Article

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 February 26

Updated Implementation Timeline Announced for Statewide Vaccine Network 

Today, the state of California and Blue Shield of California announced in a press release that on March 1: 

  • All providers and local health jurisdictions will move to uniform, state-directed eligibility criteria.
  • Blue Shield will begin making allocation recommendations to state officials for doses delivered the following week. The state will make final allocation decisions, continuing to use the existing split that prioritizes 70% of doses for those 65 and older, and the other 30% in the educational, childcare, emergency services, and food and agriculture sectors. (Note: Included in that is the 10% set aside for educational and childcare workers. This allocation is for first doses only, with second doses being sent to the provider who administered the first vaccination dose.)
  • Wave 1 and Wave 2 counties continue onboarding (counties listed on page 11 of this slide deck).

On March 7: 

  • Wave 2 counties continue and Wave 3 counties begin onboarding.

On March 31:

  • Blue Shield will take full management responsibility for the statewide vaccine network and continue providing vaccine allocation recommendations to the state to assist in its allocation decisions.

Transition for Statewide Vaccination Network Through March Announced

On today’s weekly California Department of Public Health (CDPH) COVID-19 vaccine provider office hours webinar, the state and Blue Shield announced transition details for the new statewide vaccination network — including the launch after March 31. The slide deck and a recording have been posted. Key details included:

  • Providers need to join Blue Shield network by March 22; network goes into effect after March 31: Provider status in the current network does not change through March 31. Providers who wish to continue vaccinating after March 31 will need to join the Blue Shield network by March 22, as it takes five to seven days to complete the onboarding process. All providers currently approved to vaccinate will maintain that status and will continue to receive doses throughout the transition period. Both the state of California and Blue Shield presenters specifically stated that they would work to provide second doses to vaccinators.
  • Vaccine allocations: Blue Shield will make recommendations about vaccine allocation to providers based in part on key performance measures. Key performance measures include (but are not limited to) contribution to equitable administration of vaccine, and signing a contract committing to adopt the performance management system, including My Turn.   
  • Transition plan to be created with county leaders: Together, Blue Shield and all local health jurisdictions will develop a transition plan. The plan will include achieving equity goals and transitioning all jurisdictions to a new performance management system by March 31.
  • My Turn is required, and application programming interface (API) is being developed: To participate in the network, a provider must use the My Turn application. The state is building a generic API for My Turn to connect with electronic health record interfaces. It is also working with Epic and Cerner on the interfaces for those systems to then connect to My Turn.
  • Multi-county entity allocations are by county: During the Q&A, the state clarified that multi-county entities (MCEs) need to keep allocations within the specific counties for which the MCE was allocated the doses. In other words, MCEs are not to move doses around between the counties for which they were provided by the state’s allocation. 
  • Blue Shield next steps: 
    • Providers interested in joining the vaccine network should contact them at CovidVaccineNetwork@blueshieldca.com.
    • Existing providers registered in the state’s COVID-19 vaccine system will receive information from the state’s provider communication channels.
    • The state and Blue Shield will work directly with providers and provider associations on enrollment processes. 

Blue Shield Sends Letter to Vaccination Providers 

Today, Blue Shield sent this letter to all current vaccination providers about the transition to the new statewide vaccine delivery network. Note that the letter cites March 15 as when the new network would be managed by Blue Shield, not March 31, as announced this morning on the webinar and in today’s press release. CHA will confirm that March 31 is the effective date of the network and provide an update, once available, via Coronavirus Response.

ICYMI: Update on CHA’s Advocacy on the Statewide Vaccine Delivery Network

In case you missed it, in yesterday’s CHA News, CHA provided an update on its continued advocacy with the state and Blue Shield on this new network, as well as the recent announcement of provider contract revisions by Blue Shield. 

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

Dial: (844) 721-7239  

Passcode: 7993227 

Summary of Feb. 23 CDPH Call

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

Data Resources 

  • State Resources: Monitor ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.

