recent infographic on the state of federal funding highlights that, so far, federal relief funds have been both insufficient and disproportionately low for California’s hospitals.

On Monday, CHA will issue an alert to member hospitals and health systems asking them to lend their voices to this important advocacy by reaching out to their congressional representatives, as well as Sens. Harris and Feinstein.

DMHC Issues Regulations on Medical Necessity for COVID-19 Testing
On July 17, the Office of Administrative Law approved emergency regulations issued by the Department of Managed Health Care (DMHC). The regulations specify that, during the state of emergency, health plans must cover COVID-19 diagnostic testing as a medically necessary basic health care service for all essential workers, including those who work with patients or the public in hospitals and other health care settings, congregate living facilities, the home of an elderly or disabled person, food service, and education.

The regulations also prohibit health plans from 1) imposing utilization management requirements on COVID-19 diagnostic tests for essential workers and 2) delegating financial risk of testing to a contracted provider without renegotiating the contract. The regulations, which are in effect for 180 days, do not apply to Medi-Cal managed care plans. CHA is reviewing the regulations and developing comments for DMHC to update the FAQs the department has developed.

CMS Launches New Initiatives to Assist SNFs
The Centers for Medicare & Medicaid Services (CMS) has announced several new initiatives for skilled-nursing facilities (SNFs) to protect nursing home residents.
 

  • New funding: $5 billion of the provider relief funds from the Coronavirus Aid, Relief, and Economic Security Act for SNFs and state veterans’ homes to enhance their COVID-19 response and address critical needs.
     
  • Enhanced testing: CMS will require that nursing homes in states with a 5% positivity rate or greater test all staff each week. Over the next few months, CMS will provide more than 15,000 testing devices to help support this mandate.
     
  • Training: In partnership with the Centers for Disease Control and Prevention (CDC), CMS will develop an online, self-paced, on-demand Nursing Home COVID-19 training focused on infection control.
     
  • Identification of high-risk facilities: CMS will release to each state a list of nursing homes with an increase in cases, based on data submitted by nursing homes to the CDC and CMS.
     
  • Additional technical assistance: Federal task force strike teams have been deployed to several states to provide onsite technical assistance and education to nursing homes experiencing outbreaks.


New Waiver Addresses Ratio of Pharmacists to Interns, Immunizations

On July 23, the Board of Pharmacy issued a waiver, which expires on Oct. 20, permitting an increase in the ratio of pharmacy interns. The waiver allows one additional intern pharmacist for each supervising pharmacist if:

  • The additional intern pharmacist is administering immunizations consistent with the provisions of pharmacy law.
     
  • The pharmacy maintains a readily retrievable record documenting the date(s) and time(s) when the ratio is increased, per the waiver, and the staff operating under the waiver. Records must be maintained for one year following the end of the declared emergency.


In addition, the waiver allows intern pharmacists to provide immunizations under the general supervision of a pharmacist at the discretion of the supervising pharmacist.


CHA Offers Updated Resources to Assist Hospitals During COVID-19 Surge

As hospitals and health systems respond to COVID-19 during the current summer surge, CHA has developed this quick-reference list of FAQs and resources to help hospitals address the pandemic’s persistent challenges such as personal protective equipment, testing, treatment, staffing, and other demands.

CHA’s Coronavirus Response web page also serves as a comprehensive source of information and FAQs, updated frequently with new information. This week’s updates include an FAQ on what hospitals should do if a local public health order conflicts with state guidance.

Summary of July 21 CDPH Call
The California Department of Public Health (CDPH) has provided a summary of its weekly call with health facilities.

Next CDPH Call for Health Care Facilities: July 28, 8-9 a.m. (PT)

Dial: (844) 721-7239

Passcode: 7993227

News for July 21

Nurse-Staffing Ratios in Effect, Unless in Receipt of CDPH Waiver

A reminder that, per All-Facilities Letter (AFL) 20-26.3 issued July 3, the two-week grace period to come into compliance with nurse-staffing ratios — or secure a waiver from the California Department of Public Health (CDPH) — ended July 17.

Only hospitals experiencing a COVID-19-related surge of patients or staffing shortages due to COVID-19 impacts may request a waiver of nurse-staffing ratios from CDPH. A hospital seeking a waiver must submit CDPH form 5000A and provide supporting documentation to the CDPH Center for Health Care Quality duty officer at CHCQDutyOfficer@cdph.ca.gov and copy the CDPH district office.

State, Federal Data Tracking Process to Change Starting July 22

The recently announced plans by the U.S. Department of Health and Human Services (HHS) to consolidate channels for hospital COVID-19-related data reporting have necessitated a change to the information collected by the CHA COVID-19 Tracking Tool. CHA has worked with CDPH to ensure that data collected by the state through the CHA COVID-19 Tracking Tool are aligned with HHS’ requirements, to spare hospitals the need to enter different data daily into multiple platforms.

For today, hospitals must enter data into the CHA COVID-19 Tracking Tool as well as data for the following seven required fields listed below into the TeleTracking portal:

  • Previous day’s new adult admissions for confirmed COVID-19
     
  • Previous day’s new adult admissions for suspected COVID-19
     
  • Total adults hospitalized for COVID-19 — suspected and confirmed
     
  • Total hospitalized for COVID-19 — confirmed only
     
  • Total adults in ICU with COVID-19 — suspected and confirmed
     
  • Total adults in ICU with COVID-19 — confirmed
     
  • Remdesivir doses (being added to TeleTracking very soon)
     

Beginning July 22, hospitals will need to enter COVID-19 capacity and utilization data daily into the CHA COVID-19 Tracking Tool only, as explained in CDPH’s July 17 AFL 20-31.2. For the tracking tool to accommodate the HHS updates and meet the needs of the state, significant changes to the data fields and definitions had to be made. See the revised data dictionary listing the fields for which hospitals will need to enter data. Questions about the data and the process can be sent to COVIDTracker@calhospital.org.

Hospital Remdesivir Allocations Changed From Biweekly to Weekly
CDPH announced today that the scheduled biweekly remdesivir allocations will occur weekly beginning this week and are anticipated to last through October. When the state gets its allocation each week from the federal government, CDPH will create the county allocations based on the most recent hospitalized census of confirmed COVID-19-positive patients. County Medical Health Operational Area Coordinators (MHOACs) have 24 hours to submit their hospital allocation information to CDPH, which will then submit the information to distributor AmerisourceBergen. If for some reason the county does not submit its hospital allocation determinations to CDPH, CDPH will use the prior week’s proportionate amount to allocate to that county’s hospitals. AmerisourceBergen has been asked to notify CDPH of any hospital unpurchased amounts at the end of each week so it can be reallocated to other hospitals in need within the Regional Disaster Medical and Health Specialists/MHOAC area. 

While AmerisourceBergen will notify CDPH of unused hospital amounts, hospitals are also asked to contact their MHOAC immediately if they plan not to purchase their allocated amount, so there is sufficient time to prevent the loss of remdesivir doses from the state.

Board of Pharmacy Extends Waivers

The California Board of Pharmacy has extended the following limited waivers through Sept. 22:

AFLs Address Testing Data, Transportation for Dialysis Patients at SNFs
CDPH has issued two AFLs for SNFs:

  • AFL 20-60 addresses weekly reporting by skilled-nursing facilities (SNFs) of COVID-19 testing data. As of July 20, SNFs must report results of weekly COVID-19 surveillance or response-driven testing data to CDPH via an online survey in the COVID-19 SNF Survey Hub. Each week, facilities will have a three-day window (Monday through Wednesday) to enter their surveillance or response-driven testing data.
     
  • AFL 20-61 provides recommendations to SNFs for the transportation of COVID-19-positive residents to dialysis clinics for treatment.
     

Office for Civil Rights Issues Guidance Related to COVID-19

Yesterday, the Office for Civil Rights at HHS issued guidance for health care providers on complying with federal civil rights laws during the COVID-19 public health emergency. The guidance focuses on prohibitions against discrimination based on race, color, and national origin, and includes many practical considerations and actions hospitals can take to ensure equitable access to care. Hospitals are reminded that additional laws prohibit discrimination based on other factors, such as a person’s sex, religion, ancestry, disability, medical condition, genetic information, marital status, sexual orientation, citizenship, primary language, or immigration status (unless required by federal law). These and other patients’ rights laws are discussed in chapter 1 of CHA’s Consent Manual, which is available online free to CHA members.

Multimedia Strategy Urges More Federal Funding for Health Care Providers
The Coalition to Protect America’s Health Care, a digital community of 2 million people that advocates on behalf of hospitals and patient care, has launched a comprehensive multimedia strategy to urge additional federal emergency COVID-19 economic relief to hospitals and health systems. The strategy includes a national television ad with spots purchased on Sunday morning political shows, ESPN, and Fox. The coalition also plans to activate its community through a robust social media amplification to reinforce the television advertising.

News for July 17

State Guidance to Counties on Surge Planning

On July 14, in response to a request from CHA, the state released guidance to counties on COVID-19 surge planning. The guidance advises counties to consult with the state before issuing local health orders. It also clarifies that counties should consider the impact of local health orders that cancel scheduled surgeries and non-emergency procedures, or furlough potentially exposed asymptomatic health care workers, on the ability to provide medically necessary care. Other key points from the document include:

  • Hospital surge capacity should be implemented in real time to maintain the ability to provide medically necessary care for all Californians.
     
  • County health care coalitions and local health officers should co-convene hospitals to review the guidance by Aug. 14.
     
  • Counties should recognize four surge status levels that outline the roles of county health departments, hospitals, and the state based on dynamic local conditions.


CHA provided the state with recommendations on planning for COVID-19 resurgences last month and will continue to engage state leaders on hospital surge preparations.


HHS Announces Additional Payments to High-Impact Hospitals
The U.S. Department of Health and Human Services (HHS) has announced an additional $10 billion distribution of the Provider Relief Fund in a second round of funding to hospitals in high-impact COVID-19 areas. In California, HHS will distribute $554,444,985 across 56 hospitals. The funding announced today was based on a formula for hospitals with over 161 COVID-19 admissions between Jan. 1 and June 10, or one admission per day, or that experienced a disproportionate intensity of COVID-19 admissions (exceeding the average ratio of COVID-19 admissions/beds). Hospitals will be paid $50,000 per eligible admission, and funds will be distributed next week.

The first round of funding was based on a formula that distributed funds to hospitals with 100 or more COVID-19 admissions between Jan. 1 and April 10 and paid $76,975 per eligible admission. These previous high-impact payments were also taken into account when determining each hospital’s payment from the second-round distribution. HHS has provided data listing the distributions by hospital as well as a state-by-state breakdown.

FAQs Explain Department of Defense Medical Teams

CHA has developed a set of FAQs on the Department of Defense medical teams being deployed to some California hospitals. The information includes what the teams will focus on, the duration of their deployment, what supplies hospitals are responsible for, and more.

CMS to Distribute Rapid Point-of-Care Testing Supplies to SNFs, Updates Testing Guidance

The Centers for Medicare & Medicaid Services (CMS) has announced that, beginning next week, rapid point-of-care diagnostic tests will be distributed to skilled-nursing facilities (SNFs) in COVID-19 geographic hot spots. The one-time procurement and distribution of these Food and Drug Administration-authorized instruments and tests is intended to augment current capacity for SNF testing. Following initial distribution, nursing homes will be able to procure additional tests directly from the respective manufacturers.

CMS has also issued a revised MLN Matters article that updates information about CDC guidance for testing SNF residents, and clarifies the SNF benefit period waiver.  

Local Paid Sick Leave Ordinances Vary Throughout California
Over the past several months, several California cities and counties have adopted COVID-19 supplemental paid sick leave ordinances. Hospitals and health systems are covered by all of these in some fashion. While the Families First Coronavirus Response Act (FFCRA) allowed hospitals and health systems to exempt all employees, the local ordinances take varying approaches. Several follow the FFCRA model, allowing a hospital to exempt some or all employees. Others, such as Santa Rosa, contain no exemptions. Hospitals and health systems with operations in the following locales should review their ordinances closely: Emeryville, city of Los Angeles, Los Angeles County, Long Beach, Oakland, San Francisco, Sacramento, San Mateo, Santa Rosa, and San Jose. For links to each of the ordinances, see CHA’s FAQs on human resources.

CHA Joins California Medical Association to Ask State to Promote, Increase Flu Vaccinations
CHA and the California Medical Association sent a joint letter yesterday to Gov. Newsom, urging him to create an advisory committee to support a public campaign to increase influenza vaccination rates for the 2020-21 flu season. The letter notes the increased threat of preventable illness due to the ongoing COVID-19 pandemic and asks the state to work closely with federal authorities to ensure there is an adequate supply of flu vaccine for California.

CDPH Guidance Recommends Nursing Students Continue Clinical Training
CDPH has issued revised visitation guidance with a new section on nursing students. To help ensure that new nurses entering the health care workforce can obtain the clinical experience they need, CDPH recommends students in an approved nurse assistant, vocational nurse, or registered nurse training program be permitted in health care facilities if they meet the CDC guidelines for health care workers.

Summary of July 14 CDPH Call
CDPH has provided a summary of its weekly call with health facilities.

Next CDPH Call for Health Care Facilities: July 21, 8-9 a.m. (PT)
Dial: (844) 721-7239

Passcode: 7993227

Upcoming CMS Calls

CMS will host several calls next week, one for hospitals and health systems and others for home health/hospice providers, dialysis organizations, nursing homes, and nurses. Call details are as follows:
 

Hospitals and Health Systems: July 21 at 2 p.m. (PT)
Dial: (833) 614-0820
Passcode: 7477995
Audio webcast

Home Health and Hospice Providers: July 21 at noon (PT)
Dial: (833) 614-0820
Passcode: 6080197
Audio webcast

Nursing Homes: July 22 at 1:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 1143564
Audio webcast

Dialysis Organizations: July 22 at 2:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 7692208
Audio webcast

Nurses: July 23 at noon (PT)
Dial: (833) 614-0820
Passcode: 7971869
Audio webcast

News for July 14

State Moves Back to Modified Stay-at-Home Order
With hospitalizations rising, and an increased testing positivity rate, Gov. Newsom announced yesterday that California will step back to a modification of its original stay-at-home order. Effective July 13, all counties must close indoor operations of:

  • Dine-in restaurants
     
  • Wineries and tasting rooms
     
  • Movie theaters
     
  • Family entertainment centers
     
  • Zoos and museums
     
  • Card rooms
     

Additionally, bars, brewpubs, breweries, and pubs must close all indoor and outdoor operations statewide, unless they offer sit-down, outdoor dine-in meals. Counties that have been on the monitoring list for three consecutive days are also required to shut down the following activities unless they can be modified to operate outside or by pick-up: fitness centers, worship services, protests, offices for non-essential sectors, personal care services, hair salons and barbershops, and malls. More information is available here.

State Announces New Plans for COVID-19 Testing
The California Health and Human Services Agency today announced new plans for COVID-19 testing in California, including updated testing guidance, new requirements for health plans to cover testing, and the new co-chairs of the state’s COVID-19 Testing Task Force. Today’s announcements include:

  • Testing: The California Department of Public Health (CDPH) released updated testing guidance that focuses on testing hospitalized individuals with signs or symptoms of COVID-19 and people being tested as part of the investigation and management of outbreaks, including contact tracing.
     
  • Testing Task Force: Two new co-chairs will lead California’s Testing Task Force. They are Dr. Gilbert Chavez, founding chief of CDPH’s Center for Infectious Diseases, and Dr. Bechara Choucair, senior vice president and chief health officer for Kaiser Foundation Health Plan, Inc.
     
  • Health Plan Coverage: To help ensure that testing is widely available to all Californians, the state is working collaboratively with health insurers to provide reimbursement for testing and with private providers to create additional in-office testing capacity.
     

Hospital Assistance Needed with Remdesivir Allocations
Remdesivir is one of the few promising treatments for COVID-19, so CHA is asking for member hospitals’ and health systems’ help in keeping as much of it as possible in California. Due to a limited supply, each state has been allocated a limited number of doses, and hospitals can begin buying the drug this week directly from Gilead’s distributor, AmerisourceBergen. (Remdesivir costs approximately $3,200 per treatment course of approximately 6.25 vials. Hospitals that do not have an account with AmerisourceBergen should email sales@asdhealthcare.com.)

As remdesivir allocations are tallied statewide and apportioned by individual hospital, hospitals are asked to contact their Medical Health Operational Area Coordinator if they decide not to purchase their full allotment. This information is vital to our work with the Health and Human Services Agency to ensure that all doses sent to California remain here.

Changes to Federal COVID-19 Data Reporting Requirements
Yesterday, the U.S. Department of Health and Human Services (HHS) announced plans to consolidate channels for hospital COVID-19-related data reporting, which will eliminate the need for periodic requests related to remdesivir distribution. Due to this announcement, changes in the data collection process will be necessary.

Starting tomorrow and through Tuesday, July 21, hospitals will need to report data into both the CHA COVID-19 Tracking Tool and HHS’ TeleTracking portal concurrently. Beginning Wednesday, July 22, hospitals will need to report only into the CHA COVID-19 Tracking Tool. CDPH will then upload data on hospitals’ behalf to meet HHS’ requirements. A more detailed announcement was sent to hospital staff who report into the CHA tracker. Questions about this process can be directed to COVIDTracker@calhospital.org.

CHA Readying Response to Petris Report
CHA is preparing a response for state and federal lawmakers that addresses the many flaws in a July 9 study from the Nicholas C. Petris Center on COVID-19 relief payments among California health systems. The response will largely focus on three aspects of the report: misleading assumptions about hospitals’ fiscal health, inaccurate calculations related to financial reserves, and the dangerous conclusion that lawmakers might draw from these incorrect findings about the equity of relief allocations to hospitals. Also, the media are beginning to pick up on this report; CHA President & CEO Carmela Coyle had a chance to respond and flag the many concerns via a CapRadio interview on Monday, which we expect to be released in the coming days.

State Health Leaders Call for Suicide Screening
Citing concern about COVID-19’s immediate and long-term impact on individuals’ mental health, the directors of the Department of Health Care Services and CDPH and the state Surgeon General have called on all California medical and behavioral health providers to ask four suicide screening questions of the people they care for. The letter also provides instructions and resources for providers who identify an individual at risk. Additionally, it encourages health care providers to assess their own mental health — pointing them to a guide developed by the Surgeon General’s office, which includes things to do that will help support mental and physical health.

News for July 10

HHS Announces Additional $4 Billion Distribution of Provider Relief Funds
The federal Department of Health and Human Services (HHS) has announced an additional $4 billion distribution of the Provider Relief Fund — approximately $3 billion in funding to safety net hospitals and approximately $1 billion to specialty rural hospitals, urban hospitals with certain rural Medicare designations, and hospitals in small metropolitan areas.

The $3 billion in additional safety net hospital funding follows HHS’s initial safety net distribution of $10 billion in June. HHS is expanding the criteria for payment qualification so that certain acute care hospitals that meet a revised profitability threshold of less than of 3% averaged consecutively over two or more of the last five cost reporting periods — as reported on the Medicare cost report — will now be eligible for payment. HHS has provided a list of the payments by state. 

HHS will also distribute approximately $1 billion to urban hospitals with certain rural Medicare designation, as well as others that provide care in smaller non-rural communities. These may include some suburban hospitals that are not considered rural but serve rural populations and operate with smaller profit margins and limited resources than larger hospitals. HHS has provided a list of these payments by state. 

In addition, HHS will open its Enhanced Provider Relief Fund Payment Portal to allow dentists who have not received Provider Relief Funds to apply for a reimbursement of 2% of their annual reported patient revenue. Eligible dentists must apply by July 24. 

CDCR to Reduce Prison Populations and Maximize Space 
The California Department of Corrections and Rehabilitation (CDCR) announced today additional actions to protect its most vulnerable population and staff from COVID-19, and to allow state prisons to maximize available space for physical distancing, isolation, and quarantine efforts. Under release authority that allows alternative confinement or release in any case in which an emergency endangering the lives of incarcerated persons has occurred or is imminent, CDCR is pursuing a series of cohorted release efforts. The department estimates 8,000 currently incarcerated persons could be eligible for release by end of August under these new measures. All individuals will be tested for COVID-19 within seven days of release. CDCR is working closely with stakeholders, local law enforcement partners, and other agencies to leverage state and federal resources for housing in the community to help meet the re-entry needs of these individuals.

OSHPD Support for Temporary Spaces on Hospital Campuses for COVID-19 Response
CHA received an update from the Office of Statewide Health Planning and Development (OSHPD) that it is available to assist hospitals in making temporary changes to accommodate additional patients during the COVID-19 State of Emergency. Hospitals should contact their OSHPD field office (either Sacramento or Los Angeles ); contact information for both offices is here. For closed or vacant buildings that hospitals have not used due to issues such as seismic safety requirement non-compliance, OSHPD will offer advice and recommendations on how hospitals can temporarily use these buildings as alternate care sites. 

OSHPD also notes that, as recently clarified in All-Facilities Letter (AFL) 20-26.3 released by the California Department of Public Health on July 3, temporary changes of use or modification to the physical environment must be restored to original conditions following the expiration of AFL 20-26.3 on March 1, 2021. If the temporary changes are to be made permanent, projects must be submitted to OSHPD by March 15, 2021. By contrast, permanent changes of use or modifications to the physical environment must be submitted to OSHPD as projects for review and approval. 

CMS to Provide Assistance for SNFs in COVID-19 Hot Spots
The Centers for Medicare & Medicaid Services (CMS) has announced plans to deploy quality improvement organizations in order to provide immediate assistance to skilled-nursing facilities in COVID-19 hot spots. Additionally, CMS will implement an enhanced survey process designed to meet the specific concerns of those areas and will coordinate federal, state, and local efforts to leverage all available resources to these facilities. 

New Publishing Schedule for Coronavirus Response
Beginning next week, Coronavirus Response will be published regularly on Tuesday and Friday — and as needed on other days. You can also find COVID-related news and updates in CHA’s twice-weekly newsletter, CHA News, to be distributed on Mondays and Thursdays.
 

News for July 8

CHA Participation in Today’s Press Conference with Governor Newsom

CHA President & CEO Carmela Coyle joined Governor Gavin Newsom at his press conference on COVID-19 today to give an update on how hospitals plan, prepare, and partner in their response to COVID-19. The press conference can be viewed here.

Recording of Call on COVID-19 Hospitalizations with Secretary Dr. Mark Ghaly

On July 7, CHA hosted a call with California Health and Human Services Secretary Dr. Mark Ghaly for member hospital CEOs. On the call, Dr. Ghaly provided an update on increasing numbers of COVID-19 cases, expected hospitalizations in California, and the state’s ongoing partnership with hospitals. He also answered questions. A recording is available here.

Prisons Activate Incident Command, Distribute 4 Million Masks
The California Department of Corrections and Rehabilitation (CDCR) has announced that, to ensure state prisons are immediately prepared to address COVID-19 cases, all prisons will activate their incident command posts, regardless of whether they have active COVID-19 cases. Additionally, 4.2 million surgical masks and 104,000 face shields from the Governor’s Office of Emergency Services (OES) will be distributed to prisons statewide. In June, CDCR and California Correctional Health Care Services established a PPE workgroup to ensure staff have an adequate supply of PPE to immediately address COVID-19 and to protect staff and incarcerated people. The workgroup will continue to collaborate with OES to identify deficiencies and ensure adequate supplies are available at each institution.

AHA to Host Call July 9 With FDA Commissioner

The American Hospital Association (AHA) will host a call for all hospital and health system leaders July 9 from 11:30 a.m.-12:45 p.m. (PT) with Food and Drug Administration (FDA) Commissioner Stephen Hahn, MD. Dr. Hahn will address FDA’s response to the COVID-19 epidemic, including emergency use authorizations, remdesivir distribution, and vaccine clinical trials. Callers are encouraged to dial in at least 10-15 minutes in advance. To join the call, dial (800) 469-8538 and enter passcode 43576#.

Summary of July 7 CDPH Call

CDPH has provided a summary of its weekly call with health facilities. This link includes the call summary and documents that speakers referenced during the call.

New Publishing Schedule for Coronavirus Response
Beginning the week of July 13, Coronavirus Response will be published regularly on Tuesday and Friday of each week — and as needed on other days. You can also find COVID-related news and updates in CHA’s twice weekly newsletter, CHA News, to be distributed on Mondays and Thursdays.
 

News for July 6

State Urges Labs to Prioritize Test Results for At-Risk Groups
California Health and Human Services Secretary Dr. Mark Ghaly issued a statement over the weekend addressing the high volume of COVID-19 testing that is slowing processing timelines. To address those processing challenges, the state is urging laboratories to prioritize testing turnaround for individuals who are most at risk of spreading the virus to others. According to the statement, this includes those who are symptomatic, hospitalized, or in long-term care, skilled-nursing, and assisted living facilities. The statement also emphasizes the importance of prioritizing the specimens of patients in institutional settings, including prisons and jails, so that appropriate interventions can be implemented soon enough to mitigate the spread of the virus within those facilities.

CDPH Revises Waiver of Certain Hospital Licensing Requirements

On July 3, the California Department of Public Health (CDPH) released All-Facilities Letter (AFL) 20-26.3, which revises its waiver of certain hospital licensing requirements. It now specifies that, per the Proclamation of a State of Emergency, all staffing waivers will be posted on the CDPH website. CDPH has also added that hospitals must resume mandatory staffing levels as soon as feasible “during the waiver period to minimize the need for additional waivers.” Waivers are still effective for 90 days, with the ability to request subsequent waivers. By re-releasing the AFL, the grace period for requesting a waiver of nurse-staffing ratios is extended until July 17.

This also revises the notice requirements, limiting waiver of them to downgrade, change, or elimination of supplemental services. For these actions, the hospital must provide notice at least 24 hours in advance of the service change to the public and CDPH.

Waiver for Nurse Preceptorship and Restrictions on Nursing Student Training Extended Until August 1
The Department of Consumer Affairs has issued an order extending its original waiver to allow for continued relaxation of clinical preceptorship and nursing student clinical training requirements. Set to expire July 3, the waiver has now been extended to August 1. More details are available in the original waive of nurse preceptor requirements and a memo to nursing program directors.

Next CDPH Call for Health Care Facilities: July 7, 8-9 a.m. (PT)

Dial: (844) 721-7239

Passcode: 7993227

Upcoming CMS Calls

The Centers for Medicare & Medicaid Services will host several calls this week, one for hospitals and health systems and others for home health/hospice providers, dialysis organizations, nursing homes, and nurses. Call details are as follows:
 

Hospitals and Health Systems: July 7 at 2 p.m. (PT)
Dial: (833) 614-0820
Passcode: 3048844
Audio webcast

Home Health and Hospice Providers: July 7 at noon (PT)
Dial: (833) 614-0820
Passcode: 9480618
Audio webcast

Nursing Homes: July 8 at 1:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 2997138
Audio webcast

Dialysis Organizations: July 8 at 2:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 8481378
Audio webcast

Nurses: July 9 at noon (PT)
Dial: (833) 614-0820
Passcode: 9386539
Audio webcast 

News for July 2

CMS Updates on Hospital Quality Reporting and Value-Based Payment Programs
The Centers for Medicare & Medicaid Services (CMS) has announced that the COVID-19 public health emergency extraordinary circumstance exception (ECE) for hospital quality reporting and value-based payment programs ended effective July 1. Data reporting requirements will resume for the following programs: 

•    Hospital Inpatient Quality Reporting 
•    Hospital Outpatient Quality Reporting 
•    PPS-Exempt Cancer Hospital Quality Reporting 
•    Hospital Value-Based Purchasing 
•    Hospital-Acquired Condition Reduction
•    Hospital Readmissions Reduction 

Hospitals can continue to submit an ECE request if they have been impacted by COVID-19 or another event beyond their control. ECEs must be submitted to CMS within 90 calendar days of the extraordinary circumstance. 

CMS also notes that it intends to address hospital concerns with how the data are impacted by the COVID-19 public health emergency in future rulemaking. 

CDPH Revises Provisions on Nurse-Staffing Ratio Waiver
The California Department of Public Health (CDPH) has modified the nurse-staffing ratio waiver provisions in the June 29 All-Facilities Letter 20-26.2 to include additional reasons for a hospital to secure a waiver of nurse-staffing ratios. In addition, CDPH has clarified it is able to respond quickly to urgent requests from hospitals seeking a waiver and has 24/7 coverage to respond.  Hospitals should mark a waiver request urgent if they need a request approved within eight hours.

Summary of June 30 CDPH Weekly Call
CDPH has provided a summary of its weekly call with health facilities. 

News for June 29

CDPH Extends and Modifies Waivers of Hospital Licensing Requirements

On June 26, the California Department of Public Health (CDPH) released All-Facilities Letter 20-26.1, which extends the suspension of certain hospital licensing requirements — including those related to bed classification and physical space — until March 1, 2021. CHA advocated for an extension of certain provisions from the prior waiver; this extension includes all of them, except the area of nurse-staffing ratios, which has been modified.

CDPH has modified the nurse-staffing ratio waiver to be upon request by a hospital. A hospital seeking a nurse-staffing ratio waiver must submit CDPH form 5000A and provide supporting documentation to the CDPH Center for Health Care Quality duty officer at CHCQDutyOfficer@cdph.ca.gov and copy the CDPH district office. Any hospital currently out of compliance with nurse-staffing ratios has a grace period until July 10 to secure approval from CDPH for a hospital-level waiver.

CHA is engaging with CDPH on important revisions needed for reasons for a hospital to secure a waiver of nurse-staffing ratios. CDPH has committed to considering these revisions, and CHA is urging CDPH to release a revised All-Facilities Letter addressing them.

HHS Announces Major Acquisition of Remdesivir

The federal Department of Health and Human Services (HHS) has announced an agreement with Gilead Sciences for more than 500,000 treatment courses of remdesivir through September. Hospitals nationwide will be able to purchase the drug in amounts allocated by HHS and their state health departments.

Hospitals will pay no more than Gilead’s wholesale acquisition price — which amounts to approximately $3,200 per treatment course — and the product will be shipped by AmerisourceBergen. Generally, patients do not pay directly for hospital-administered drugs like remdesivir; rather, Medicare and most private insurers incorporate the drug’s cost into payments made by the insurer, such as Medicare paying for the drug through a diagnostic-related group.

Cal/OSHA Updates Guidance to Hospitals on Severe Respirator Supply Shortages
Cal/OSHA has revised its Interim Guidance on COVID-19 for Health Care Facilities: Severe Respirator Supply Shortages. The recent changes will likely make it much more difficult to use facemasks rather than respirators for routine care of COVID-19 positive patients and persons under investigation. The guidance states that “when severe respirator shortages make it impossible to provide NIOSH-certified filtering facepiece respirators, employer must protect employees with the best available methods in the order listed” in the guidance. The guidance further states that “use of surgical masks cannot be used until all other respiratory protection options have been exhausted.”

CHA is analyzing the guidance and will contact Cal/OSHA with its concerns. If a hospital receives a Cal/OSHA complaint based on the new guidance, they should share the information with Gail Blanchard-Saiger at gblanchard@calhospital.org.

Board of Pharmacy Extends Some Waivers, Another Expires Soon

The California Board of Pharmacy has extended the following waivers:

Additionally, the Use of Sterile Disinfectant Agents limited waiver will expire July 1. Although the broad waiver is expiring, an individual or entity may request that the board issue a site-specific waiver. To submit a request, follow the guidelines posted on the board’s website at How to Request a Pharmacy Law Waiver.

On-Demand Webinar Offers Tools to Care for the Caregiver
As the demands of COVID-19 extend into the summer and continue to stretch frontline health care workers both mentally and physically, CHA reminds hospitals that the Hospital Quality Institute’s Care for the Caregiver webinar is available as an on-demand recording. The webinar includes practical and necessary tools to assist hospitals and their employees in creating a peer support model for adverse events such as the COVID-19 pandemic. Additionally, the webinar offers information on how to engage in empathic conversation with both patients and families.

Next CDPH Call for Health Care Facilities: June 30, 8-9 a.m. (PT)

Dial: (844) 721-7239

Passcode: 7993227

News for June 26

Governor Announces Open Source Assessment Tool for Current and Future Data Modeling
Yesterday, Gov. Newsom announced the state’s new California COVID Assessment Tool, a data analysis and repository intended to provide a better understanding of the impact of COVID-19. The tool contains assessments of the current spread of COVID-19, short-term forecasts of disease trends, and future scenarios of the course of the disease from modeling groups across the country. The state is also making the source code available to the public, with the goals of refining statewide and county-level insights and knowledge, and spurring collaboration with other states and researchers. See the Governor’s press release for additional details.

Process Changes for Health Care Workers Hotel Program
The Non-Congregate Sheltering for California Healthcare Workers Program provides hotel rooms to front-line health care workers who are exposed to or test positive for COVID-19 and do not have the ability to self-isolate or quarantine at home. The cost is covered by the federal or state government. On June 17, several important changes to the program were implemented to address fraudulent use of the program. For details about the revised process, see CHA’s FAQ about the program.

CMS Provides Updates, FAQs for Skilled-Nursing Facilities

The Centers for Medicare & Medicaid Services (CMS) has issued key information for skilled-nursing facilities (SNFs), including:

  • Important updates on SNF requirements for submitting staffing data and posting quality reporting information on Nursing Home Compare. Notably, CMS plans to end the emergency blanket waiver that temporarily suspended the requirement for SNFs to submit staffing data through the Payroll-Based Journal system. Facilities must submit data for the calendar second quarter by August 14.
     
  • Frequently asked questions about guidelines for SNF visitation policies. Topics covered include preparing for re-opening to visitors, communal activities, and access for long-term care ombudsmen.

CMS Updates SNF Waivers for Three-Day Hospital Stay Requirements

CMS has issued updates about SNF waivers for the requirement of a three-day qualifying hospital stay and for continuation of the benefit period for individuals requiring continued care when their benefit period would have otherwise expired. Notably, CMS clarifies the following:

  • That all beneficiaries qualify for the qualifying hospital stay
     
  • That the status of being “affected by the emergency” exists nationwide under the current public health emergency
     
  • That SNFs do not need to verify individual cases.

However, to qualify for the benefit period waiver, SNFs must demonstrate that a beneficiary’s continued receipt of skilled care in the SNF is in some way related to the public health emergency. Related billing instructions are also provided.

CDPH Guidance for SNFs
The California Department of Public Health (CDPH) has issued updated guidance for SNFs on infection control and prevention practices, including updated information on visitation practices. All-Facilities Letter (AFL) 20-22.3 reflects revised CMS guidance on visitation to safely reopen SNFs to visitors. Additionally, CDPH has issued AFL 20-32.1, which updates information about regulatory enforcement in SNFs. The AFL includes information about waivers that will be extended, as well as updated requirements for COVID-19 staffing waivers.

Update on Workers’ Compensation Presumption
The Governor’s Executive Order N-62-20 implemented a presumption in the workers’ compensation system that expires on July 5. It is CHA’s understanding that the order will not be extended. However, three bills are pending in the Legislature that seek to create a presumption, although with varying scope, conditions, and requirements. Given that the Governor’s Executive Order expires on July 5, it is unlikely that any legislation, even if passed, would be signed before September. Because workers’ compensation legislation can be applied retroactively, hospitals need to decide how to handle COVID-19-related workers’ compensation claims during the period from July 6 through September — specifically, whether to continue to apply the presumption assuming a new law will pass, or whether to discontinue applying a presumption with the understanding that, if a new law passes, they will likely need to convert some situations as covered by workers’ compensation.

AHA Virtual Advocacy Day June 30
Hospitals are encouraged to join the American Hospital Association June 30 at 11 a.m. (PT) for a live presentation on the next COVID-19 economic relief package to be considered by Congress. The session will also explain ways to engage with lawmakers virtually to ensure hospitals’ and health systems’ priorities are at the top of their list. Register by 2 p.m. (PT) on June 29 to participate.

News for June 24

CHA Advocates for Extension of CDPH Waiver of Hospital Licensing Requirements

Per the Governor’s declaration of a state of emergency related to COVID-19, the California Department of Public Health (CDPH) waived most hospital licensing requirements in All-Facilities Letter 20-26, which expires June 30 unless CDPH extends it.

CHA is actively advocating with CDPH to extend the waivers, requesting they continue through March 31, which is the anticipated end of the combined disease burden of COVID-19 and influenza. While CDPH has not yet made a decision, CHA continues to press for extension of these key provisions:

  • Requirements related to hospital physical space and bed classification
     
  • Hospital staffing requirements, including nurse-staffing ratios, during a patient surge or staffing shortage

FAQs on California’s Face Covering Requirements

The state health officer has mandated that Californians must wear face coverings when they are in certain situations, including in hospitals, pharmacies, clinics, labs, physician or dental offices, and blood banks. CHA has compiled a list of FAQs from member hospitals about this latest mandate. The state has identified the following exceptions to the face covering requirement:

  • When directed otherwise by a health care provider or other employee of the hospital, pharmacy, clinic, lab, physician or dental office, or blood bank
     
  • Children ages 2 or younger. These very young children must not wear a face covering because of suffocation risk.
     
  • Anyone with a medical condition, mental health condition, or disability that prevents wearing a face covering. This includes those with a medical condition for whom wearing a face covering could obstruct breathing or who are unconscious, incapacitated, or otherwise unable to remove a face covering without assistance.
     
  • Persons who are hearing impaired, or communicating with a person who is hearing impaired, where the ability to see the mouth is essential for communication.
     
  • Anyone receiving a service involving the nose or face for which temporary removal of the face covering is necessary to perform the service.

CHA Webinar Will Explain Medi-Cal Enrollment, Payment for COVID-19 Patients

CHA will offer a complimentary, members-only webinar to help providers understand flexibilities in Medi-Cal enrollment and payment for services for COVID-19 patients. The program, to be held 10-11:30 a.m. (PT) July 1, will be presented by René Mollow, MSN, RN, deputy director of health care benefits and eligibility at the Department of Health Care Services.

Mollow will explain the pathways to enrollment, applicable benefits, and the claims submission, review, and payment processes. Unique situations, such as when patients are transferred across county lines, will also be addressed.