News for February 18

State Provides Limited Additional Information on Third-Party Administration of Vaccination

This slide deck provided by the state offers limited additional information about the new statewide vaccination network for which Blue Shield of California is the state’s third-party administrator. Of note:

  • Providers not a part of the initial network Blue Shield is setting up will be considered for transition to the network, by county, in waves beginning next week. Counties were placed in one of three waves based on rankings that considered their COVID-19 disease burden, among other factors.
    • Wave 1 (Feb. 21): Fresno, Imperial, Kings, Madera, Merced, Riverside, San Joaquin, Stanislaus, and Tulare
    • Wave 2 (March 3): Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Inyo, Lake, Lassen, Los Angeles, Monterey, Nevada, Orange, Placer, Sacramento, San Benito, San Bernardino, San Diego, San Luis Obispo, Shasta, Sierra, Solano, Sonoma, Sutter, Tehama, Trinity, Tuolumne, and Ventura
    • Wave 3 (March 14): Alameda, Alpine, Contra Costa, Del Norte, Humboldt, Marin, Mariposa, Mendocino, Modoc, Mono, Napa, Plumas, San Francisco, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Siskiyou, Yolo, and Yuba
  • Blue Shield has set up an email for inquiries at CovidVaccineNetwork@blueshieldca.com.

News for February 16

State Posts Vaccine Inventory by Hospital

On Feb. 15, the state published the amount of vaccine reported on hand for each vaccine provider (under “Toggle Views,” select drop down for “Provider Detail”). Multi-county entities are reported in aggregate, instead of by each hospital campus. The posted data are reported daily by each provider into the Centers for Disease Control and Prevention’s (CDC) VaccineFinder database. These data reflect vaccine on hand and do not account for scheduled appointments. Vaccines available may likely be reserved for appointments already planned for the week. For hospitals and health systems that may need to respond to questions about the many reasons that providers may have vaccines on hand, CHA has prepared these key messages.

State Issues Vaccine Third-Party Administrator Contract

On Feb. 15, the state issued its contract with Blue Shield of California to be the third-party administrator for vaccine distribution in California, charged with creating, managing, and overseeing the statewide network of vaccine providers. For a summary of the contract’s details, see this overview released by the California Department of Public Health (CDPH).

Latest Changes in Vaccine Allocation Guidelines

On Feb. 12, CDPH again updated its COVID-19 vaccine allocation guidelines. This latest guidance announces that, beginning March 15, health care providers may use their clinical judgement to vaccinate individuals age 16-64 who are deemed to be at the very highest risk for morbidity and mortality from COVID-19 as a direct result of one or more of the “severe health conditions” specified in the department’s provider bulletin. These specified severe health conditions include cancer (current with debilitated or immunocompromised state); chronic kidney disease (stage 4 or above); chronic pulmonary disease (oxygen dependent); Down syndrome; immunocompromised state from solid organ transplant; pregnancy; sickle cell disease; heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies (excludes hypertension); severe obesity (BMI ≥40 kg/m2); Type 2 diabetes mellitus with hemoglobin A1c level greater than 7.5%; or if, as a result of a developmental or other severe high-risk disability, one or more of conditions specified in the bulletin applies.

This latest guidance also clarifies that family member caregivers with direct risk of COVID-19 exposure who care for regional center consumers at high risk of COVID-19 complications and related fatalities are eligible for the COVID-19 vaccine as health care providers. The regional center consumers at such high risk include those with cerebral palsy, Down syndrome, epilepsy, and those with specialized health care needs, including dependence on ventilators, oxygen, and other technology. Eligible family members must obtain documentation from their regional centers verifying the qualifying condition of the family member cared for and caregiver status.

CHA Posts Step-by-Step Guide for Requesting Resources

CHA has prepared a guide to requesting resources from the state and through Medical Health Operational Area Coordinators, including a chart that illustrates the flow of information and resources.

CDC Updates Quarantine Guidance for COVID-19 Vaccinated Individuals

On Feb. 10, the CDC updated its quarantine guidance for vaccinated individuals. The new guidance suggests that persons with an exposure to someone with suspected or confirmed COVID-19 are not required to quarantine if they meet certain criteria.