State Testing Task Force to Host Webinar
In response to testing shortages and a need to scale rapidly, the state established the California COVID-19 Testing Task Force to manage testing throughout the state. On June 26 from 1 to 2 p.m. (PT), the task force will host a webinar titled Creating a Testing Infrastructure in California — the Road to 80,000 Tests Per Day. Speakers will include task force co-chair Dr. Charity Dean, assistant director, CDPH; task force co-chair Paul Markovich, president and CEO, Blue Shield of California; and task force senior adviser Bob Kocher, non-resident senior fellow, USC Schaeffer Center and adjunct professor, Stanford Medicine. To learn more about how the task force is creating capacity and an infrastructure to support and optimize testing across California, register in advance here.

Summary of June 22 CDPH Weekly Call
CDPH has provided a summary of its weekly call with health facilities.

News for June 22

Pandemic Crisis Care Guidelines Webinar June 23

The California Department of Public Health (CDPH) recently released the California SARS-CoV-2 Pandemic Crisis Care Guidelines. In a complimentary, members-only webinar from CHA tomorrow, June 23 from 3 to 4:30 p.m. (PT), CDPH senior leadership will present a review of the new guidance, insights into its development, and explain how it can inform real-time clinical decisions. Topics include:

  • Developing and updating your Emergency Operations Plan 
     
  • Key operational strategies for health care facilities during crisis, including identifying and incorporating indicators and triggers
     
  • Core strategies to employ in anticipation of a shortage of space, supplies, or staff
     
  • Developing and implementing critical policies and plans, including staff engagement and education
     
  • Principles and processes for allocating scarce resources, including ventilator management, and strategies for other scarce resources situations
     
  • Ensuring equity and nondiscrimination in resource allocation and other ethics issues
     
  • Resources and checklists


CDPH Updates SNF Daily Data Submission Process

CDPH has issued All-Facilities Letter (AFL) 20-43.3, announcing a new process for skilled-nursing facilities (SNFs) to submit COVID-19 data to the Centers for Disease Control and Prevention (CDC). SNFs are required to submit their daily data via an online survey to ensure the state has the necessary information for its response to the COVID-19 public health emergency. The new process is effective June 22.

Final COVID-19 Testing Task Force Briefing for Hospitals is June 25
CHA members are encouraged to join the final California COVID-19 Testing Task Force briefing for hospitals and health systems June 25 from 3 to 4 p.m. (PT). The webinar will include updates on next steps as the state continues to increase testing capacity and capabilities across the state, as well as a county “playbook” that will help each county address its specific concerns. Details for participating include:


Zoom: https://calhospital.zoom.us/j/94875209114

Listen only: (669) 900-9128 or (213) 338-8477

Meeting ID: 948 7520 9114


CMS Directs Testing for Nursing Home Residents to Be Covered
The Centers for Medicare & Medicaid Services (CMS) has instructed Medicare administrative contractors and Medicare Advantage plans to cover COVID-19 tests for nursing home residents. This includes residents with COVID-19 symptoms, as well as asymptomatic residents who have been exposed to COVID-19. The recommendations are consistent with updated guidance from the CDC.

CDPH Offers New Infection Prevention Webinars
CDPH has issued AFL 20-50.1 to notify SNFs that it will hold weekly infection prevention webinars beginning June 24. The webinars are in addition to weekly infection prevention calls that CDPH has been hosting since early May. Registration for each webinar is required at the Health Services Advisory Group (HSAG) website.

Next CDPH Call for Health Care Facilities: June 23, 8-9 a.m. (PT)

Dial: (844) 721-7239

Passcode: 7993227

Upcoming CMS Calls

CMS will host several calls this week, one for hospitals and health systems and others for home health/hospice providers, dialysis organizations, nursing homes, and nurses. Call details are as follows:
 

Hospitals and Health Systems: June 23 at 2 p.m. (PT) 

Dial: (833) 614-0820
Passcode: 5775248
Audio webcast

Home Health and Hospice Providers: June 23 at noon (PT)
Dial: (833) 614-0820
Passcode: 3676539
Audio webcast

Nursing Homes: June 24 at 1:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 3089577
Audio webcast

Dialysis Organizations: June 24 at 2:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 6494855
Audio webcast

Nurses: June 25 at noon (PT)
Dial: (833) 614-0820
Passcode: 9496814
Audio webcast

News for June 19

Board of Pharmacy Extends Some Waivers, Lets Others Expire

The Board of Pharmacy has extended the following waivers:

The board also announced that the following waivers will expire:

Pharmacies are reminded that although the above waivers are expiring, an individual or entity may request a site-specific waiver. To submit a request, please follow the guidelines posted on the board’s website: How to Request a Pharmacy Law Waiver.

Register Now for Upcoming CHA Webinars

CHA is currently offering several webinars to help members understand ever-changing regulations and their obligations as health care providers during the pandemic. Upcoming webinars include: 

  • Pandemic Crisis Care Guidelines: The California Department of Public Health (CDPH) recently released the California SARS-CoV-2 Pandemic Crisis Care Guidelines. In a complimentary, members-only webinar from CHA on June 23 from 3 to 5 p.m. (PT), senior leadership from CDPH will present a review of the new guidance, insights into its development, and explain how it can inform real-time clinical decisions. Topics include:
     
    • Developing and updating your Emergency Operations Plan 
       
    • Key operational strategies for health care facilities during crisis, including identifying and incorporating indicators and triggers
       
    • Core strategies to employ in anticipation of a shortage of space, supplies, or staff
       
    • Developing and implementing critical policies and plans, including staff engagement and education
       
    • Principles and processes for allocating scarce resources, including ventilator management, and strategies for other scarce resources situations
       
    • Ensuring equity and nondiscrimination in resource allocation and other ethics issues
       
    • Resources and checklists
       
  • Provider Relief Fund Challenges and Risk Mitigation: CHA will host a complimentary, members-only webinar on June 29 from 1:30 to 3:30 p.m. (PT) to discuss the U.S. Department of Health and Human Services’ (HHS) Provider Relief Program and potential pitfalls that could cost hospitals dearly. HHS guidance on the program changes frequently, often without notice, and available funds can come with complicated qualifying and accounting rules.

Experts from Hooper, Lundy & Bookman, PC will discuss the biggest compliance risks and how to mitigate them, including the most problematic terms and conditions, False Claims Act implications, and how and when you give money back. 

  • COVID-19: Mid-Response After Action Reporting: Writing an After Action Report (AAR) and Improvement Plan for a real event can be challenging enough. Having to write one during an ever-changing event that doesn’t have an end in sight can seem impossible. On June 23 from 9:30 to 10:30 a.m. (PT), CHA’s Vice President of Emergency Management Mary Massey will host a complimentary, members-only webinar on how a midterm AAR can bring together lessons learned to meet regulatory, accreditation, and grant requirements. You will also be able to identify areas to change for a better response, and areas to share with other partners that can also help the community reaction.

Statewide Requirement for Face Coverings

On June 18, the state released guidance on its new requirement that Californians must wear face coverings in common and public indoor spaces and outdoors when social distancing is not possible. This includes the explicit requirement that people wear face coverings when they are obtaining services from the health care sector, unless directed otherwise by an employee or health care provider.

News for June 17

HHS Clarifies Provider Relief Fund Reporting Requirements in Updated FAQs
The Department of Health and Human Services (HHS) has updated its frequently asked questions on Provider Relief Fund payments, including questions related to reporting requirements for providers that have received funds. Specifically, HHS clarified that recipients of Provider Relief Fund payments do not need to submit a separate quarterly report to HHS or the Pandemic Response Accountability Committee.

HHS says the statutory requirement for quarterly reports related to these funds is being met by HHS’ public release of the data on each payment it has distributed via the HHS’ Tracking Accountability in Government Grants System website. The site includes the name and payment amount for each provider that has attested to receiving the emergency relief funds and agreed to the terms and conditions (or has retained their payment for more than 90 days). HHS is also working with the Department of the Treasury to reflect the aggregate total of each recipient’s attested to Provider Relief Fund payments on USAspending.gov.

HHS also clarifies that providers are required to submit any reports requested by the HHS secretary that are necessary to ensure compliance with the payment terms and conditions. In the coming week, HHS will notify recipients of reports that will be required related to the use of Provider Relief Funds.

CDPH Updates Guidance on Hospital Visitors
The California Department of Public Health (CDPH) has updated its guidance on hospital visitors during the COVID-19 pandemic. The guidance recommends that hospitals allow NICU and PICU patients to have two designated support persons at the same time. CDPH continues to recommend that support persons be asymptomatic, stay in the patient’s room, comply with facility personal protective equipment requirements, etc. Because these recommendations are not legal requirements, hospitals may deviate from them as appropriate.

CDPH Provides List of N95 Masks Approved for Decontamination with Battelle System

CDPH has updated its information on the state’s program with Battelle Memorial Institute to decontaminate N95 masks free of charge, as a crisis capacity strategy. Specifically, it notes that this program, consistent with Food & Drug Administration guidance released on June 7, does not accept non-NIOSH-approved N95s or N95s with exhalation valves. Battelle Memorial Institute has developed a list of the N95s that are approved for decontamination through the Battelle system.

CDC Updates Testing Guidelines for SNF residents, health care personnel
The Centers for Disease Control and Prevention has updated its COVID-19 testing guidelines for skilled-nursing facility residents and health care personnel. The updated guidance includes recommendations regarding initial (baseline) testing as well as testing in response to an outbreak.   

Summary of June 9 CDPH Weekly Call

CDPH has provided a summary of its weekly call with health facilities.

Upcoming CMS Call
The Centers for Medicare & Medicaid Services will host Lessons from the Front Lines: COVID-19” on June 19 from 9:30 to 11 a.m. (PT). Physicians and other clinicians are invited to share their experiences, ideas, strategies, and insights with one another related to their COVID-19 response. There will be an opportunity to ask questions of presenters. Call details are as follows:
 

Dial: (833) 614-0820
Passcode: 2258722
Audio webcast

News for June 15

6 p.m. (PT) Deadline Today for Hospital Data Submission to HHS
A reminder that 6 p.m. (PT) today, June 15, is the deadline for hospitals to report certain data to be eligible for a share of the $10 billion from the U.S. Department of Health and Human Services Provider Relief Fund. Hospitals are asked to report through the TeleTracking platform the number of COVID-19-positive inpatient admissions, per facility, that they had between January 1 and June 10. California hospitals are required to submit this data, as the California Department of Public Health (CDPH) is not able to do it based on data submitted through the COVID-19 Tracking Tool.

For more information, see a Special Bulletin issued by the American Hospital Association. Questions about the data request can be directed to providerreliefcontact@hrsa.gov. Questions about the TeleTracking of CARES Act portals can be directed to (877) 570-6903.

CHA COVID-19 Tracking Tool Updates
Recently, the Centers for Disease Control and Prevention (CDC) updated the National Healthcare Safety Network (NHSN) acute care hospital COVID-19 Module to collect additional data elements. As a result, the CHA COVID-19 Tracking Tool will be modified on June 17 to incorporate the new data fields so that CDPH can continue uploading data into NHSN on hospitals’ behalf (as described in All Facilities Letter 20-31.1).
 

These changes will include the addition of nine new fields: 

  • Previous Day’s Conversions to COVID Confirmed
     
  • Previous Day’s New Hospital Onset COVID Confirmed
     
  • Hospital Onset COVID Confirmed
     
  • ED/Overflow COVID Confirmed
     
  • ED/Overflow and Ventilated COVID Confirmed
     
  • Previous Day’s COVID Confirmed Deaths
     
  • NICU Beds
     
  • ICU COVID Occupancy (calculated field – no data entry required)
     
  • NICU Bed Occupancy
     

One of these fields, Previous Day’s Conversions to COVID Confirmed, was not generated by NHSN but was added to meet the state’s needs.


Most of the new fields ask for pieces of data to be separated out from existing, more comprehensive measures. For this reason, and to address some common misinterpretations, clarifying language was added to the data dictionary for some existing fields. All data elements that are newly added or have updated definitions are highlighted in light blue. Hospitals are encouraged to review the data dictionary before inputting data into the revised COVID-19 Tracking Tool.

As always, please contact COVIDTracker@calhospital.org with questions.

AHA Webinar on Effectively Managing Critical Patients with COVID-19
The American Hospital Association is hosting a members-only webinar from 11 a.m. to noon (PT) on June 16. The webinar will include speakers from the Louisiana Hospital Association, University Medical Center New Orleans, and Our Lady of the Lake Regional Medical Center, who will discuss effectively managing critical patients with COVID-19. They will cover how Louisiana hospitals have been able to limit the number of patients on ventilators, the amount of time patients spent on ventilators, and improve patient outcomes. Register here.

Next California Department of Public Health Call for Health Care Facilities: June 16, 8-9 a.m. (PT)

Dial: (844) 721-7239

Passcode: 7993227

News for June 12

Department of Consumer Affairs Extends Some Waivers

The Department of Consumer Affairs has extended, until August 12, waivers that eliminate:

  • The cap on the number of physician assistants, nurse practitioners, and certified nurse midwives that a physician may supervise.
  • The requirement for a physician assistant to have a practice agreement with a specific physician under certain circumstances. Physician supervision is still required, but that supervision can be provided by any physician; no written practice agreement is required.

The original waivers are available here.

Recording of Imperial County Surge and Patient Transfers Call Now Available

CHA held a call yesterday for hospital representatives to learn more about transfers from Imperial County as the state works to coordinate a response to the COVID-19 surge there. A recording of the call is now available. Speakers included Dr. Dave Duncan, Emergency Medical Services Authority director; Lynne Smith-Kinniburgh, director of transfer center services; and René Mollow, deputy director, health care benefits and eligibility for the Department of Health Care Services.

News for June 10 

CHA Submits Recommendations to the State on Resurgence Response, Extending State Regulatory Waivers

CHA has submitted these recommendations to the California Health and Human Services Agency for responding to future resurgences of COVID-19, as an alternative to the spring 2020 response. To ensure Californians can continue to access the care they need and keeping hospitals’ financial viability in mind, the recommendations propose the following:

  • That hospitals work with counties to develop local area surge plans based on California Department of Public Health (CDPH) guidelines
     
  • That hospitals surge in real time to care for additional COVID-19 patients
     
  • That the state funds a COVID-19 Surge Facilities Network to provide the additional care California will need in its response to COVID-19

The recommendations may also be useful to hospitals as they plan their surge capacity for COVID-19 resurgences.

So that hospitals can surge their capacity to care for additional COVID-19 patients in real time, this document also includes the state regulatory waivers that must be maintained — including the COVID-19 State of Emergency, key Executive Order provisions, and specific state waivers and guidance. Given the forecasted COVID-19 resurgences and seasonal Influenza during fall and winter, these need to be continued through the end of March 2021. The waivers that hospitals utilize specifically during patient surges and staffing shortages are proposed to be triggered only during those situations.

CDPH Releases Final Crisis Care Guidelines
CDPH has posted its final California SARS-CoV-2 Pandemic Crisis Care Guidelines. CHA is planning to host a webinar about the guidelines and will provide details in a future edition of Coronavirus Response.

HHS Announces Provider Relief Fund Allocations to Safety Net Hospitals, COVID Hot Spots
The U.S. Department of Health and Human Services (HHS) has announced that it will distribute $10 billion from the Public Health and Social Services Emergency Fund to hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care. HHS will identify eligible hospitals as those with:

  • A Medicare disproportionate payment percentage of 20.2% or greater
     
  • Average uncompensated care per bed of $25,000 or more
     
  • Profitability of 3% or less, as reported to the Centers for Medicare & Medicaid Services (CMS) in the most recently filed cost report
     

The payment is being sent to hospitals this week via direct deposits. Eligible hospitals will receive a minimum distribution of $5 million and a maximum distribution of $50 million.

HHS also announced an additional $10 billion distribution to hospitals located in COVID-19 hot spots. To be eligible, hospitals must report — by 6 p.m. (PT) on June 15 — data on their COVID-19-positive inpatient admissions for the period January 1 through June 10, using the TeleTracking Portal. Note that California hospitals are required to submit this information, as CDPH is not able to do it based on data submitted through the COVID-19 Tracking Tool. For more information, see a Special Bulletin issued by the American Hospital Association.

CMS Releases Patient, Facility Guides on Non-Emergency Care

On June 8, CMS released guides for patients and health care facilities on non-emergency care. The patient guide, Reopening America: What Patients Should Know About Seeking Health Care, provides recommendations to help patients as they consider seeking non-emergency treatment, including not postponing necessary care. The facility guide, Reopening Facilities to Provide Non-emergent Non-COVID-19 Healthcare, provides a summary of CMS’ previous recommendations on delivering in-person care when telehealth is not an option.

In a statement on the patient guide, encouraging the reopening of health care facilities, CMS Administrator Seema Verma said, “Those needing operations, vaccinations, procedures, preventive care, or evaluation for chronic conditions should feel confident seeking in-person care when recommended by their provider.”

DHCS Extends Deadlines for Rural Health Clinic Requests, Data Submissions

On June 4, the Department of Health Care Services (DHCS) issued a notice that, while the Governor’s Executive Order N-55-20 is in effect, federally qualified health centers (FQHCs) and rural health clinics (RHCs) will have 90 days beyond the statutory deadline to submit a scope-of-service change request and rate setting cost report. In addition, DHCS’ time frame to finalize reviews of change in scope of service requests, rate setting cost reports, and reconciliation requests will be extended for an additional 90 days beyond the statutory deadline date. FQHCs and RHCs that have any questions should contact DHCS’ Audits and Investigations FQHC/RHC Section at clinics@dhcs.ca.gov.

FDA Posts Presentation Slides from PPE Webinar
On June 9, the Food & Drug Administration (FDA) hosted a webinar on personal protective equipment, including decontamination methods, and has posted the webinar presentation slides. As recently reported in Coronavirus Response, on June 7 the FDA reissued emergency use authorizations that revise policy on the types of N95 respirators that can be decontaminated for reuse.

New Online Counseling Registry Supports First Responders, Health Professionals

A new online counseling registry of California licensed mental health professionals contains a list of over 1,500 volunteer counselors available to assist and support first responders and front-line health professionals fighting the COVID-19 crisis. Volunteers are licensed mental health professionals solicited through their professional associations who volunteered to provide at least two one-hour sessions at no cost to those seeking care. For assistance accessing the website or with questions about the site or the program, email community@covid19counselingca.org.

CMS Call for Nurses: June 11 at noon (PT)

CMS will host a call June 11 at noon (PT) for nurses. Call details are as follows:

Dial: (833) 614-0820
Passcode: 2863547
Audio webcast

News for June 8 

FDA Revision to N95 Decontamination Policy, Webinar Tomorrow
On June 7, the Food & Drug Administration (FDA) reissued emergency use authorizations that revise policy on the types of N95 respirators that can be decontaminated for reuse. Tomorrow, June 9, from 9 to 10 a.m. (PT), the FDA will host a webinar on respirators for health care personnel use during the COVID-19 pandemic. Registration is not necessary. Here is the participation information:
 

Dial-in: (888) 455-1392
Conference Number: PWXW1396032
Passcode: 5820545
 

COVID-19 Testing Task Force Releases PCR Test Kit Analysis

The California COVID-19 Testing Task Force has released a Test Kit Analysis spreadsheet with all available polymerase chain reaction (PCR) test kits as of May 2020. This document can be used to help guide your understanding and/or purchase of COVID-19 PCR testing machines and kits.