CHA Webinar Explains Updated Provider Relief Fund Reporting Requirements

On Jan. 15, the U.S. Department of Health and Human Services updated its Provider Relief Fund (PRF) reporting requirements to reflect changes required by the Consolidated Appropriations Act of 2021. In addition to calculating lost revenue attributable to COVID-19 based on the difference between 2019 and 2020 actual patient care revenue, PRF recipients may now choose from two other methodologies.

CHA will host a complimentary, members-only webinar on Feb. 25 at 1:30 p.m. (PT) to discuss these updated reporting requirements, how the changes will impact hospitals, and how to be prepared for what lies ahead.

Considerations for Administrative Meetings

Some hospitals have asked CHA whether they can hold in-person administrative meetings. To determine the guidelines for your local health jurisdiction:

  1. Determine in which county you would hold the meeting. Visit Blueprint for a Safer Economy – Coronavirus COVID-19 Response   to figure out that county’s color tier.
  2. Then check this chart to see what is allowed in that color tier.
  3. Finally, check the local health department’s website to see if there’s a more restrictive local health jurisdiction order.

CHA Continues Advocacy on Amount of PPE Required by Hospital Stockpile Law

A new California law requires hospitals to maintain a stockpile equivalent to three months of normal consumption for specified personal protective equipment (PPE) as of April 1. Based on the plain language of the statute and legislative history, CHA has advocated that the stockpile amount should be based on 2019 data. Unfortunately, at this point, Cal/OSHA has not agreed to that plain language reading and instead believes emergency rulemaking is necessary to define normal consumption.

As part of the pre-rulemaking discussions, Cal/OSHA has shared its concept that “normal consumption” for the purposes of determining the amount of the PPE stockpile is a rolling number based on the previous 24 months of PPE consumption. CHA strongly disagrees with this concept and has submitted written comments further explaining why the stockpile amount should be based on 2019 PPE consumption. Cal/OSHA has scheduled an Advisory Committee meeting for Feb. 19 to solicit stakeholder input on this issue. Hospitals should monitor developments and encourage any stakeholders that may be interested in this issue to participate in the Advisory Committee meeting and/or submit written comments to Cal/OSHA before the Feb. 19 meeting.

Next CDPH Office Hours: Feb. 19

CDPH will hold a COVID-19 Vaccination Office Hours call for hospitals on Feb. 19 from 9 to 10 a.m. (PT). To participate, visit this link.

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

Dial: (844) 721-7239  

Passcode: 7993227 

Summary of Feb. 9 CDPH Call

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

Recent Media Coverage on Vaccines

Below are some recent news stories about the state’s third-party administrator and vaccination efforts:

Surge-Related Data Resources

  • State Resources: Monitor ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.

News for February 9

Update on CDPH COVID-19-Related Waivers

Hospitals report that the California Department of Public Health (CDPH) continues to process requests for additional staff and will maintain staffing waivers until those staff arrive. As a reminder, all existing approved COVID-19 staffing-related waivers ended at 11:59 p.m. on Feb. 8 (per All Facilities Letter (AFL) 20-26.6) unless CDPH explicitly extended a waiver in the last week following conversations with the hospital. CHA has asked CDPH to process all remaining requests as soon as possible. CDPH has advised that hospitals still waiting for staff and/or needed waivers to be maintained should contact the Centralized Program Flexibility Unit at centralizedprogramflex@cdph.ca.gov

Hospitals should be aware that CDPH plans to revoke a staffing waiver effective 48 hours after when 90-95% of the requested staff are scheduled to arrive, because it expects hospitals to utilize its float pool for the other 5-10%. Hospitals should bear this timing with their staffing waiver in mind when planning for the arrival of these additional staff.