Next COVID-19 Testing Task Force Briefing for Hospitals: June 25
CHA has been hosting bi-weekly webinars with the California COVID-19 Testing Task Force. Please note that the June 11 webinar has been rescheduled to June 25 from 3 to 4 p.m. (PT). For more information about the webinars, contact BJ Bartleson at bjbartleson@calhospital.org. Here is the information to participate in the June 25 webinar:
 

Zoom: https://calhospital.zoom.us/j/94875209114
Listen only: (669) 900-9128 or (213) 338-8477
Meeting ID: 948 7520 9114


Next California Department of Public Health Call for Health Care Facilities: June 9, 8-9 a.m. (PT)
Dial: (844) 721-7239

Passcode: 7993227

Upcoming CMS Calls

The Centers for Medicare & Medicaid Services will host several calls over the next two days, one for hospitals and health systems and others for home health/hospice providers, dialysis organizations, and nursing homes. Call details are as follows:
 

Hospitals and Health Systems: June 9 at 2 p.m. (PT)

Dial: (833) 614-0820
Passcode: 4892554
Audio webcast

Home Health and Hospice Providers: June 9 at noon (PT)
Dial: (833) 614-0820
Passcode: 7359947
Audio webcast

Nursing Homes: June 10 at 1:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 9782909
Audio webcast

Dialysis Organizations: June 10 at 2:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 6553907
Audio webcast

News for May 29

The Joint Commission to Resume Surveys in June

On May 27, The Joint Commission (TJC) announced that it will resume surveys in June. The announcement explains that TJC account executives will begin contacting organizations due for a survey to assess the impact COVID-19 has had on their operations and their current state. It also notes that TJC is reviewing factors and criteria for determining which organizations will be surveyed, including prioritizing those in low-risk areas.

CMS Issues New COVID-19 FAQs on Medicare Fee-for-Service Billing

The Centers for Medicare & Medicaid Services has issued FAQs that clarify billing requirements for Medicare fee-for-service providers, including physicians, hospitals, and rural health clinics during the pandemic. The FAQs address outpatient therapy, telehealth and appropriate coding, and federally qualified health centers, among other topics.

DMHC Issues FAQs on Reimbursement for COVID-19 Testing
The Department of Managed Health Care has issued FAQs clarifying that all health plans and other payers — commercial, Medi-Cal, Medicare, and ERISA — must cover COVID-19 tests without prior authorization, at no cost to the enrollee. Plans may not deny coverage based on lack of medical necessity. This requirement applies to all tests approved or authorized by the Food and Drug Administration or the state, including follow-up tests, tests administered by a skilled-nursing facility, and testing for asymptomatic patients.

Summary of May 26 CDPH Weekly Call
The California Department of Public Health has provided a summary of its weekly call with health facilities.

News for May 27

HHS Announces 45-Day Deadline Extension for Providers Receiving Relief Fund Payments

The U.S. Department of Health and Human Services (HHS) has announced a 45-day deadline extension for providers receiving payments from the Provider Relief Fund to accept the terms and conditions. This includes the Coronavirus Aid, Relief, and Economic Security Act, as well as the Paycheck Protection Program and Health Care Enhancement Act. Under the extension, providers now have 90 days from the date they received a payment to accept the HHS terms and conditions or return the funds. More information is available at hhs.gov/providerrelief.

California Receives Additional Remdesivir, Including Doses for Pediatric Care

California received its third shipment of remdesivir on May 22, totaling 17,280 doses. A portion of the allocation is remdesivir lyophilized powder used for pediatric cases. It will be distributed to the county medical health operational area coordinators in the next few days. Previous shipments to California were in solution form; the powder does not require refrigeration. As most counties are moving into Stage 2 of modifying the stay-at-home order, the state is closely monitoring for increased hospitalization rates. To account for potential changes in COVID-19-related hospitalizations over the next two weeks, the California Department of Public Health (CDPH) will distribute 50% of the shipment based on May 22 data for hospitalized patients with confirmed COVID-19, and 50% based on May 29 data. The shipment will likely be California’s largest and the last one until early June. More guidance about remdesivir is available on the CDPH website under the bullet on remdesivir.

Hospital Workgroup to Address COVID-19 Testing Challenges
CHA is actively working with the California COVID-19 Testing Task Force to increase COVID-19 testing capacity and access. In addition, CHA and the Regional Associations have established an internal workgroup to help troubleshoot hospitals’ testing concerns and elevate them to the statewide testing task force. We are interested in hearing about your challenges with testing capacity, supplies, roles and responsibilities, and more. Comments, questions, and concerns can be sent to BJ Bartleson at bjbartleson@calhospital.org.

Statewide Testing Task Force Newsletter and Upcoming Call with Hospitals

The California COVID-19 Testing Task Force is working diligently to rapidly produce test results, increase capacity, and develop strategies to meet the ongoing demands of the COVID-19 pandemic. Among the many resources available on the task force’s website is a regularly published newsletter with the latest developments, as well as FAQs. The latest newsletter is here. The task force reports the state has surpassed 50,000 tests administered per day this week.

Tomorrow, May 28, CHA will again host the biweekly CHA/California COVID-19 Testing Task Force call from 3 to 4 p.m. This is a chance for hospitals to hear updates from members of the task force and to ask questions of task force leaders. Details for joining the call are:

Zoom: https://calhospital.zoom.us/j/94875209114

Listen only: (669) 900-9128 or (213) 338-8477

Meeting ID: 948 7520 9114
 

CDPH Infection Control Surveys Checklist

CHA requested and obtained from CDPH the COVID-19 Outbreak Facility Healthcare Assessment Tool, which CDPH surveyors are using during their infection control surveys of hospitals and skilled-nursing facilities (SNFs). The checklist was developed by the CDPH Healthcare-Acquired Infections Program. CDPH surveyors are using this tool along with the CMS entrance checklist and the hospital-specific information on Focused Survey for Acute and Continuing Care Providers on pages 19-28 of CMS’ Survey and Certification Memo to State Survey Agencies QSO 20-20.

CMS Fact Sheet Covers Payment for Alternate Care Sites
The Centers for Medicare & Medicaid Services (CMS) has issued a fact sheet for state and local governments and others who are developing alternate care sites to expand capacity for providing needed care. The fact sheet provides information on how to seek payments through CMS programs — Medicare, Medicaid, and the Children’s Health Insurance Program — for acute inpatient and outpatient care.

CDPH Issues Guidance for Testing at SNFs
CDPH has issued All-Facilities Letter (AFL) 20-53, which provides recommendations for testing residents and health care personnel at SNFs. Previous CDPH guidance (AFL 20-52) required the development of a COVID-19 mitigation plan with several specific elements, including a plan for testing. The current guidance includes recommendations for baseline, surveillance, and response-driven testing to prevent spread of infection.

New Childcare Resource Document and Closure of Emergency Childcare ‘Pop-up’ Services
The California Child Care Resource & Referral Network has created a list of resources and contacts to assist essential workers in finding childcare and help paying for it. In addition, the California Department of Social Services (CDSS) is phasing out its emergency childcare “pop-up” services. The department is contacting all operators to assist in transitioning the emergency temporary sites to permanent care sites, or to help the sites assist families with finding other permanent care. Questions about the emergency pop-up site changes can be directed Shanice Orum, program administrator for the Childcare Licensing Program at CDSS, at (916) 651-6040.

Summary of May 19 CDPH Weekly Call
CDPH has provided a summary of its weekly call with health facilities. It has not yet distributed the summary from its May 26 call. 

News for May 22

HHS Announces Nearly $4.9 Billion Distribution to SNFs Impacted by COVID-19
The U.S. Department of Health and Human Services (HHS) announced today that it has begun distributing billions in additional relief funds to skilled-nursing facilities (SNFs), including distinct part nursing facilities. The funding is intended to help nursing homes address critical needs such as labor, scaling up their testing capacity, acquiring personal protective equipment, and a range of other expenses directly linked to this pandemic. HHS will distribute funding to all certified SNFs with six or more certified beds on both a fixed basis and variable basis. Each SNF will receive a fixed distribution of $50,000, plus a distribution of $2,500 per bed.

California Receives Additional Remdesivir Allocation
California’s allotment of remdesivir was significantly increased from 1,200 vials last week to 17,000 vials this week. The California Department of Public Health (CDPH) has issued guidance and additional information about the distributions, and county-by-county allocations can be found here.

CDPH Anticipates Extending Suspension of Hospital Licensing Requirements, Enforcement
In response to an inquiry from CHA, CDPH has communicated that it anticipates extending — with possible modifications — All-Facilities Letter (AFL) 20-26. This AFL temporarily waives hospital licensing requirements and suspends regulatory enforcement of the requirements, with certain exceptions. It expires June 30, unless extended by CDPH, which has this authority through the period of the declared emergency. CHA will continue to advocate with CDPH for an extension that creates the regulatory environment hospitals need to respond to the COVID-19 crisis and the forecasted resurgences.

DMHC All Plan Letter Encourages Health Plans to Help Providers
On Wednesday, the Department of Managed Health Care (DMHC) issued an All Plan Letter that will help hospitals negotiate with health plans on claims, advance payments, and administrative burdens. In the letter, DMHC notes it will closely monitor plans’ compliance with timely claims processing and other activities. The letter:

  • Reminds these plans of their duty to maintain adequate networks that provide enrollees with medically necessary services in a timely manner, especially in a period when hospitals and other providers are reporting significant financial difficulties
     
  • Mandates that all plans with commercial lines of business submit an informational filing to DMHC explaining the steps the plan has taken, and/or will take, to ensure continued network adequacy.
     
  • Strongly encourages these plans and risk-based organizations to take steps to:
     
    • Expedite claims review and payment to decrease the accounts receivables owed to providers
    • Identify and remove administrative burdens that may be delaying providers’ abilities to submit and be paid for claims
    • Work with their contracted providers to give the providers advance payments when feasible and desired
    • Amend coordination of benefit procedures in situations where the enrollee has not yet verified they do not have alternative coverage, such that the default is to pay the claim


CHA Asks State for Support in Access to SNF Care

CHA has sent a letter to leadership at the California Health and Human Services Agency and CDPH, requesting that the state consider two actions to support post-hospital access to SNF care during the current COVID-19 public health emergency. Specifically, CHA requested that CDPH establish an easily accessible list of COVID-ready facilities, including admission policies and patient criteria, as well as significantly increase the availability of training and support resources for infection prevention practices in SNFs.

CMS Issues Guidance on Outpatient Therapy Coding and Billing
The Centers for Medicare & Medicaid Services (CMS) has issued guidance on coding and billing for outpatient therapy services, including services provided remotely. The additions to the therapy code list reflect those made in calendar year 2020 for the COVID-19 public health emergency.

Health Affairs Article Demonstrates Racial and Ethnic Inequities in COVID Patients

A recent article published in Health Affairs found that African American patients are nearly three times as likely to be hospitalized with COVID-19 as non-Hispanic whites. The article describes how African American patients with COVID-19 are accessing health care at a point where they are more seriously ill and more likely to be hospitalized. It also explores possible explanations, including societal factors that result in barriers to timely access to care or create circumstances in which patients view delaying care as the most sensible option.

Resources Available for Reducing Risk Among Drug Users

The Harm Reduction Coalition has published a series of resources aimed at reducing risk and minimizing infection complications for drug user. Materials are available in English, Spanish, Portuguese, and Arabic.

News for May 20

CMS Provides Payment Information for COVID-19 Serology Tests
The Centers for Medicare & Medicaid Services (CMS) has updated its fact sheet on COVID-19 diagnostic test pricing with CPT codes for nucleic acid and serology tests. Specifically, the American Medical Association developed CPT code 87635 for infectious agent detection by nucleic acid tests, and CPT codes 86769 and 86328 for serology tests. CMS notes that local Medicare administrative contractors (MACs) are responsible for developing payment amounts for the newly created codes in their respective jurisdictions until Medicare establishes national payment rates. Noridian, California’s MAC, has set the payment rate for code 87635 (nucleic acid test) at $51.31, code 86769 (serology test) at $42.13, and code 86328 (serology test) at $45.23.

Prior to this update, laboratories could bill for COVID-19 diagnostic tests using the code U0001 for tests developed by the Centers for Disease Control and Prevention (CDC) and code U0002 for non-CDC developed tests. The payment rate for CDC tests is $35.91 and for non-CDC tests is $51.31.

CMS Issues Guidance for Reopening SNFs
CMS has issued guidance and frequently asked questions for state and local officials about reopening of skilled-nursing facilities (SNFs). Recommendations include a phased process for relaxing certain restrictions, visitation, and service changes, and for restoring survey activities.

Rural Health Clinics to Receive $225 Million to Expand Testing
The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), has announced $225 million to support COVID-19 testing efforts and expand access to testing at more than 4,500 rural health clinics (RHCs) nationwide. The funding is part of the Paycheck Protection Program and Health Care Enhancement Act. HRSA will also award $500,000 to support technical assistance efforts to the RHCs as they expand testing capabilities. This includes activities such as conducting webinars, providing resources and guidance for implementation, and management of testing programs. A state-by-state breakdown of the funding can be found here.

New Guidance on Swing Bed Waiver
CMS has released guidance on the blanket waiver that expands hospitals’ ability to offer skilled-nursing level care through the use of swing beds for patients who do not require acute care but cannot find nursing home placement during the COVID-19 public health emergency. The guidance includes information on how hospitals can request approval for swing beds through their MAC, clarifications on the waiver’s requirements, and information on hospital billing and payment for swing bed services.

FAQs Available on Workers’ Compensation Presumption

The Division of Workers’ Compensation has issued frequently asked questions related to the Governor’s May 6 Executive Order, which created a workers’ compensation presumption for COVID-19 claims.

Upcoming CMS Calls

CMS will host several calls over the next two days — one for hospitals and health systems, one for nurses, and a third that will cover lessons from the front lines. Call details are as follows:
 

Nurses: May 21 at noon (PT)

Dial: (833) 614-0820

Passcode: 2874976

Audio webcast

Hospitals and Health Systems: May 21 at 2 p.m. (PT)

Dial: (833) 614-0820

Passcode: 9984433

Audio webcast

Lessons from the Front Lines: May 22 at 9:30 a.m. (PT)

Dial: (877) 251-0301

Passcode: 6086125

Audio webcast
 

News for May 18

To support hospitals and health systems during the COVID-19 public health crisis and as they resume care for non-COVID patients, CHA has created a web page as a repository of information and is distributing this regular email update.

Today’s Data Reporting Deadline for Remdesivir Distribution Canceled

On Friday, CHA informed members about a deadline today for submitting data related to the allocation of remdesivir. The U.S. Department of Health and Human Services (HHS) has now canceled that request, so hospitals do not need to submit data today.

Over the weekend, HHS determined that it did not need the additional data at this time. We recognize the frustration many members are experiencing over the uncertainty of these data requests. HHS has indicated it intends to ask for updated data again soon; CHA will share that request and any additional information as soon as it is available. More information, including a link to the HHS notification, is available in this Special Bulletin from the American Hospital Association.

DHCS Updates on State Plan Amendment and More
The Department of Health Care Services has provided website updates with new and additional information for providers. The updates include the May 13 Centers for Medicare & Medicaid Services (CMS) approval of California’s State Plan Amendment (retroactive to March 1), a county operations survey summary, fee-for-service pharmacy benefits, pharmacy coverage clarifications, and the Telehealth for Billing Option Program.

Slides Available from State Testing Task Force Meeting with Hospitals
On May 14, CHA member hospitals had an opportunity to meet with members of the state’s COVID-19 Testing Task Force — including CHA President & CEO Carmela Coyle and task force co-chairs Dr. Charity Dean, assistant director of the California Department of Public Health (CDPH), and Paul Markovich, CEO of Blue Shield California. The call included a briefing on the Testing Task Force’s progress toward statewide testing capacity and goals, as well as questions from hospitals for the task force members. The slide deck from that call is available here. Questions can be emailed to testing.taskforce@state.ca.gov.

Summary of May 12 CDPH Call
CDPH has provided a summary of its weekly call with health facilities.

Next CDPH Call: May 19, 8-9 a.m. (PT)

Dial: (844) 721-7239

Passcode: 7993227

Upcoming CMS Calls

CMS will host several calls over the next two days, one for hospitals and health systems and others for home health/hospice providers, dialysis organizations, and nursing homes. Call details are as follows:
 

Hospitals and Health Systems: May 19 at 2 p.m. (PT)
Dial: (833) 614-0820
Passcode: 1908409
Audio webcast

Home Health and Hospice Providers: May 19 at noon (PT)
Dial: (833) 614-0820
Passcode: 6477704
Audio webcast

Nursing Homes: May 20 at 1:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 4879622
Audio webcast

Dialysis Organizations: May 20 at 2:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 3287645
Audio webcast

News for May 15

Next Data Reporting Deadline is Monday for Remdesivir Allocation

The U.S. Department of Health and Human Services (HHS) has announced that the next deadline for submitting data to aid in its allocation of the drug remdesivir is Monday, May 18 at 8:59 p.m. (PT). Hospitals are being asked to provide, on a weekly basis, the number of hospitalized coronavirus patients and, of those admissions, the number who currently require placement in an intensive care unit. Data should be submitted using the TeleTracking web portal. Hospitals that already use TeleTracking for their daily reporting do not need to do anything differently for this remdesivir data collection, other than ensure their data are submitted on time. For more information about TeleTracking and the HHS announcement about availability of remdesivir, see the American Hospital Association’s Special Bulletin.

CMS Confirms Continuing “Enforcement Discretion” and Limited Survey Activity

CHA has confirmed that the general enforcement discretion announced by the Centers for Medicare & Medicaid Services (CMS) on March 23 has been extended indefinitely. It applies to hospitals, long-term care facilities, home health agencies, hospices, and laboratories. No surveys will be conducted except: 

  • In response to complaints and facility-reported incidents that CMS believes may constitute an immediate jeopardy (a streamlined infection control review tool will be used during these surveys, regardless of the allegation) 
     
  • For targeted infection control surveys of acute and long-term care providers
     
  • For initial certification surveys
     

The streamlined infection control review tool and explanation are included with the CMS announcement. The California Department of Public Health (CDPH) may also use this entrance checklist. While it is labeled for skilled-nursing facilities (SNFs) and references “residents,” it is being used for both SNFs and hospitals. CDPH might also use the acute care worksheets issued by CMS.


State Testing Task Force Members Brief Hospitals on Testing Capacity, Statewide Goals

CHA member hospitals conferenced yesterday with members of the state’s COVID-19 Testing Task Force — including CHA President & CEO Carmela Coyle and task force co-chairs Dr. Charity Dean, assistant director of CDPH, and Paul Markovich, CEO of Blue Shield California. The co-chairs explained the task force’s objectives, as well as its progress on achieving the Governor’s proposed daily testing numbers. Notably, the state is establishing more sites to ensure equitable access, and progress has been made on securing scarce collection supplies such as swabs and reagents. The co-chairs also discussed improving the process, facilitating innovation, and using data and analytics to reach goals. In addition, hospitals had an opportunity to ask questions of the task force members.

Subsequent meetings with task force members will be held biweekly rather than weekly, as originally scheduled. The next meeting will take place May 28 from 3 to 4 p.m. (PT). To participate:

 

Zoom: https://calhospital.zoom.us/j/94875209114
Meeting ID: 948 7520 9114
Listen only: (669) 900-9128 or (213) 338-8477


CDPH Updates Guidance on SNF Data Submissions

CDPH has issued All Facilities Letter (AFL) 20-43.2, which provides information about the requirement that all SNFs submit daily COVID-19 facility data via an online survey. The updated AFL reflects additional information from the recently released interim final rule from CMS.

Clarification on Health Care Exemption in Families First Coronavirus Response Act
The Department of Labor (DOL) recently responded to CHA’s request for clarification on the technical aspects of the health care exemption from the leave provisions in the Families First Coronavirus Response Act (FFCRA). There was some confusion over how a covered health care employer (those with fewer than 500 employees and public employers) could exempt some or all of its workforce from the expanded family and medical leave provisions and the newly created paid sick leave provisions. Based on the FAQs issued shortly after the law was passed, it was unclear whether a blanket exemption was permitted or whether it had to be on a “case-by-case” basis. The DOL has now clarified that, “Both the EPSLA and EFMLEA permit an employer to elect to exclude an employee from eligibility for paid leave under the Acts if the employee is a health care provider or emergency responder. Please see the regulations at 29 CFR 826.30(c) and Frequently Asked Questions numbers 56 and 57 for more information, including the definitions of “health care provider” and “emergency responder” for these purposes under the FFCRA. The Acts do not require specific individual notice to the employee(s) of the election to exclude.”

EDs Eligible for Federal Grants Supporting Suicide Prevention Efforts

Recognizing that the current crisis will cause increases in depression, anxiety, trauma, grief, isolation, loss of employment, financial instability, and other challenges that can lead to suicide and suicide attempts, the Substance Abuse and Mental Health Services Administration is accepting applications for fiscal year 2020 COVID-19 Emergency Response for Suicide Prevention grants. The grants are intended to support efforts to prevent suicide and suicide attempts among adults age 25 and older. Emergency departments are eligible for the grants, which are anticipated to be for 16 months at up to $800,000 per grantee. Applications are due May 22.

News for May 13

CHA Urges California Representatives to Support New Congressional Funding Proposal

Today, CHA today sent a letter to the California congressional delegation in support of a new House of Representatives bill. The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, H.R. 6800 is the Democrats’ legislative effort to provide relief during the pandemic and financial crisis facing the nation. The House expects to vote on the bill May 15, marking the beginning of what promises to be a partisan negotiation; hospitals are urged to respond to CHA’s alert from last week before the vote on Friday.

Last week CHA sent a letter to the delegation outlining our priorities and, while the HEROES Act does not address all of them, it takes the critical step of not only adding $100 billion to the provider relief fund but also targeting those funds toward hospitals that made significant investments to prepare for the pandemic. The measure also prioritizes funding for lost revenues.

CDPH Announces Remdesivir Distribution in California
On May 11, the California Department of Public Health (CDPH) announced that a limited supply of remdesivir is anticipated to be sent to California this week, with additional allotments to be sent regularly going forward. For each allotment received from the federal government, CDPH will use the most recent hospital census data to proportionately distribute remdesivir to the counties’ Medical and Health Operational Area Coordinator (MHOAC). Details about the first distribution are available here.

Until the number of patients who are eligible for remdesivir treatment under the federal emergency use authorization no longer significantly outstrips the available supply, CDPH recommends a random allocation among each county’s acute care hospitals that are treating COVID-19 patients. Counties should track the cumulative distribution of the medication to each hospital. CDPH advises that hospitals should consider an ethical framework for the distribution of remdesivir to patients, and refer to the California SARS-CoV-2 Crisis Care Guidelines and California Guidance for Hospitals Regarding Allocation of Scarce Medications for COVID-19.

CDPH Updates Staffing Resources Letter, Quick Reference Guide
CDPH has updated AFL 20-46.1 on requests by health care facilities (e.g. hospitals, skilled-nursing facilities) for urgent COVID-19 staffing resources, to include a quick reference resource on multi-jurisdictional responses to emergencies and disasters in California, as well as for clarity. Specifically, it now includes that, “If a facility requires ongoing staffing support and a local resource’s ability to continue supplying supplemental staff changes during that period, the MHOAC should work to locate and coordinate supplemental staff through alternate local resources.”

Waiver, Guidance for Pharmacies and Pharmacy Staff
The Department of Consumer Affairs has waived regulations so pharmacists may order and collect specimens for authorized COVID-19 tests. The order terminates 60 days from the date it was issued (May 12), unless further extended. In addition, CDPH has issued guidance for pharmacies and pharmacy staff on operations during the public health emergency, in order to minimize their risk of exposure and reduce customer risk. The guidance emphasizes principles of infection prevention and control, as well as physical distancing.

CDPH Guidance for SNF Mitigation Plans
CDPH has issued All Facilities Letter (AFL) 20-52, which advises skilled-nursing facilities to submit a COVID-19 mitigation plan within 21 days. The plan must include several specific elements, including items addressing infection prevention and control, plans to ensure adequate access to personal protective equipment, space for separation of infected patients, and more. The AFL also provides comprehensive updated infection control guidance.

FAQs Clarify COVID-19 Diagnostic Testing Price Transparency Requirements
The Department of Health and Human Services (HHS) has issued FAQs about recent federal legislation related to coverage of COVID-19 diagnostic testing. The FAQs clarify price transparency requirements of the Coronavirus Aid, Recovery, and Economic Security Act, which mandates that providers post the cash price for a COVID-19 diagnostic test on their website from March 27 through the end of the public health emergency. Providers that do not comply with the requirement and have not completed a corrective action plan could be subject to civil monetary penalties in an amount not to exceed $300 per day that the violation is ongoing.

CalOES Announces Webinars for FEMA Funding Applicants
The California Governor’s Office of Emergency Services (CalOES) has announced it will act as the grantee for Federal Emergency Management Agency’s public assistance program and is ready to assist potential applicants with applying for a public assistance subgrants and understanding eligibility requirements. CalOES will present applicant briefings to provide an overview of the program process and requirements at upcoming webinars. The webinars for private non-profits, which includes non-profit hospitals, will be held:

  • ​May 14, 9 a.m.–noon (PT)
     
  • ​May 15, 2-5 p.m. (PT)
     
  • ​May 18, 9 a.m.–noon (PT)
     
  • ​May 19, ​​2-5 p.m. (PT)
     
  • ​May 20, 9 a.m.–noon (PT) ​
     
  • ​May 21, 2-5 p.m. (PT)​

Participants can register here.

CMS Reaches Out to Nursing Home Staff, Issues New Toolkit
The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma has sent a letter to nursing home management and staff expressing gratitude for their “unwavering dedication and commitment to keeping residents safe.” The letter also includes links to and information about CMS guidance, flexibilities, recommendations, and other information specific to nursing homes.

CMS has also issued a Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes, which provides a compilation of actions taken by state governments and others throughout the U.S. to help nursing homes meet the needs of residents since the onset of the COVID-19 pandemic.

Upcoming CMS Calls

CMS will host several calls over the next two days — one for hospitals and health systems, one for nurses, and a third that will cover lessons from the front lines. Call details are as follows:
 

Nurses: May 14 at noon (PT)

Dial: (833) 614-0820
Passcode: 4279137
Audio webcast

Hospitals and Health Systems: May 14 at 2 p.m. (PT)
Dial: (833) 614-0820
Passcode: 5688374
Audio webcast

Lessons from the Front Lines: May 15 at 9:30 a.m. (PT)
Dial: (877) 251-0301
Passcode: 8983296
Audio webcast

News for May 11

To support hospitals and health systems during the COVID-19 public health crisis and as they resume care for non-COVID patients, CHA has created a web page as a repository of information and is distributing this regular email update.

State Serology Testing Guidance
The California COVID-19 Testing Task Force has released guidance on serology testing, addressing when it should and should not be used. The guidance is included in the task force’s May 8 newsletter, which is issued on a weekly basis.

CMS Releases Additional Blanket Waivers for Hospitals and Other Facilities
The Centers for Medicare & Medicaid Services (CMS) has released additional blanket waivers that apply for the duration of the COVID-19 public health emergency. The new waivers expand hospitals’ ability to offer long-term care services for patients who do not require acute care but meet the skilled-nursing facility level of care criteria. CMS is also waiving distance requirements, market share, and bed requirements for sole community hospitals and certain eligibility requirements for Medicare-dependent small rural hospitals. In the waivers, CMS also updates specific life safety code requirements for hospitals, hospice, and long-term care facilities.

CMS Waiver Provides Additional Medi-Cal Flexibilities

On May 8, the Department of Health Care Services received its second approval from CMS in response to its 1135 Waiver requests submitted over the past two months. The approval provides additional flexibilities for the Medi-Cal program, including extension of pre-existing authorizations through the end of the public health emergency, and other home- and community-based services flexibilities.

CDC Expands Symptoms List

The Centers for Disease Control and Prevention (CDC) has updated its list of COVID-19 symptoms, broadening the range from mild to severe illness. In All Facilities Letter 20-51, the California Department of Public Health (CDPH) identifies the symptoms in two categories: 1) symptoms — such as cough, shortness of breath, fever, chills, muscle pain, sore throat, and new loss of taste or smell, and 2) emergency warning signs — such as trouble breathing, persistent pain or pressure in the chest, new confusion, or bluish lips or face ­— that require medical attention immediately.

Some N95 Respirators from China No Longer FDA pproved
The Food and Drug Administration (FDA) has revised its Emergency Use Authorization (EUA) for disposable respirators made in China that are not approved by the National Institute for Occupational Safety and Health. It supersedes the agency’s prior EUA from April 3, adds new conditions for authorization, and removes several previously approved N95 and KN95 respirators from its approved list. According to the FDA, the revision was “in response to questions and concerns” and led the agency to conclude that a revision “is appropriate to protect the public health or safety.” More information is available here.

Next CDPH Call: May 12, 8-9 a.m. (PT)

Dial: (844) 721-7239

Passcode: 7993227

Upcoming CMS Calls

CMS will host several calls over the next two days, one for hospitals and health systems and others for home health/hospice providers, dialysis organizations, and nursing homes. Call details are as follows:

Hospitals and Health Systems: May 12 at 2 p.m. (PT)
Dial: (833) 614-0820
Passcode: 8968295
Audio webcast

Home Health and Hospice Providers: May 12 at noon (PT)
Dial: (833) 614-0820
Passcode: 9503927
Audio webcast

Nursing Homes: May 13 at 1:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 2675207
Audio webcast

Dialysis Organizations: May 13 at 2:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 6772827
Audio webcast

News for May 7

CHA Letters to Governor and Congress Request Financial Relief for Hospitals
In a letter sent yesterday to Gov. Newsom, CHA urges the state to allocate billions in economic relief for hospitals, citing extreme revenue losses as a result of their response to COVID-19. The letter explains that, as hospitals took necessary measures to prepare and care for COVID-19 patients, they’ve also sustained a 50% decline in emergency care; revenue losses averaging 20% to 30%; significant costs for special COVID-19-ready construction, PPE purchases, standing up alternate sites of care; and more. Noting that hospitals are key to safely reopening the economy, to keeping people working, and to meeting the indicators the Governor has laid out, CHA asks for:

  • The Legislature to immediately redirect $1 billion in general funds from the budget for the state fiscal year that ends June 30.
     
  • A $3.1 billion allocation from the 2020-21 budget to support hospitals with the submission of a second Section 1115 Emergency Disaster Waiver request.


In a similar letter to the California congressional delegation, CHA urgently requests additional funding for hospitals and health systems to support expenses being incurred as a result of COVID-19. In addition to an immediate and substantial lifeline of financial resources, the letter also requests:
 

  • Safeguarding frontline providers from legal action
     
  • Improvements to the Medicare Accelerated Payment Program
     
  • Implementation of an additional Federal Medical Assistance Percentages increase
     
  • Protection for teaching hospitals
     
  • Preserving 340B eligibility
     
  • Further addressing reimbursement cuts
     
  • Support for our health care workforce
     
  • Elimination of regulatory and administrative burdens


CHA Media Campaign Highlights Economic Impact on Hospitals

Today, CHA launched a new campaign that highlights the economic impact of the COVID-19 pandemic on hospitals. The campaign opened with a statewide audio press briefing this morning that featured Carmela Coyle, CHA President & CEO; Scott Reiner, CEO, Adventist Health; and Diane Hansen, CEO, Palomar Health. The campaign continues next week with daily press briefings highlighting the pandemic’s geographic impact — specific to the Bay Area, Los Angeles, and San Diego — as well as on rural hospitals and health care systems. The initiative also includes social media, digital advertising, targeted asks of the Governor and the Legislature, and a microsite — www.protectourhospitals.org.


HHS Extends Attestation Deadline for Provider Relief Funds
The Department of Health and Human Services (HHS) has extended the deadline for health care providers to attest to receipt of payments from the Provider Relief Fund and accept the terms and conditions. Providers will now have 45 days – increased from 30 days – from the date they receive a payment to attest and accept the terms and conditions or return the funds. For example, the initial 30-day deadline for providers who received payment on April 10 is extended from May 9 to May 24. With the extension, not returning the payment within 45 days of receipt of payment will be viewed as acceptance of the terms and conditions. Additional information on the Provider Relief Fund Attestation portal is available on HHS’s Provider Relief Fund website.

Federal Distribution of Remdesivir
The drug Remdesivir, which has been associated with improvement in COVID-19 patients, is being made available to select hospitals through a federal distribution process. Gilead, the manufacturer, donated 1.5 million doses — which represents 140,000 treatment courses — to the federal government for distribution. CHA is not aware of any California hospitals receiving distributions and anticipates a federal announcement about the distribution soon.

News for May 6

Executive Order Extends Workers’ Compensation Benefits to Workers Who Report to Work During Shelter-in-Place Order

Today, Gov. Newsom signed an Executive Order to extend workers’ compensation benefits to all employees who were required to report to work outside their homes from March 19 through July 3. While CHA has not had an opportunity to fully analyze the order, here are the significant points:

  • Applies to all sectors, not just first responders and health care
     
  • Requires the employee to have tested positive or be diagnosed by a physician, followed by a positive test within 30 days
     
  • Requires the employee to have performed work at the place of employment and at the employer’s direction within 14 days of a positive test or diagnosis
     
  • Allows employers to present evidence to show the virus exposure did not occur at work
     
  • Requires employees to exhaust COVID-19 specific supplemental paid sick leave (FFRCA, etc.) before receiving temporary disability benefits. If no such benefits are available, there is no waiting period to receive temporary disability benefits.
     
  • Employers have 30 days to reject a claim.
     
  • Allows for recertification of temporary disability every 15 days, for the first 45 days

The Department of Industrial Relations intends to provide additional guidance in the next few days. There are many questions from the provider and the employer sides, as well; CHA is working to have these addressed.

CDC Revises Return-to-Work Criteria for Health Care Workers
The Centers for Disease Control and Prevention has further revised its guidance for return-to-work criteria for health care workers with confirmed or suspected COVID-19. Of note, the guidance moves to “symptom-based” and “time-based” strategies. For symptomatic workers, the timeframe to return to work under the symptom-based strategy has increased from seven to 10 days.

CMS Extends Regulatory Enforcement Discretion
On March 23, the Centers for Medicare & Medicaid Services (CMS) announced general regulatory enforcement discretion for at least three weeks. CHA has confirmed with CMS that this has been extended indefinitely. The enforcement discretion applies to hospitals, long-term care facilities, home health agencies, hospices, and laboratories. No surveys will be conducted except: 

  • In response to complaints and facility-reported incidents that CMS believes may constitute an immediate jeopardy. A streamlined infection control review tool will be used during these surveys, regardless of the allegation.
     
  • Targeted infection control surveys of acute and long-term care providers. The streamlined infection control review tool included with the CMS announcement will be used. The California Department of Public Health (CDPH), as the CMS contractor, may use this entrance checklist as it conducts infection control surveys of both skilled-nursing facilities (SNFs) and hospitals. While the checklist is labeled for SNFs and references “residents,” it is being used for both SNFs and hospitals. CHA has received clarification that CDPH surveyors may use the hospital-specific information on Focused Survey for Acute and Continuing Care Providers on pages 19-28 of CMS’ Survey and Certification Memo to State Survey Agencies QSO 20-20.
     
  • Initial certification surveys.

Updated Guidance on Transfers to Alternate Care Sites
CDPH has issued revised All Facilities Letter (AFL) 20-48.1, providing guidance for the transfer of COVID-19 positive patients and residents to alternate care sites.

Summary of May 5 CDPH Call
CDPH has provided a summary of its weekly call with health facilities.

Upcoming CMS Calls
CMS will host several calls over the next two days for hospitals and health systems, nurses, and a third that will cover lessons from the front lines. Call details are as follows:


Hospitals and Health Systems: May 7 at 2 p.m. (PT)
Dial: (833) 614-0820
Passcode: 1181167
Audio webcast

Nurses: May 7 at noon (PT)
Dial: (833) 614-0820
Passcode: 5486361
Audio webcast

Lessons from the Front Lines: May 8 at 9:30 a.m. (PT)
Dial: (877) 251-0301
Passcode: 9146779
Audio webcast

New Publishing Schedule for Coronavirus Response

Coronavirus Response is now being published on Monday, Wednesday, and Friday. As a reminder, key updates for hospitals and FAQs on a broad range of topics related to the pandemic are available and continually updated on CHA’s website.
 

News for May 4

CDPH Updates Visitor Guidance

The California Department of Public Health (CDPH) has updated its visitor guidance by issuing All Facilities Letter (AFL) 20-38.1, which supersedes AFL 20-38. The updated AFL recommends that facilities allow support persons to accompany patients with physical, intellectual, or developmental disabilities and patients with cognitive impairments, when medically necessary and appropriate.

CHA and Coalition Recommend State Action on PPE

CHA has signed on to a coalition letter to the Governor, asking the state to ensure adequate personal protective equipment (PPE) for all essential workers. Specifically, the letter recommends that the state:

  • Provide regular reports on the current inventory of PPE in the state stockpile and the status of those supplies.
     
  • Create a supply chain strike team within the administration, designate a lead to coordinate the expansion of PPE supply in the state stockpile, and ensure a comprehensive and equitable distribution process.
     

Other coalition members include Service Employees International Union California, California Association of Health Facilities, and California Health Advocates.


Public Hospital Eligibility for Paycheck Protection Program

The Small Business Administration (SBA) has issued updated FAQs that address eligibility for certain public hospitals under the Paycheck Protection Program (PPP). For the purposes of the PPP, the SBA will treat a nonprofit hospital exempt from taxation under section 115 of the Internal Revenue Code — related to tax exemption of governmental organizations — as meeting the definition of “nonprofit organization” if the hospital reasonably determines, in a written record maintained by the hospital, that it is an organization described in section 501(c)(3) of the Internal Revenue Code.

CMS Commission on Nursing Home Safety

The Centers for Medicare & Medicaid Services (CMS) has established an independent commission to conduct a comprehensive assessment of the nursing home response to the pandemic and provide recommendations to help inform immediate and future responses. The new commission is expected to convene in late May and will include leading industry experts, family members, clinicians, resident/patient advocates, medical ethicists, administrators, academicians, infection control and prevention professionals, state and local authorities, and other selected experts.