Hospitals are reminded that the state may subsidize staffing provided through its contracted staffing agencies (see AFL 21-07). CHA understands these subsidies are being made available to hospitals with fewer than 200 licensed beds that are not a part of a large health system. Each hospital will negotiate a memorandum of understanding (MOU) with CDPH, and that MOU will indicate the specific level of support CDPH will provide.

CDPH has rescinded  AFL 21-09, which provided certain administrative and documentation flexibilities in the counties affected by the State Public Health Officer Order on Hospital Surge because the order has now been lifted. As a reminder, that order required hospitals to notify various government entities when transitioning to crisis care standards, postpone certain elective surgeries, and make/accept certain patient transfers. All hospitals continue to be able to utilize the flexibilities in AFL 20-26.6, related to the use of space and processes for the discharge of homeless patients, among others.

State Revises Guidance on Vaccination Allocation

On Feb. 4, CDPH updated its COVID-19 vaccine allocation guidelines. While this guidance reaffirms that individuals in Phase 1A (health care workers and long-term care residents) and Phase 1B, Tier One (individuals 65 and older and those working in the sectors of education and childcare, emergency services, or food and agriculture) currently are or will be eligible for the vaccines, it clarifies what individuals fall within these categories.  

For example, the guidance specifies that workers in the state’s health care workforce who are not considered eligible for Phase 1A vaccinations include those who manage health plans, billing, and health information (as opposed to administrative workers in clinical or other settings). More details about the revised guidelines are available in this CHA News article.

State’s CalVax Provider System Gets a New Name

CDPH has announced that the recently launched CalVax provider vaccine management system will soon be renamed myCAvax. The intent of the name change is to reduce confusion with other systems and ensure consistency with California’s vaccine scheduling system, My Turn. Aside from the name and other branding changes, functionality remains the same, and providers do not need to do anything differently. In a few weeks, CDPH will send information about a new login site. More details about the name change are available in an FAQ document.

Recording Available of CHA’s Webinar on COVID-19 Vaccination Third-Party Administration

CHA has posted a recording of the Feb. 9 webinar it hosted with Paul Markovich, CEO of Blue Shield of California, and Marta Green, the state’s lead on COVID-19 vaccination third-party administration.

Next CDPH Office Hours: Feb. 12

CDPH will hold a COVID-19 Vaccination Office Hours call for hospitals on Feb. 12 from 9 to 10 a.m. (PT). To participate, visit this link.

Next CDPH Call for Health Care Facilities: Feb. 16, 8-9 a.m. (PT)  

Dial: (844) 721-7239  

Passcode: 7993227 

Summary of Feb. 2 CDPH Call

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

Recent Media Coverage

Below are recent news stories how COVID-19 is impacting hospitals and their front-line workers:

Surge-Related Data Resources

  • State Resources: Monitor ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.

News for February 4

Urgent Steps Hospitals Should Take If Nurse Staffing Ratio Waivers Are Still Needed

CHA has been advised by the California Department of Public Health (CDPH) of the steps that hospitals must take to maintain any needed staffing waivers. As a reminder, all existing approved COVID-19 staffing-related waivers end at 11:59 p.m. on Feb. 8 (per All Facilities Letter (AFL) 20-26.6). Hospitals that do not have enough staff to meet the standard ratios are encouraged to take these steps immediately, if they have not already.

First, hospitals that need to maintain staffing waivers should request additional staff from their Medical Health Operational Area Coordinator (MHOAC) or contracted staffing agencies. Alternatively, if a hospital has received a call from CDPH’s Centralized Program Flexibility Unit about its existing approved staffing waiver(s) and requested staff during that call, CDPH will request those staff directly from the state’s deployment team (bypassing the MHOAC). However, the hospital may want to also notify their MHOAC they have made a staffing request to CDPH so the MHOAC is aware of their urgent staffing needs.