Next CDPH Call: May 5, 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.

Upcoming CMS Calls

CMS will host several calls over the next two days, one for hospitals and health systems and others for home health/hospice providers, dialysis organizations, and nursing homes. Call details are as follows:

Hospitals and Health Systems: May 5 at 2 p.m. (PT)

Dial: (833) 614-0820
Passcode: 3996146
Audio webcast

Home Health and Hospice Providers: May 5 at noon (PT)
Dial: (833) 614-0820
Passcode: 7844154
Audio webcast

Nursing Homes: May 6 at 1:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 8899983
Audio webcast

Dialysis Organizations: May 6 at 2:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 8278522
Audio webcast

New Publishing Schedule for Coronavirus Response

Beginning today, Coronavirus Response will be published on Monday, Wednesday, and Friday. As a reminder, key updates for hospitals and FAQs on a broad range of topics related to the pandemic are available and continually updated on CHA’s website.

News for May 1

HHS Begins Distributing Payments to Hospitals with High COVID-19 Admissions, Rural Providers

The U.S. Department of Health and Human Services (HHS) announced today that it is processing payments from the Provider Relief Fund to hospitals with large numbers of COVID-19 inpatient admissions through April 10, as well as to rural providers. California hospitals and rural providers will receive $543.2 million of the $22 billion total.


HHS is distributing $12 billion to 395 hospitals that provided inpatient care for 100 or more COVID-19 patients through April 10. Of those funds, $2 billion will be allocated based on the hospitals’ Medicare and Medicaid disproportionate share and uncompensated care payments. Recipients of the $10 billion rural distribution will include rural acute care general hospitals and critical access hospitals, rural health clinics (RHCs), and community health centers located in rural areas. Hospitals and RHCs will each receive a minimum base payment plus a percent of their annual expenses.

These hospitals will begin receiving funds via direct deposit in the coming days. A state-by-state breakdown of high-impact hospitals and rural providers is available here.

Updated Testing Prioritization Released
The California Department of Public Health has released updated guidance for public health officials, health care providers, and laboratories for prioritizing specific groups for PCR molecular testing when testing availability is limited. Compared to its interim guidance released April 19, this guidance combines the prior four priority groups into Tier 1 (e.g., hospitalized patients, health care personnel, persons at risk for severe COVID-19 illness, and others), and has a Tier 2 consisting of low-risk asymptomatic individuals.

State Portal for Finding Childcare Options

Gov. Newsom announced yesterday that the state has launched a new portal to help parents find safe and reliable childcare options. The portal follows previous action by the Governor to expand childcare subsidies and after-school programs for essential workers.

Updated EMTALA Guidance
The Centers for Medicare & Medicaid Services has released a new and comprehensive set of FAQs about the Emergency Medical Treatment and Labor Act (EMTALA). Topics covered include patient presentation to the emergency department, where EMTALA applies, qualified medical professionals, medical screening exams, patient transfer and stabilization, telehealth, Section 1135 waivers, and more.

Online COVID-19 Resource Center for Nurses and Nursing Students

HealthImpact has launched a COVID-19 Resource Center with toolkits, guidance, and additional resources to help guide hospitals’ nurses and nursing students on all aspects of the Governor’s Executive Order to increase the workforce. The toolkits and guidance were created by a coalition of academic, clinical practice, workforce, and nursing leaders, including CHA.

CHA Letter on Increasing Nursing Workforce

CHA has submitted a letter to Gov. Newsom urging an increase in the COVID-19 Board of Registered Nursing waiver for simulation hours from 50% to 75%. Such an increase would allow fourth-year students to complete their clinical rotations this year and graduate on time, helping to secure a viable acute care nursing workforce for hospitals.  

Behavioral Health Best Practices and Protocols Available

The Rapid Response Network — a partnership between the Mental Health Services Oversight and Accountability Commission (MHSOAC) and Social Finance, a nonprofit organization — was established to help county behavioral health departments and their community partners respond to the evolving demands of the pandemic and its aftermath. MHSOAC has published Rapid Response Network’s answers to COVID-related questions from the field, which include quarantine protocols for serving the homeless, guidance for inpatient psychiatric facilities, best practices in behavioral telehealth, and more.

New Publishing Schedule for Coronavirus Response

Beginning May 4, Coronavirus Response will be published on Monday, Wednesday, and Friday. As a reminder, key updates for hospitals and FAQs on a broad range of topics related to the pandemic are available and continually updated on CHA’s website.

News for April 30

CMS Announces Additional Flexibilities for Hospitals
The Centers for Medicare & Medicaid Services (CMS) has issued an interim final rule providing hospitals and health care providers with additional flexibilities to respond to the COVID-19 public health emergency. The new regulatory waivers and rules — most of which apply immediately and for the duration of the public health emergency — include provisions to support and expand COVID-19 diagnostic testing, increase hospital capacity, augment the health care workforce, reduce administrative burden, and expand Medicare telehealth services. CHA has advocated for many of these changes and will provide members with additional details in the coming days. Key hospital provisions are listed here. CMS has updated its list of blanket waivers and flexibilities, and more information is available in a CMS press release.

CDPH Conducting Infection Control Surveys
The California Department of Public Health (CDPH) is conducting targeted infection control surveys at the direction of CMS. CDPH has been conducting the surveys for both skilled-nursing facilities (SNFs) and hospitals, using this entrance checklist. While the checklist is labeled for SNFs and references “residents,” it is being used for both SNFs and hospitals.

Cal/OSHA Issues Forms on Respirator Availability
Earlier this week, Cal/OSHA began using a Certification of Extreme Respirator Shortage form when processing complaints that a hospital is not following the Aerosol Transmissible Disease Standard with respect to respiratory protection. It is CHA’s understanding that the form is intended to create a consistent approach in handling such complaints. CHA’s review of the form, however, has raised several concerns, which we have shared with Cal/OSHA. Until there is clarification, hospitals should consult with their legal counsel and consider their unique circumstances and risk tolerance before signing the form. Hospitals may decide to submit their own certification form that is consistent with the April 2, 2020, Cal/OSHA guidance.

Cal/OSHA has also created a Respirator Inventory Worksheet, making it clear that the document is voluntary and hospitals are not required to use it. Note that the Centers for Disease Control and Prevention has a PPE burn rate calculator that may be easier to use.

CMS to Host ‘Lessons from the Front Lines’ Call May 1
CMS will host the next in its series of “Lessons from the Front Lines” calls from 9:30 to 11 a.m. (PT) on May 1. The calls are a joint effort between CMS, the Food & Drug Administration, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experiences, ideas, strategies, and insights related to their COVID-19 response, and participants have an opportunity to ask questions of presenters. Participants may join by phone or web link.

Dial-In: (877) 251-0301

Access Code: 9545128

Audio webcast

News for April 29

HRSA to Host Call Tomorrow on COVID-19 Uninsured Program
On April 30 from 11 a.m. – noon (PT), the Health Resources and Services Administration (HRSA) will host a webinar about the COVID-19 Uninsured Program. As authorized by the Coronavirus Aid, Relief, and Economic Security Act, the program allows every health care provider who has provided treatment for uninsured COVID-19 patients on or after February 4 to be reimbursed at Medicare rates, subject to available funding. Information about joining the call is available here.

For more information about the program and to register to participate, visit the HRSA COVID-19 Uninsured Program Portal.

CDC Expands List of COVID-19 Symptoms
The Centers for Disease Control and Prevention (CDC) has added to its list of possible symptoms that could indicate COVID-19. Previously, the CDC listed three possible symptoms — fever, cough, and shortness of breath — and has now added six new symptoms: chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell.

Summary of April 28 CDPH Call
The California Department of Public Health has provided a summary of its weekly call with health facilities, held April 28.

CMS to Host Two Calls on April 30
The Centers for Medicare & Medicaid Services (CMS) will host the next in its series of calls for hospitals and health systems at 2 p.m. (PT) on April 30. The call will allow participants to ask questions of agency officials about the temporary actions that empower providers to increase capacity, rapidly expand the health care workforce, put patients over paperwork, and further promote telehealth in Medicare.

Dial: (833) 614-0820

Passcode: 7476619

Audio webcast

CMS will also host a call at noon (PT) on April 30 for nurses. The call will provide updates on the agency’s latest guidance, as well as best practices shared by leaders in the field.

Dial: (833) 614-0820

Passcode: 4268398

Audio webcast

News for April 28

CDPH Reverts to Original All-Facilities Letter on Licensing Requirements

The California Department of Public Health (CDPH) has rescinded All-Facilities Letter (AFL) 20-26.1. As a result, AFL 20-26 is in effect through June 30. AFL 20-26 temporarily waives licensing requirements and suspends regulatory enforcement of all licensing requirements for hospitals, with certain exceptions. This includes the waiver of nurse staffing ratios while no longer explicit.

Reminder: Free N95 Decontamination Program for Health Care Facilities

Today, on CDPH’s weekly call with health care facilities, a representative from the Governor’s Office of Emergency Services reminded facilities that the state is making the Battelle Memorial Institute’s N95 decontamination system available for health care facilities free of charge.

There are four steps for health care facilities to take: 1) sign the agreement and email to Jon Cartlidge at cartlidgej@battelle.org; 2) label with the three-digit identifier Battelle assigns to your facility; 3) collect the used N95 respirators (free of makeup); and 4) ship the N95 respirators via UPS using the account provided by the state. The federal government pays for the cleaning and system, and the state pays for the shipping costs to and from the decontamination sites. Battelle should be able to turn them around within 24 hours of receipt, so a hospital could have them back within three days depending on shipping times.

For details about participating, see the information packet and infographic. For more information, call (833) 998-2381.

Federal Blueprint to Support Testing
Yesterday, the President released his Blueprint for Testing Plans and Rapid Response Programs, which describes how the federal government plans to support state and local governments, and partner with private entities, for a nationwide testing strategy. The blueprint is intended to support the administration’s Opening Up America Again guidelines. California’s Testing Task Force continues to meet to increase testing capacity and availability within the state.

‘Care for the Caregiver’ Webinar Recording Available

The Hospital Quality Institute’s “Care for the Caregiver” webinar is now available as an on-demand recording. The webinar includes practical and necessary tools to assist hospitals and their employees in creating a peer support model for adverse events such as the COVID-19 pandemic. Additionally, the training offers information on how to engage in empathic conversation with both patients and families. More information and the recording are available here.

Researching the Pandemic’s Effects on Health Care Workers’ Mental Health

The National Institutes of Health is conducting a study to learn about how the COVID-19 pandemic affects the mental health of health care workers over time. Participation involves health care workers completing online questionnaires every one to three months for 12 months; each questionnaire takes about 30 minutes to complete. Participation is voluntary and may be withdrawn at any time. Learn more at covidhcwstudy.ctss.nih.gov and email questions about participating to covidhcwstudy@nih.gov.


CMS to Host Two Calls April 29

The Centers for Medicare & Medicaid Services (CMS) will host two calls on April 29, one for dialysis organizations and one for nursing homes. The calls will provide updates on the agency’s latest guidance, as well as best practices shared by leaders in the field.


Nursing Homes, 1:30–2 p.m. (PT)
Dial: (833) 614-0820
Passcode: 4680237
Audio webcast

Dialysis Organizations, 2:30–3 p.m. (PT)
Dial: (833) 614-0820
Passcode: 6965645
Audio webcast

News for April 27

State Guidelines for Resuming Preventive Health Care
The California Department of Public Health (CDPH) today released guidelines for gradually resuming, “as soon as practicable,” the many health care services that have been deferred in response to the surge of COVID-19 patients. CHA worked closely with the Governor’s team on these guidelines, which offer a statewide framework while noting that all facilities should comply with local guidelines and recognize local or regional circumstances that require different timelines for resumption of services. Among the other considerations for health care facilities that the guidelines describe for a gradual reintroduction of services:

  • COVID-19 indicators (e.g., infection rates, hospitalizations, emergency department admissions, ICU beds, and skilled-nursing facility [SNF] outbreaks)
     
  • Adequate personal protective equipment
     
  • Availability of testing when knowing the COVID-19 status of staff or patients is important for clinical care and infection control
     
  • Consultation with local public health officers
     
  • Availability of qualified staff
     
  • Having patient flow systems and infection control precautions in place

The guidelines also address care prioritization and scheduling, outpatient visits, hospital and outpatient surgery care, dental services, SNF operations, and more.

Medicare Accelerated and Advanced Payment Programs Suspended

The Centers for Medicare & Medicaid Services (CMS) has announced it will suspend and re-evaluate its Accelerated and Advanced Payment Programs in light of the $175 billion for provider relief payments under the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act. CMS says it will re-evaluate all pending and new applications under the Accelerated Payment Program for Part A providers and will not accept any new applications under the Advanced Payment Program for Part B providers. More information is available in CMS’ updated fact sheet.

Testing Task Force Issues Updates
In its recent newsletter, California’s COVID-19 Testing Task Force details testing supply guidelines. In these guidelines, they state they are making progress to secure additional testing supplies (e.g., swabs and viral transport medium) from multiple manufacturers. The state intends to use the existing Medical and Health Operational Area Coordination (MHOAC) Program infrastructure to equitably distribute limited sample collection supplies across the state. The newsletter also includes updates on the state’s testing sites, options, and processing. See the task force website for more information about its testing goals, how testing data are tracked, and more.

Provider Registration Opens for COVID-19 Uninsured Program
As authorized by the CARES Act, every health care provider who has provided treatment for uninsured COVID-19 patients on or after February 4 can request claims reimbursement through the COVID-19 Uninsured Program and will be reimbursed at Medicare rates, subject to available funding. Beginning today, hospitals can register to participate via the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program Portal. Additional information is available on HRSA’s website.

CMS to Host Two Calls April 28

CMS will host the next in its series of calls for hospitals and health systems at 2 p.m. (PT) April 28. The call will allow participants to ask questions of agency officials about the temporary actions that empower providers to increase capacity, rapidly expand the health care workforce, put patients over paperwork, and further promote telehealth in Medicare.

Dial: (833) 614-0820

Passcode: 5787874

Audio webcast

CMS will also host a call at noon (PT) on April 28 for home health and hospice providers. The call will provide updates on the agency’s latest guidance, as well as best practices shared by leaders in the field.

Dial: (833) 614-0820

Passcode: 1854778

Audio webcast
 

Next CDPH Call: April 28, 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.

News for April 24

CHA Urges DMHC to Issue Directives to Health Plans
CHA today sent a letter to the Department of Managed Health Care (DMHC) explaining some of the serious issues facing hospitals and describing how health plans can support hospitals and their patients. The letter urges the department to direct all health plans that DMHC regulates — including commercial, Medi-Cal, and behavioral health carveout plans — to:

  • Resolve all unpaid claims to hospitals within 30 days 
  • Support hospitals by offering voluntary advance payment programs
  • Remove administrative barriers to speed payment to hospitals 


Details for Participating in N95 Decontamination Program
Earlier this month, the California Department of Public Health (CDPH) issued an All Facilities Letter about preserving used N95 respirators in order to decontaminate them. The state is working with Battelle Memorial Institute to deploy its Food and Drug Administration-authorized emergency use decontamination system in California. Participation in the program is free to hospitals. The federal government is paying for the cleaning and system, and the state is paying for the shipping costs to and from the decontamination sites. Each compatible N95 respirator can be decontaminated up to 20 times. 

For details about participating, see the information packet, infographic on the sign-up process, and sample service agreement. Signed service agreements and questions can be directed to Jon Cartlidge at cartlidgej@battelle.org

Emergency Childcare Subsidies for Health Care Workers
The emergency childcare funding made available to health care professionals as essential workers during the COVID-19 crisis — through an Executive Order by the Governor — has recently been allocated for distribution to county Resource and Referral Networks. Hospital staff are encouraged to take advantage of available vouchers to support childcare expenses by contacting their county Resource and Referral Network and referring to the statewide member directory. If they have difficulty connecting with the county Resource and Referral Network, they can also contact their county Local Planning Council. More details are available in a bulletin from the California Department of Education. 

The funding is intended to support childcare options that best meet the needs of the family — whether they are licensed childcare centers, licensed family childcare, or a family, friend, or neighbor. While vouchers will be limited, all interested parties are encouraged to apply so that each region can gather accurate information about the ongoing need, which will help with future advocacy efforts for additional funding.

Interim Guidance for SNFs on Transfer of Residents
CDPH has issued an All Facilities Letter (AFL) providing interim guidance for transfer and continuity of care of residents with suspected or confirmed COVID-19, including admission of COVID-19-positive residents following hospitalization who still need transmission-based precautions. The AFL also clarifies that the guidance applies when residents are transferred from an alternate care site; that SNFs must accept the return of a resident from a hospital or alternate care site; and that residents may be transferred between facilities for the purposes of cohorting COVID-19 patients.

Billing Instructions for COVID-19 Presumptive Eligibility
The Department of Health Care Services (DHCS) issued billing instructions for presumptive eligibility (PE) for COVID-19, noting the new aid code V2 to identify this population. The code is limited to diagnostic testing, testing-related services, and treatment, including all medically necessary care such as the associated laboratory services, or office, clinic, or emergency room visits related to COVID-19. Providers must include ICD-10 diagnosis code U07.1 on all claims for reimbursement of COVID-19 medically necessary care for PE individuals in aid code V2. The department has also posted new information for qualified providers for the PE for Pregnant Women program, including aid code (code 7F) and procedures. 

Billing-related questions can be directed to the telephone service center at (800) 541-5555, 8 a.m. to 5 p.m. (PT) Monday through Friday.

Behavioral Health Updates from DHCS
DHCS has updated its website with new information related to behavioral health and COVID-19, including:

  • Flexibility for residential mental health facilities and for alcohol and other drug facilities
  • FAQs for mental health and psychiatric health facilities, narcotic treatment programs, and medication-assisted treatment via telehealth
  • Behavioral health services for formerly homeless persons under Project Roomkey


Rural Hospitals to Receive Stimulus Funds
The Small Business Administration has issued an interim final rule clarifying that hospitals owned by a state or local government are eligible for the Paycheck Protection Program (PPP) if the hospital receives less than 50% of its funding from state or local government sources, exclusive of Medicaid. The PPP was authorized by the Coronavirus Aid, Relief, and Economic Security Act; the Paycheck Protection Program and Health Care Enhancement Act signed today allocated an additional $321 billion in funding to the PPP, because previous funding was depleted last week. For more information about federal funding opportunities for hospitals, see CHA’s summary

White House Reaffirms Substance Use Disorder Treatment as Essential 
The White House’s Office of National Drug Control Policy (ONDCP) has reaffirmed that substance use disorder treatment is an essential medical service. In a letter to colleagues, the ONDCP noted that, while it already supports emergency federal exemptions to increase access and use of telemedicine to treat substance use disorder during the COVID-19 pandemic, in-person patient/provider interactions will inevitably occur and require appropriate personal protective equipment.

News for April 23

Deadline to Submit Data for Federal Funding Extended to April 25
Many hospitals have experienced technical difficulties in trying to meet today’s deadline to submit the necessary data to qualify for funding through the Coronavirus Aid, Relief, and Economic Security Act. As a result, the U.S. Department of Health and Human Services has extended the deadline for data submission to noon (PT) on April 25. The first distribution of the $100 billion allocation was $30 billion; the amount of this second distribution is unknown. 

While submitting data does not guarantee eligibility or amount, hospitals that do not submit will not be eligible. More information about the process and the data that must be submitted is available in the CHA Alert sent to member hospitals yesterday. 

Clarification on Restarting Services
At yesterday’s press conference, the Governor’s discussion of restarting some hospital procedures raised questions among hospital leaders. In a subsequent press statement, Gov. Newsom referenced “plans to allow hospitals and health systems to resume delayed medical care for Californians,” rather than an immediate move to restart.

The state’s strategy remains to proceed with a planning process — on an extremely fast track — that includes CHA and other health care leaders working with the Governor’s team on a framework to increase access to care. An initial plan is expected by next week.

CHA Social Media Campaign on ED Readiness
CHA has begun a statewide campaign using social media to reassure the public that hospital emergency departments are safe and prepared for non-COVID-19 health emergencies. The three-tier strategy includes messaging on Twitter, Facebook, and LinkedIn; amplifying individual hospital and system campaigns focused on the same core messaging; and a public-facing campaign (beginning tomorrow) on Our Health California, CHA’s digital community of more than 1 million members. Core messages across all channels include:

  • Emergencies don’t wait. If you’re experiencing a pressing health crisis, your local ER is safe, ready, and waiting
  • California’s ERs: Safe. Ready. Waiting.
  • Safe. Ready. Waiting. California’s ERs are prepared for your emergency 24/7.
  • If you’re hurt, we’re here. California’s ERs are always open and ready to care.


CMS to Host ‘Lessons from the Front Lines’ Call April 24
The Centers for Medicare & Medicaid Services (CMS) will host the next in its series of “Lessons from the Front Lines” calls from 9:30 to 11 a.m. (PT) on April 24. The calls are a joint effort between CMS, the Food & Drug Administration, and the White House Coronavirus Task Force. Physicians and other clinicians are invited to share their experiences, ideas, strategies, and insights related to their COVID-19 response, and participants have an opportunity to ask questions of presenters. Participants may join by phone or web link.
Dial-In: (877) 251-0301 
Access Code: 5096006
Audio webcast

News for April 22

CARES Act Funding Details
Today, the U.S. Department of Health and Human Services (HHS) released an outline describing how the $100 billion Public Health Social Services Emergency Fund will be distributed to providers. Note that these are the funds provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act and do not include the additional $75 billion in the package currently being considered by Congress. Please refer to the CHA Alert sent earlier today for additional information about submitting data — by 11:59 p.m. (PT) on April 23 — for one of the distributions. CHA will continue to work with HHS to learn more about the allocations and distributions and will share information as soon as it becomes available.

State Resources for Health Care Facilities with Urgent Staffing Needs
The California Department of Public Health (CDPH) has issued All Facilities Letter 20-46, which outlines the process for health care facilities experiencing an urgent staffing shortage to request staffing resources from the state. Health care facilities must report these as unusual occurrences to their CDPH Licensing and Certification District Office. CDPH, in collaboration with the local public health department, will assess the situation and determine whether the facility can continue to operate safely.

At the same time, the local public health department will contact the Medical Health Operational Area Coordinator to begin the process of locating resources within the area, region, or state. State resources include the California Emergency Medical Services Authority’s California Medical Assistance Teams, the California Health Corps, and other staffing contracts.

Waiver for Intern Pharmacists
The Board of Pharmacy has issued a waiver to allow for general supervision of an intern pharmacist at the discretion of the supervising pharmacist if:

  • The pharmacy documents the need for the supervision modification due to COVID-19
     
  • The intern pharmacist meets certain criteria
     
  • The pharmacy maintains documentation of the general supervision activities performed under the waiver
     
  • The supervising pharmacist is generally aware of all activities performed by the intern pharmacist
     

CMS to Host Two Calls on April 23
The Centers for Medicare & Medicaid Services (CMS) will host the next in its series of calls for hospitals and health systems at 2 p.m. (PT) on April 23. The call will allow participants to ask questions of agency officials about the temporary actions that empower providers to increase capacity, rapidly expand the health care workforce, put patients over paperwork, and further promote telehealth in Medicare.

Dial: (833) 614-0820

Access Passcode: 5899488

Audio Webcast

CMS will also host a call at noon (PT) on April 23 for nurses. The call will provide updates on the agency’s latest guidance, as well as best practices shared by leaders in the field.
Dial: (833) 614-0820
Passcode: 6004019
Audio webcast

News for April 21

Urge Congress to Vote for Additional Funding for Health Care Providers
Federal lawmakers have reached a deal to expand the Paycheck Protection Program and Health Care Enhancement Act with an additional $75 billion for health care providers. The Senate is expected to vote today; the House is scheduled to vote on Thursday. There is still time before Thursday’s vote to urge House members to vote yes on the package and articulate hospitals’ need for additional funding. Find your representative’s contact information here, and see the template letter CHA has provided for members’ use.

When the first draft of this expansion of the PPP was announced, there was no additional funding for hospitals. House Speaker Nancy Pelosi pushed for $100 billion in additional funds for hospitals, and Minority Leader Kevin McCarthy has endorsed the final package. CHA worked closely with congressional leaders to ensure these additional funds would be included.

Crisis Care Guidelines

The California Department of Public Health (CDPH) has released California State SARS-CoV-2 Pandemic Health Care Surge and Crisis Care Guidelines. In addition to providing an overview of surge capacity and crisis care operational considerations for health care facilities, the document includes detailed processes and guidelines for allocating potentially insufficient critical care/ventilators during the current public health emergency, as well as other pandemic patient care strategies for addressing scarce resource situations. CHA is planning to host a webinar about the guidelines and will provide details in a future edition of Coronavirus Response.
 

Second Tranche of Federal Funding to Be Distributed Soon
The federal Department of Health and Human Services (HHS) announced it will soon make targeted distributions to hospitals and other facilities that have been affected by the increased burden of caring for those with COVID-19. This funding is part of the second round of the $100 billion authorized by the Coronavirus Aid, Relief, and Economic Security Act for health care providers. HHS is asking hospitals to provide the agency with specific data to inform this targeted distribution. Specifically, HHS asks that hospitals report the following information for each facility with a Medicare tax identification number:
 

  • Total number of Intensive Care Unit beds as of April 10, 2020
     
  • Total number of admissions with a positive diagnosis for COVID-19 from Jan. 1-, April 10, 2020
     
  • National Provider Identifier
     

CHA does not know the amount of the distribution (the first distribution was $30 billion), nor do we know what other factors (e.g., Medicaid revenue, Medicare Advantage, or rural status) may be used to calculate the allocations.


Hospital information must be submitted by 11:59 p.m. (PT) on April 23 through an authentication portal established by an HHS vendor, TeleTracking. Hospital administrators should have already received an email from TeleTracking — as part of previous federal data collection efforts — to register for access to the TeleTracking portal. Questions about the registration process can be directed to TeleTracking Technical Support at (877) 570-6903.

Hospital Coalition Urges Financial Stabilizing Medi-Cal Policies
CHA has joined a coalition of hospital groups in requesting that the Department of Health Care Services (DHCS) make several Medi-Cal policy changes in response to the COVID-19 crisis. In a letter sent yesterday, the coalition urges DHCS to help stabilize existing programs and increase the predictability of vital funding sources hospitals need. The request follows the first round of federal funding last week, of which less than 5% was allocated to California’s hospitals. In addition, the smallest proportion of that funding went to providers that deliver the largest share of services to Medi-Cal beneficiaries.

Health Care Facilities Must Certify Employees for Hotel Rooms
The state’s Non-Congregate Sheltering for California Healthcare Workers Program provides hotel rooms to front-line health care workers who are exposed to or test positive for COVID-19 and do not have the ability to self-isolate or quarantine at home. CDPH has issued an All-Facilities Letter notifying health care facilities that, in order for their employees and staff to participate in the program, they must certify that employees within their facility have presumably been exposed to COVID-19.

CHA has prepared a template letter for health care facilities to submit to the Governor’s Office of Emergency Services at HealthcareNCS@caloes.ca.gov by April 30. CDPH recommends saving and printing the completed and signed letter on official letterhead. The letter must be signed by a leading or supervisory medical official (e.g., chief medical officer, rather than administrative official).
 

CMS to Host Two Calls April 22
CMS will also host two call on April 22, one for dialysis organizations and one for nursing homes. The calls will provide updates on the agency’s latest guidance, as well as best practices shared by leaders in the field.

  • Nursing Homes, 1:30 – 2 p.m. (PT)
    Dial: (833) 614-0820
    Passcode: 2672118
    Webcast
     
  • Dialysis Organizations, 2:30 – 3 p.m. (PT)
    Dial: (833) 614-0820
    Passcode: 1796168
    Webcast
     

News for April 20

Initial CMS Recommendations for Re-Opening Facilities

The Centers for Medicare & Medicaid Services (CMS) has issued recommendations for a phase one re-opening of facilities to provide non-emergent non-COVID-19 health care. The recommendations apply if states or regions have passed the gates in the White House Opening Up America Again Guidelines announced April 16. These guidelines recommend a phased approach implementable on a statewide or county-by-county basis at Governors’ discretion.

CMS notes this is the first in what will be a series of recommendations to guide health care systems and facilities as they consider resuming in-person care for non-COVID-19 patients in regions with low incidence of COVID-19. CMS still strongly encourages “maximum use of all telehealth modalities.”


State Task Force on Business and Jobs Recovery

Gov. Gavin Newsom has announced a state Task Force on Business and Jobs Recovery. The task force will work to develop actions government and businesses can take to help Californians recover as fast as safely possible from the COVID-19-induced recession. The group will meet twice a month throughout 2020 and will be co-chaired by the Governor’s Chief of Staff, Ann O’Leary, and businessman Tom Steyer. More details are available in this press release, and a full list of task force members is available here.


Revised Guidance on Daily Hospital Reporting

The California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 20-31.1, which supersedes AFL 20-31 and modifies previous daily reporting information for general acute care hospitals (GACHs). It notifies GACHs of the need to have daily updates on the number and status of COVID-19 patients, bed capacity, and personal protective equipment (PPE). It also notes that CDPH will submit data on behalf of hospitals through the National Healthcare Safety Network COVID-19 module per the Centers for Disease Control and Prevention’s (CDC’s) instructions.


Updated State Testing Prioritization

CDPH AFL 20-44 provides guidance to support local public health departments, health care providers, and laboratories in determining prioritization of specific groups for testing and provides four specific levels of testing priorities. Priority 1 is hospitalized patients, symptomatic health care workers, and residents and staff in high-risk settings (e.g., congregate living facilities and correctional facilities).

The guidance will be reassessed on a weekly basis based on California’s evolving situation and input from stakeholders. The prioritization categories are suggested as guidance to sequential expansion of testing. As capacity increases, testing should expand accordingly at the discretion of the local health officer.


Solid and Medical Waste Determination for PPE

The CDPH Medical Waste Management Program has issued a memo recognizing that not all PPE used in connection with COVID-19 testing, treatment, specimen handling, and cleaning is mandated to be managed as medical waste based on current Occupational Safety and Health Administration (OSHA) and CDC guidelines. It applies to any business generating PPE waste, including all types of health care facilities.

The memo states that the facility/company shall determine the waste management procedures for PPE, meaning it can determine whether the PPE should be disposed of as medical or solid waste. It directs that solid waste should be placed in a lined container, preferably with a lid/cover, and the bag disposing the solid waste items into the solid waste bin should be tightly closed. The CDC recommends anyone handling these items should clean their hands with soap and water for 20 seconds (preferred) or alcohol-based hand sanitizer immediately after handling.

Increased Reporting Requirements for Skilled-Nursing Facilities (SNFs)

  • CDPH has issued AFL 20-43, requesting that SNFs provide via an online survey a daily report of staffing levels, equipment availability, the number of COVID-19 residents — including confirmed positive and suspected — and other facility needs.
     
  • CMS has issued a memo and will soon issue a regulation requiring SNFs to report COVID-19 cases to the CDC and to residents/families. CDC reporting will be done through the National Healthcare Safety Network system. This reporting is additional to reporting to local public health and the CDPH district office. In addition, SNFs will have to report a confirmed positive case to residents within 12 hours. Residents must also be notified within 72 hours if three or more staff/residents have new onset respiratory symptoms.

CMS to Host Two Calls April 21

CMS will host the next in its series of calls for hospitals and health systems at 2 p.m. (PT) on April 21. The call will allow participants to ask questions of agency officials about the temporary actions that empower providers to increase capacity, rapidly expand the health care workforce, put patients over paperwork, and further promote telehealth in Medicare. Participants may join by audio webcast or by phone:

Dial: (833) 614-0820

Passcode: 963515


CMS will also host a call at noon (PT) on April 21 for home health and hospice providers. The call will provide updates on the agency’s latest guidance, as well as best practices shared by leaders in the field. Join by audio webcast or by phone:

Dial: (833) 614-0820

Passcode: 9895252

Next CDPH Call: April 21, 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.

News for April 17

CHA Urges Governor to Issue Executive Order to Support Hospitals During COVID-19 Crisis

CHA sent a letter to the Governor urging him to issue an Executive Order that directs insurance companies and health plans to:

  • Resolve all unpaid claims to hospitals within 30 days
     
  • Support hospitals by offering voluntary advance payment programs
     
  • Remove administrative barriers to speed payment to hospitals
     

The letter notes that during this time of crisis, insurance companies and health plans have continued to receive premiums, while claims for care services have significantly reduced. A few insurance companies and health plans have taken immediate, yet small steps to rebalance cash flow by providing loans or accelerated payments to hospitals, but it’s time for all insurance companies and health plans to quickly do more.


AFLs Address Staffing Ratios, Acute Psychiatric Hospitals, Stockpile Supplies

  • The California Department of Public Health (CDPH) has updated the All Facilities Letter (AFL) providing a temporary waiver of regulatory requirements. Specifically, it clarifies that hospitals experiencing a COVID-19 related surge of patients or staffing shortages resulting from COVID-19 impacts — including, but not limited to, staff testing positive, staff exposures to COVID-19, school closures, and other COVID-19 related impacts — may temporarily operate without meeting mandatory staffing ratios. Hospitals are to resume mandatory staffing ratios as soon as feasible. A hospital whose operation is not impacted by COVID-19 is not eligible for waiver of staffing ratios.
     
  • CDPH has issued an AFL notifying acute psychiatric hospitals (APHs) of the need to submit information about bed space, the number of COVID-19 patients — both confirmed positive and suspected — equipment availability, and other urgent facility needs to CDPH. Information for this one-time survey should be submitted no later than 5 p.m. (PT) on April 24. All other reporting requirements to CDPH district offices will continue using the standard reporting process.
     
  • CDPH has issued an AFL that states the facility cannot charge for any federally supplied medical assets or pharmaceuticals received from the Strategic National Stockpile (SNS). Under federal billing rules, health care facilities cannot charge patients for any federally supplied medical assets or pharmaceuticals, but they may charge patients a fee for administering medical countermeasures. A facility may charge a patient for administration; however, if that medication came from the federal government (e.g., pharmaceuticals from the SNS), the facility cannot charge the patient for the actual medication.

Judicial Council Issues Advisory Memo on Mental Health Proceedings
The Judicial Council of California has issued an advisory to assist the courts in responding to both criminal and civil cases involving individuals with behavioral health issues. The advisory addresses the steps courts can take to protect the rights of involuntarily detained individuals without putting judicial officers and court staff at risk and states that technology should be used to facilitate remote proceedings whenever possible.

Flexibilities for Rural Health Clinics and Federally Qualified Health Centers
The Centers for Medicare & Medicaid Services (CMS) has issued guidance for rural health clinics and federally qualified health centers related to flexibilities under the Coronavirus Aid, Relief, and Economic Security (CARES) Act, including new payment for telehealth and virtual communication services, billing for visiting nursing services furnished to homebound individuals, and accelerated or advanced payments.

Resources for Behavioral Health Facilities

The Department of Health Care Services has shared some resources on COVID-19 mitigation in behavioral health facilities:

In addition, the NCBH is ordering bulk personal protective equipment (PPE) from China and re-distributing to U.S. behavioral health organizations. NCBH anticipates having a link set up in the next few days at which organizations — both outpatient and inpatient — can order PPE.


Reminder: Final ‘Care for the Caregiver’ Webinar on April 21
The third and final “Care for the Caregiver” webinar will be held from 9 a.m. to noon (PT) on April 21. This complimentary webinar is designed to provide “psychological first aid” to health care workers navigating through the COVID-19 pandemic. Hear more about the webinar in this video with CHA President & CEO Carmela Coyle and Hospital Quality Institute President Robert Imhoff.

Details and registration information can be found here.

News for April 16

Updated All Facilities Letter has Toolkit for Skilled-Nursing Facilities
The California Department of Public Health has issued an updated All Facilities Letter that provides a toolkit for managing exposures and recognized cases in skilled-nursing facilities and congregate living settings. The toolkit includes topics such as preparing to receive residents with suspected or confirmed COVID-19, preparing to care for residents with suspected or confirmed COVID-19 infection, preventing spread of COVID-19 within a facility, and notifying residents’ family members or the resident’s representative if there is a COVID-19 positive health care worker or resident in their facility.

FDA Actions Authorize Serology Tests, N95 Decontamination Process
The Food and Drug Administration (FDA) has issued a pair of emergency use authorizations (EUAs) for serology tests to detect for the presence of coronavirus antibodies. The EUAs were issued to Ortho-Clinical Diagnostics, Inc. and Chembio Diagnostic Systems, Inc.

The FDA also authorized the emergency use of Stryker Instrument’s Sterizone VP4 Sterilizer1 N95 Respirator Decontamination Cycle. This device uses vaporized hydrogen peroxide and ozone to decontaminate N95 or N95-equivalent respirators.

Final ‘Care for the Caregiver’ Webinar on April 21
The third and final “Care for the Caregiver” webinar will be held from 9 a.m. to noon (PT) on April 21. This complimentary webinar is designed to provide “psychological first aid” to health care workers navigating through the COVID-19 pandemic. Hear more about the webinar in this video with CHA President & CEO Carmela Coyle and Hospital Quality Institute President Robert Imhoff.

Details and registration information can be found here.

Upcoming Calls and Webinars

  • The National Emerging Special Pathogens Training and Education Center: At 9 a.m. (PT) on April 17. The webinar will cover the what, how, and why of masks for health care workers during the COVID-19 outbreak. More information and registration details are available here.
     
  • Centers for Medicare & Medicaid Services “Lessons from the Front Lines: COVID-19”: From 9:30 to 11 a.m. (PT) on April 17. This call series is an opportunity to hear physicians and other clinical leaders share their experiences, best practices, strategies, and insights related to COVID-19. Participants may join by audio webcast or by phone:
    Dial-In: (877) 251-0301
    Access Code: 8672948 
     
  • The Centers for Disease Control and Prevention Clinician Outreach and Communication Activity: From 11 a.m. to noon (PT) on April 17. Hear about the current impact of the COVID-19 pandemic on health care systems in the United States. More information and registration details are available here.