Second, if those staff will not be obtained and onboarded before Feb. 8, hospitals should tell the Centralized Program Flexibility Unit that they need to maintain their waiver while they await additional staff. This can be done by emailing the Centralized Program Flexibility Unit at centralizedprogramflex@cdph.ca.gov

Hospitals are reminded that the state may, at its discretion, subsidize staffing provided through the state’s contracted staffing agencies (see AFL 21-07). However, the state’s contracted hourly rates may be higher than rates hospitals have negotiated directly with their own staffing agencies. Hospitals may wish to talk to the state about available subsidies and compare the final cost to their other options for obtaining additional staff, if any.

CDPH Director Letter to Vaccination Providers Has Four Key Messages

On Feb. 3, CDPH Director and State Public Health Officer Tomás J. Aragón sent a letter to all vaccination providers. It carries four key messages:

  • We want you to get your doses out.
  • Manage your vaccine inventory normally: a dose is a dose.
  • We will begin to manage and approve future orders based on shots in arms.
  • We need you to report your shots administered and your inventory. Every day.

State Announces Partnership with Biden Administration for Community Vaccination Sites in Los Angeles, Oakland

On Feb. 3, Gov. Newsom and the Biden-Harris administration announced a pilot project to establish community vaccination sites at the Oakland-Alameda Coliseum and California State University, Los Angeles. The goal of these joint pilot sites is to continue to expand the rate of vaccinations in California in an efficient, effective, and equitable manner. The sites will be co-run by the Federal Emergency Management Agency and the Governor’s Office of Emergency Services and are expected to be open to the public by Feb. 16.

Summary of Feb. 2 CDPH Call

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

Surge-Related Data Resources

  • State Resources: Monitor ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.

News for February 2

Changes Announced to Nurse Staffing Ratio, Space Waivers

On Feb. 1, the California Department of Public Health (CDPH) released All Facilities Letter (AFL) 20-26.6, which ends all nurse staffing ratio waivers for hospitals on Monday, Feb. 8. CDPH recognizes that any given hospital’s individual circumstances may necessitate that some waivers to be extended beyond Feb. 8 and plans to issue those letters on Feb. 5. Hospitals will receive a call from CDPH’s Centralized Program Flexibility Unit seeking information on whether additional staff from the state’s contracts with staffing agencies would obviate their need for a nurse staffing ratio waiver. CDPH has asked any hospitals that no longer have a continued need for a nurse staffing ratio waiver to contact their district office to let them know.

In addition, CDPH will no longer accept expedited staffing waiver requests. These were the more recently available waivers that went into effect upon submission to CDPH. As a result, CDPH will individually review all nurse staffing ratio waiver requests hospitals submit moving forward.

Finally, AFL 20-26.6 removed the March 1 expiration date of the waiver, which also suspends state licensing requirements related to space. As a result, hospitals can continue to temporarily use spaces they have converted. CHA has requested that CDPH provide advance notice before any future rescission of this AFL, so hospitals have time to convert any spaces back.

CDPH also released AFL 21-09, which makes explicit which hospitals can utilize the nurse documentation flexibilities CDPH previously announced. These are hospitals in the following counties, currently affected by the State Health Order on Hospital Surge: Fresno, Kern, Kings, Madera, Merced, San Benito, San Joaquin, Stanislaus, Tulare, Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego, Santa Barbara, and Ventura.

CDPH Issues Quarantine Guidance for Health Care Personnel Exposed to COVID-19

Last week, CDPH issued AFL 21-08, providing quarantine guidance for health care personnel who may have been exposed to COVID-19. CHA requested this AFL to clearly articulate how CDPH views guidance from the Centers for Disease Control and Prevention (CDC) on this issue. Specifically, CDPH confirms it has adopted the CDC Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19. CDPH has also adopted CDC guidance on Strategies to Mitigate Healthcare Personnel Staffing Shortages

With respect to the recent CDC guidance allowing for shorter quarantine periods, the AFL clarifies that shorter quarantine periods are available if a hospital is experiencing a staffing shortage. Specifically, hospitals may allow exposed health care personnel to return to work after a seven-day quarantine if the hospital is facing a critical staffing shortage and the employee receives a negative PCR test result from a specimen collected after day 5. Additionally, the AFL clarifies that hospitals may continue to use CDC guidance for staffing shortage mitigation strategies to determine when it is appropriate to allow asymptomatic health care personnel with exposure but no known infection to continue to work on-site during their 14-day post-exposure period. Finally, the AFL also addresses quarantine issues for health care personnel working at skilled-nursing facilities.       

State and Federal Governments Issue Liability Protection for Vaccinators

On Jan. 27, Gov. Newsom issued Executive Order N-02-21, which provides protection from lawsuits for hospitals and other health care providers participating in the state’s vaccine administration program. On Jan. 28, the U.S. Department of Health and Human Services (HHS) included liability protection for additional categories of qualified COVID-19 vaccinators in the Public Readiness and Emergency Preparedness (PREP) Act.

The PREP Act authorizes the HHS Secretary to provide immunity from liability for the manufacture, distribution, administration, or use of “medical countermeasures,” except for claims involving willful misconduct. A medical countermeasure is any drug, device, or biological product used to diagnose, mitigate, prevent, treat, or cure a pandemic or epidemic. PREP Act immunity covers claims under tort or contract law, as well as claims related to compliance with state/local laws. Any lawsuit seeking an exception to PREP Act immunity must be brought before a special three-judge panel in U.S. District Court in Washington, D.C. To win, the plaintiff must prove willful misconduct was the proximate cause of death or serious injury by clear and convincing evidence. The PREP Act also establishes a program to compensate individuals for serious physical injury or death caused by a covered countermeasure.

CHA Updates COVID-19 Data Reporting Guidance

Due to the surge in COVID-19 cases and the addition of vaccination fields to the COVID-19 tracker, hospitals have asked for additional clarification on reporting COVID-19 data. To provide this clarification, CHA worked with CDPH and HHS to update its data reporting guidance and other supporting documents. Updates include:

  • Data reporting guidance 
    • Added clarification for the ED and Overflow (EDOF) fields. Double-counting is permitted for COVID-19 confirmed and suspected EDOF patients with admission orders to ensure CDPH can appropriately capture the operational impact that these patients have in both the ED and inpatient (ICU or non-ICU) departments. 
    • Added information on how to classify health care personnel and patients receiving vaccines. 
  • Data dictionary
    • Changes were made to the vaccine fields, where the language was clarified and bolded to highlight if the field was intended to collect data on health care personnel or patients. Hospitals that haven’t yet reported into the Previous Week’s First COVID Vaccine Doses field, but plan to begin this week, should include all doses given up to the first date of data entry. 

In addition to the document updates, CHA has also posted:  

Questions can be directed to COVIDTracker@calhospital.org

Valencia Branch Laboratory Adds Transport Courier Service

To help mitigate the cost and distance barriers that have prevented some hospitals from using the Valencia Branch Laboratory (VBL), the state has developed a statewide network of drop boxes — the California COVID-19 Courier Network (CCN) — to transport COVID-19 test samples from VBL-affiliated test collection sites to the VBL. Current CCN drop-boxes can be found using the online locator tool. Over 40 sites are now operating across the state, with additional sites being added. To use the service, hospitals must be approved as a VBL site.

Updated Vaccination Primer Includes New Information for Hospitals

CHA has updated its COVID-19: Vaccination Primer for California Hospitals with information on California’s new standardized statewide approach, vaccine prioritization, and more.

State Offers Oxygen-Related Provider Hotline

To enhance the transparency of all oxygen-related equipment and supplies offered throughout the state, the California Health and Human Services Agency, in partnership with the Governor’s Office of Emergency Services, is offering a provider hotline for health care facilities and Medical and Health Operational Area Coordinators (MHOACs).  It is designed to answer questions and connect respective health care facilities and/or MHOACs with local vendors and/or subject matter experts to provide oxygen-related support (e.g., Office of Statewide Health Planning and Development technical assistance/permitting support, general oxygen support inquires, and direct connections to vendors to expedite resolution of infrastructure and home oxygen challenges). The provider hotline can be reached at (833) 502-1245. More information is available in CHA News