News for April 15

Billing Guidance — Inpatient Prospective Payment System/Long-Term Care Hospitals

The Centers for Medicare & Medicaid Services (CMS) has issued guidance on the implementation of Coronavirus Aid, Relief, and Economic Security (CARES) Act provisions that increase payments to inpatient prospective payment system (IPPS) hospitals and long-term care hospitals (LTCHs).

The guidance includes implementation of the 20% add-on payment under the IPPS for individuals diagnosed with COVID-19 and the waiver of site-neutral payment provisions of the LTCH prospective payment system. CMS will reprocess claims for inpatient discharges and LTCH admissions on or after January 27, as necessary. CMS also provides guidance on the waiver of the inpatient rehabilitation “3-Hour Rule,” as authorized by the CARES Act.

Increased Medicare Lab Payment for Certain COVID-19 Tests

CMS has announced it will increase Medicare payment for clinical laboratory diagnostic tests that use high-throughput technologies to detect COVID-19. CMS will pay laboratories for the tests at $100, effective April 14, through the duration of the COVID-19 national emergency. For other COVID-19 laboratory tests, local Medicare administrative contractors (MACs) remain responsible for developing the payment amount in their respective jurisdictions. Currently, MACs are paying approximately $51 for those tests.

Pharmacy Waiver for Automated Drug Delivery System Locations
The Board of Pharmacy has waived certain requirements for prelicensure inspection of proposed automated drug delivery system locations. More details are available here.

Regulatory Requirements Suspended for Nurse Assistant Training Programs
The California Department of Public Health has issued an All Facilities Letter that suspends regulatory requirements for nurse assistant training programs, including requirements for theory and clinical training, staff recruitment, in-service training, and orientation.

Upcoming CMS Calls
CMS will host the next in its series of calls for hospitals and health systems at 2 p.m. (PT) on April 16, providing an opportunity to directly engage with agency leadership on questions related to COVID-19 waivers and regulatory flexibilities. Participants may join by audio webcast or by phone:

Dial: (833) 614-0820

Passcode: 2395745

CMS will also host a call for nurses at noon (PT) on April 16. Join by audio webcast or by phone:

Dial: (833) 614-0820

Passcode: 5058949

Telehealth Resources

The National Telehealth Policy Resource Center’s Center for Connected Health Policy has developed a summary of coverage policies and a guide to state actions to assist providers in delivering telehealth services.

Behavioral Health Resources
Psych Hub, a digital platform for education about mental health, has launched a collection of free digital resources to address behavioral health needs during the pandemic. The site, which is a collaboration of advocacy groups, health care payers and the Department of Veterans Affairs, includes resources for behavioral health and health care professionals, individuals, educational institutions, veterans, and others.

New FAQs
CHA’s Coronavirus Response web page now features new navigation to streamline information hospitals need as they navigate this public health emergency. New FAQs include:

  • Childcare resources available for health care workers in different parts of the state (see Human Resources)
     
  • Updates on federal funding to support hospitals (see Federal Funding)
     
  • Details of a new pharmacy waiver of prelicensure inspection of automated drug delivery systems and automated patient dispensing systems (see Pharmacy)
     
  • Information on discounted and free hotel rooms for COVID-19 exposed or positive health care workers (see Human Resources)
     

News for April 14

New Waivers by the Department of Consumer Affairs
The Department of Consumer Affairs has waived the following:

  • The cap on the number of physician assistants, nurse practitioners, and certified nurse midwives that a physician may supervise
     
  • The requirement for a physician assistant to have a practice agreement with a specific physician. Physician supervision is still required, but that supervision can be provided by any physician, and no written practice agreement is required.

Updated and New CDC Guidance

  • Universal source control: The Centers for Disease Control and Prevention (CDC) has released updated guidance for health facilities on interim infection prevention and control. It recommends source control for everyone entering a health care facility (e.g., staff, patients, visitors) regardless of symptoms. Recognizing this could exacerbate the shortage of facemasks, the CDC provides that a cloth face covering may be appropriate for visitors and patients if they arrive at the facility with one. However, hospital facemasks should be used for staff. This revised guidance is in addition to other steps health care facilities can take, including symptom checks and temperature screening.
     
  • Mitigating staffing shortages: The CDC has released guidance on mitigating health care personnel staffing shortages. The guidance gathers options for both contingency capacity and crisis capacity strategies and may be useful as hospitals continue to develop staffing plans.

CDPH Issues Visitor Limitations Guidance
The California Department of Public Health (CDPH) has issued new visitor limitations guidance, striving to limit the spread of COVID-19 while still ensuring the support visitors provide for the mental wellbeing of pediatric, labor and delivery, and end-of-life patients. CDPH recommends limiting the patient to one visitor/support person except for pediatric patients undergoing a prolonged hospitalization, for whom two designated support persons are recommended so long as only one is present at a time.
 

The guidance provides that all support persons may be screened before entering the clinical area, must be asymptomatic for COVID-19 and not be a suspected or recently confirmed case, must comply with any health facility instructions on personal protective equipment, and must stay in the patient’s room.

CDPH encourages facilities, including skilled-nursing facilities, to create opportunities for residents and patients to have frequent video and phone call visits (using appropriate infection control measures on shared devices).

Federal Guidance Issued for Testing Provisions of New Laws
The American Hospital Association (AHA) has developed a special bulletin about jointly issued guidance from the Departments of Health and Human Services, Labor, and Treasury, implementing COVID-19 diagnostic testing and services provisions from the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act. The guidance principally implements the requirement for group health plans and group and individual health insurance (health plans) to cover both certain diagnostic testing and certain related items and services provided during a medical visit with no cost sharing. AHA’s bulletin offers a summary of the key provisions.

Board of Pharmacy Lists Outsourcing Facilities and Available Compounded Preparations
As hospitals and health systems report low supplies of drugs used to care for COVID-19 patients, the Board of Pharmacy has compiled a list of California licensed outsourcing facilities and compounded preparations that may be available from the facilities. Developed from information provided to the Food and Drug Administration, the list is not a full representation of all preparations available but includes preparations that appear to be in high demand.

CHA and Our Health California Launch Appreciation Campaign for Health Care Workers

Our Health California (OHC), supported by hospitals and CHA, has launched an appreciation campaign to recognize the hospital workers and their families who are working day and night to keep our community safe and healthy through this outbreak. A digital community of more than 1 million Californians, OHC is asking community members, the hospital family, and all Californians to sign and send digital messages of thanks to hospital staff and their families throughout the state.

Supporters will have an opportunity to select their preferred card and message, and even write a message of their own. The notes of appreciation will then be digitally passed on to hospitals and health care workers, and posted on OHC’s website. Additionally, CHA will package and deliver the notes of appreciation to hospitals so they can be displayed in highly visible areas.

CMS to Host Call for Nursing Homes Tomorrow
The Centers for Medicare & Medicaid Services (CMS) will host a call at 1:30 p.m. (PT) on April 15 for nursing homes. The call will provide updates on the agency’s latest guidance, as well as best practices share by leaders in the field. Join by audio webcast or by phone:

Dial: (833) 614-0820

Passcode: 3770227

News for April 13

CHA Submits New Waiver Request to CMS

CHA has submitted a fourth waiver request to the Centers for Medicare & Medicaid Services (CMS), in conjunction with the Washington State Hospital Association. CHA’s first waiver request was approved in full; many of the requests in the second and third letters have been granted, while others are still pending. The most recent letter asks CMS to grant the outstanding waiver requests and provide additional waivers as described in the letter. CHA has updated its lists of approved state and federal waivers and flexibilities, which include links to source documents, the status of related laws, and other helpful information.

CHA Requests Liability Protections for Hospitals

Based on growing concerns from health care providers about potential liabilities as they manage care during this crisis, CHA has requested that the state expand current law to address needed liability protections for providers.

Updates on Personal Protective Equipment (PPE) Optimization and Reuse

Funding for Hospitals’ Telecommunications Needs

The Federal Communications Commission (FCC) has begun accepting applications for its COVID-19 Telehealth Program. As authorized by the Coronavirus Aid, Relief, and Economic Security Act, the program provides immediate support to eligible health care providers responding to the COVID-19 pandemic. It fully funds — until funds are expended or the pandemic has ended — the devices and telecommunications and information services necessary to provide critical connected care services. The FCC has provided guidance on the application process, and additional questions can be submitted to EmergencyTelehealthSupport@fcc.gov.

AHA App Matches PPE Donors with Hospitals

The American Hospital Association (AHA) has a new app to further coordinate efforts around its 100 Million Mask Challenge, which calls on manufacturers, the business community, and individuals to rapidly produce needed PPE on a large scale. AHA has partnered with Kaiser Permanente, consulting firm Kearney, Microsoft, Merit Solutions, Goodwill, and UPS to launch HealthEquip™, a smart app that will match individuals and organizations donating PPE with local hospitals based on their need. The app also will track PPE donations and manage shipping to each hospital through UPS. Hospitals and health systems can begin registering and submitting requests for PPE immediately. To register, visit www.health-equip.com. For more information, see AHA’s video guide and frequently asked questions.

CMS to Host Two Calls Tomorrow

CMS will host the next in its series of calls for hospitals and health systems at 2 p.m. (PT) April 14. The call will allow participants to ask questions of agency officials about the temporary actions that empower providers to increase capacity, rapidly expand the health care workforce, put patients over paperwork, and further promote telehealth in Medicare. Participants may join by audio webcast or by phone:

Dial: (833) 614-0820

Passcode: 2395745

CMS will also host a call at noon (PT) tomorrow for home health and hospice providers. The call will provide updates on the agency’s latest guidance, as well as best practices shared by leaders in the field. Join by audio webcast or by phone:

Dial: (833) 614-0820

Passcode: 9466917

Price Gouging and Hoarding
The U.S. Department of Justice and the U.S. Department of Health and Human Services are aggressively pursuing cases to prevent the hoarding or price gouging of medical supplies and drugs essential to combat COVID-19, as well as other fraud related to the pandemic. If you have been the target or victim of price gouging, or are aware of the hoarding of medical supplies or drugs necessary to fight the virus, please call the National Center for Disaster Fraud Hotline at (866) 720-5721 or email disaster@leo.gov. For more information, visit www.justice.gov/coronavirus.

The California Attorney General is also conducting surveillance on potential price gouging in the of medical supplies and other goods and services being sold to hospitals, health care providers, and others. To share information or leads, use the Attorney General’s complaint intake portal.

Next CDPH Call: April 14, 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.

News for April 10

Hospitals Should See First Allotment of Federal Funding Today
As reported yesterday, the first portion – $30 billion – of a total $100 billion in emergency relief for hospitals from the federal Coronavirus Aid, Relief and Economic Security (CARES) Act started flowing to providers today. California hospitals’ estimated share is $2.9 billion. The funds will be distributed through direct deposit, paid via the Centers for Medicare & Medicaid Services Automated Clearing House account, and will be from Optum Bank with “HHSPAYMENT” as the payment description. 

To get money to hospitals quickly, CMS apportioned the funds based on Medicare beneficiaries served. This does not address the needs of hospitals with few or no Medicare patients or those that have significant Medicare Advantage or Medicaid patients. CMS and congressional leadership well understand this shortcoming and have committed to CHA that the second allocation of funds will help these providers.

As a condition of receiving these funds, hospitals must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider. Also, within 30 days of receiving the payment, providers must sign an attestation confirming receipt and agreeing to the terms and conditions. The portal for signing the attestation will be open the week of April 13 and will be linked from this page.

Questions about this funding can be directed to Ryan Witz at rwitz@calhospital.org or Anne O’Rourke at aorourke@calhospital.org.

Hotel Rooms for Exposed or Positive Health Care Workers
Today, the state launched the Non-Congregate Sheltering for California Healthcare Workers Program. This provides hotel rooms to frontline health care workers who are exposed to or test positive for COVID-19 and do not have the ability to self-isolate or quarantine at home. These workers can call 1-877-454-8785 to make a reservation. A fact sheet about this program, including information health care workers should have on hand when they call, is available here.

CMS Waivers Expand Scope of Practice
CMS has issued additional blanket waivers that:

  • Waive the requirement that a physician must be physically present to provide medical direction and supervision for critical access hospital patients, allowing for radio, telephone, or online communication
     
  • Expand the scope of practice for nurse practitioners, physician assistants, and clinical nurse specialists in skilled-nursing facilities, and occupational therapists in home health assessments

CDPH Guidance Notes Imported KN95 Respirators Approved During Shortages
The California Department of Public Health (CDPH) has revised All Facilities Letter 20-15, noting that previously issued Cal/OSHA guidance expands the types of respirators that can be used to comply with Cal/OSHA standards during the COVID-19 public health emergency. While KN95 respirators from China are not currently certified by the National Institute for Occupational Safety and Health (NIOSH), they may be acceptable if NIOSH-certified respirators are not available because of a shortage and prioritization of approved respirators for health care workers providing direct care to patients with COVID-19. As with N95s, KN95s should be fit tested to comply with a Cal/OSHA respiratory protection standard that requires fit testing.

Unemployed Workers to Receive an Additional $600 Per Week

Gov. Newsom announced yesterday that, starting April 12, California workers receiving unemployment benefits will begin receiving an extra $600 on top of their weekly amount, as part of the new Pandemic Additional Compensation initiated by the federal CARES Act. More information on these unemployment benefits and the additional $600 payments is available on the EDD website.

Mental Health Guide for Health Care Workers

The San Francisco Veterans Administration Health Care System has produced this guide to mental health resources for health care employees during the COVID-19 pandemic. It includes self-care strategies and addresses the challenges of front-line staff, as well as provides wellness resources, guidance for leading front-line staff, and more.

News for April 9

Federal Funding — Public Health and Social Services Emergency Funding (PHSSEF)
Hospitals should prepare for the Centers for Medicare & Medicaid Services (CMS) to issue approximately $30 billion of the PHSSEF as early as tomorrow. The funds are expected to be allocated to hospitals based on their 2019 Medicare Part A and Part B payments. It’s expected that CMS will release the payments through direct deposit paid via their Automated Clearing House account from Optum Bank, with “HHSPAYMENT” as the payment description.

This $30 billion is part of $100 billion in total funds made available to hospitals, health systems, and other providers through recent legislation, including the Coronavirus Aid, Relief, and Economic Security Act. To find out more about PHSSEF, see CHA’s summary.

Ambulatory Surgical Clinics Asked to Complete Ventilator Inventory Survey
The California Department of Public Health (CDPH) is taking inventory of ventilators (e.g., anesthesia, medical, and transport) from ambulatory surgical clinics (ASCs) across the state that may be able to be redeployed to hospitals and other facilities caring for COVID-19 patients. CDPH requests that all ASCs complete this Ventilator Equipment Inventory Survey, regardless of involvement in regional/Medical Health Operational Area Coordinator (MHOAC) plans or hospital surge plans, by 5 p.m. on April 15.

Statewide, National Data on Diversity Among COVID-19 Patients

  • Today, CDPH released confirmed COVID-19 cases and deaths by race and ethnicity. CDPH states that this initial information, representing 54% of COVID-19 cases and 53% of deaths, shows the data are roughly in line with the diversity of California overall. Yesterday was the first time CDPH released these demographic data. For details, see the press release.
     
  • Yesterday, the Centers for Disease Control and Prevention (CDC) released a report on the demographics of hospitalized patients with confirmed COVID-19 cases. The report shows African Americans significantly overrepresented in hospitalizations (33% of all patients for which there were race and ethnicity data). Three-quarters of hospitalized patients were age 50 and over, and over half were male. It also notes that additional data are needed to confirm the impact of sex and race. The data are from hospitals in the CDC’s Coronavirus Disease 2019 – Associated Hospitalization Surveillance Network and cover geographic areas that represent 10% of the country’s population. It is a sample, comprised of counties in 14 states. Participating counties in California are San Francisco, Alameda, and Contra Costa.

CDC Posts New Guidance and Tools

  • Inpatient obstetric health care settings: The CDC has issued new interim considerations for health care facilities providing obstetric care for pregnant persons under investigation or with confirmed COVID-19. The April 4 guidance offers clarification on the following:
     
    • Visitors and essential support persons
    • Prioritized testing of pregnant women with suspected COVID-19 at admission or who develop symptoms of COVID-19 during admission
    • Testing and isolation of infants with suspected COVID-19
    • Determination of whether to keep a mother with known or suspected COVID-19 and her infant together or separated after birth on a case-by-case basis, using shared decision-making between the mother and the clinical team
       
  • Outpatient and ambulatory care settings: This new interim guidance reflects the need to minimize disease transmission to patients, health care personnel, and others; identify persons with presumptive COVID-19 disease and implement a triage procedure; reduce negative impacts on emergency department and hospital bed capacity; and maximize the efficiency of personal protective equipment (PPE) utilization across the community health system while protecting health care personnel.
     
  • PPE burn rate calculator: The updated PPE Burn Rate Calculator is a spreadsheet-based model designed to help health care facilities plan and optimize the use of PPE for response to COVID-19.

Details of Main Street Lending Program
The Federal Reserve today announced the terms of the Main Street Lending Program, which will enhance support for small and mid-sized businesses. This includes borrowers who obtain loans through the Paycheck Protection Program administered by the Small Business Administration and larger borrowers with up to 10,000 employees or $2.5 billion in annual revenues. The term sheet specifies that these loans will be available to businesses without specifically addressing, or excluding, non-profits.

In an April 3 letter to the treasury secretary and Federal Reserve chairman, the American Hospital Association (AHA) urged them to implement this loan program quickly and make it available to hospitals of all ownership types, including municipal, county, and other public hospitals.

More details can be found in the AHA Special Bulletin.

News for April 8

CDPH Guidance on Decontaminating N95 Masks

The California Department of Public Health (CDPH) has released All Facilities Letter 20-36, which provides instructions for preserving used N95 respirators now in order to decontaminate them in the near future. The state is working with Battelle Memorial Institute to deploy its Food and Drug Administration (FDA)-authorized emergency use decontamination system in California. The Battelle system, a vaporous hydrogen peroxide system, received FDA authorization March 29. CDPH will provide additional guidance on the specifics of how the state plans to transport, decontaminate, and reissue used N95 respirators.

Next CMS Call on Regulatory Flexibilities: April 9 at 2 p.m. (PT)

The Centers for Medicare & Medicaid Services (CMS) is hosting a series of calls to provide hospitals and other health care providers the opportunity to ask questions about the regulatory flexibilities allowed during the COVID-19 public health emergency. In addition to the live Q&A, hospitals are encouraged to submit questions in advance to partnership@cms.hhs.gov, including “Office Hours” in the subject line. The next call is scheduled for April 9 from 2 to 3 p.m. (PT). Participation is offered via audio webcast or by dialing (833) 614-0820 and entering conference ID 1881716.

Discounted Services Available to Front Line Health Care Workers

The American Hospital Association has provided this list of hotels, airlines, and food service companies that are offering discounts or complementary items for health care workers.

FAQs on SNFs, Contributions, Health Plans Added to CHA Website

New FAQs have been added to CHA’s Coronavirus Response web page. They include:

  • Comprehensive information about patients who are currently in or may be transferred to skilled-nursing facilities
     
  • How to use the state’s new online portal to contribute supplies and services
     
  • An overview of health plan and insurer policy changes during the public health crisis

The page features regularly updated FAQs and guidance on a broad range of topics; hospitals are encouraged to bookmark it as a resource. 

 

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