HHS Issues FAQs on Vaccination Fields

To understand hospitals’ efforts in vaccinating health care workers and the community against COVID-19, the HHS recently started collecting optional vaccination data. As a result, seven new vaccine-related fields were added to the CHA COVID-19 Tracking Tool last month. HHS has received many questions from hospitals seeking clarification on these new fields and has compiled and answered the most frequently asked questions. The FAQs reference vaccination fields by number, which can be found in the federal guidance document. The numbers in the FAQ also correspond to the vaccination fields in the CHA COVID-19 Tracking Tool as follows:

  • #41 = Previous Week’s COVID Vaccine Doses
  • #42 = Unvaccinated Personnel
  • #43 = Personnel Receiving a Partial Series
  • #44 = Personnel Receiving a Complete Series
  • #45 = Total Personnel
  • #46 = Previous Week’s First COVID Vaccine Doses
  • #47 = Previous Week’s Final COVID Vaccine Doses

CHA is working with CDPH to update the data reporting guidance document to include new guidance on the vaccination fields. Questions can be directed to COVIDTracker@calhospital.org.

Next CDPH Office Hours: Feb. 5

CDPH will hold a COVID-19 Vaccination Office Hours call for hospitals on Feb. 5 from 9 to 10 a.m. (PT). To participate, visit this link.

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

Dial: (844) 721-7239  

Passcode: 7993227 

Summary of Jan. 26 CDPH Call

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

Recent Media Coverage on Nurse Staffing Ratios

Here are a few stories on CDPH’s decision to end nurse staffing ratio waivers:

Surge-Related Data Resources

  • State Resources: Monitor ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.

News for January 26

CDPH Issues AFLs on COVID-19 Staffing Flexibilities, State Cost-Sharing Program

In a positive development for hospitals, the California Department of Public Health (CDPH) has released two important All Facilities Letters (AFLs):

  • AFL 20-26.5 creates key administrative flexibilities, including on nursing documentation, for hospitals in regions with 0% ICU availability and in counties with 10% or less ICU capacity for the next 30 days. This will allow hospitals to focus on patients over paperwork. The AFL also standardizes future staffing ratio waivers to 60 days in length.
  • AFL 21-07 directs hospitals with temporary staffing waivers to maintain their efforts to return to required staffing levels. If hospitals seeking help with that effort choose to use a state staffing contract, they may now participate in the state’s cost-sharing program. 

State Ends Stay-At-Home Orders in All Regions

On Jan. 25, CDPH ended the regional stay-at-home orders for all regions statewide. Because case rates remain high across most of the state, the state’s hospital surge order remains in place to prevent hospitals from becoming overwhelmed. Lifting the regional orders allows all counties statewide to return to the rules and framework of the Blueprint for a Safer Economy and color-coded tiers that indicate which activities and businesses are open based on local case rates and test positivity. A majority of counties are in the strictest, or purple tier; counties can choose to impose stricter rules.

CDPH has stated that the recent administrative flexibilities in AFL 20-26.5 are still available to hospitals, even though it references the regional stay-at-home order that has been lifted, and that CDPH will be editing the AFL.

Governor Announces New Statewide Approach to Vaccinations

On Jan. 25, Gov. Newsom announced a unified statewide approach to vaccination administration and management intended to simplify and standardize the process. CHA issued a media statement affirming the state’s new approach and reiterating the need for a greater and more consistent vaccine supply from the federal government. Details of the state’s new approach include:

  • A single statewide standard for vaccine eligibility that will continue to vaccinate people 65 and over along with health care workers, and begin to prioritize emergency services, food and agricultural workers, and teachers and school staff
  • A unified statewide network to align the health care system, providers, and counties to ensure equitable and efficient vaccine distribution
  • A reallocation of vaccines from providers that have not used at least 65% of their available supply on hand for a week and have not submitted a plan to use it within four days of notice
  • statewide data platform that helps consumers sign up for and schedule vaccinations when it is their turn. The platform will also help certain providers automatically share data on vaccines received and administered to reduce data reporting lag time.

Additional information was released on Jan. 26 by the California Health and Human Services Agency and California Government Operations Agency.

CDPH Addresses Timely Vaccine Administration in Letter to Vaccine Providers, Local Health Officers

CDPH has notified local health officers and vaccine providers that CDPH and local health officers may recover unused COVID-19 vaccine from registered providers that have not used at least 65% of the vaccine in their possession for more than one week and have not submitted a plan to use it within four days of notice. The notice follows identification of a reporting gap in the volume of vaccine received in California and the number of vaccinations reported. The state plans to increase its California Immunization Registry workforce to help rectify the reporting issues and close the reporting gap. 

HHS Anticipates Public Health Emergency Will Last Through 2021

In a letter to governors dated Jan. 22, Acting Health and Human Services (HHS) Secretary Norris Cochran indicated the COVID-19 public health emergency will likely last through 2021. It was most recently renewed on Jan. 21, 2021, for an additional 90 days. For details about the financial support and regulatory flexibility to states and providers affected by the public health emergency, see the full CHA News article.

President Issues Executive Orders to Address Pandemic

On Jan. 20, President Biden issued two executive orders intended to address the COVID-19 pandemic — one that creates the role of a COVID-19 response coordinator to oversee the federal response to the COVID-19 pandemic, and one that requires face masks to be worn and physical distancing maintained in all federal buildings, on all federal lands, and by all federal employees (including members of the armed forces) and contractors.

On Jan. 21, the President issued additional executive orders and directives instructing various federal agencies to address the COVID-19 pandemic, including expanding testing and vaccination capacity, increasing personal protective equipment and other necessary materials to combat the pandemic, slowing the spread of COVID-19, and addressing inequitable outcomes. 

CMS Limits Hospital Survey Activity

The Centers for Medicare & Medicaid Services (CMS) has limited survey activity by accreditation organizations and state survey agencies (in California, CDPH). According to a Jan. 20 memo posted by CMS, hospital complaint surveys will be restricted to immediate jeopardy allegations, and recertification surveys will be suspended — with some exceptions to be announced in upcoming guidance. The restrictions on survey activity are in effect until Feb. 20, with potential for 30-day renewals. The memo also directs state survey agencies to contact CMS for information about additional flexibilities and assistance when their hospitals implement (or approach implementing) crisis standards of care.

Additional guidance on accreditation organizations is also forthcoming, which will describe a modified recertification survey process for a targeted sample of hospitals. CHA will provide additional information when available.

Behavioral Health Transfer and Discharge Resource for Hospital EDs

CHA has been working closely with the California Health and Human Services Agency, the Department of Health Care Services (DHCS), and the County Behavioral Health Directors Association (CBHDA) to find ways to assist and decompress hospital emergency departments (EDs) during the pandemic once an individual with a behavioral health condition is ready for discharge.  

CBHDA has reached out to its 58 county behavioral health director members to identify a primary/secondary contact for both mental health conditions and substance use disorders who can help facilitate ED discharges. The individuals in this spreadsheet can help coordinate ED transfers or referrals for any beneficiary who is uninsured or insured by Medi-Cal, and is a beneficiary of county behavioral health services. The spreadsheet includes the names, email addresses, phone numbers, and preferred method of communication for these county contacts.

Most — but not all — counties have identified individuals. As additional county contact information is gathered, the spreadsheet will be updated. Questions about this new resource can be directed to Sheree Lowe or BJ Bartleson.

DHCS Announces Flexibility on Medi-Cal IRF Requirements

DHCS has announced temporary regulatory flexibility for the amount of therapy required for Medi-Cal beneficiaries admitted for inpatient acute rehabilitation services, or 18 hours of therapy per week. During the public health emergency, inpatient rehabilitation facility days will be reviewed for consideration of authorization when therapy hours may not have met prior criteria. This flexibility is retroactive to March 18 and aligns with a Medicare waiver of the three hours per day guideline for the provision of an interdisciplinary program of intensive therapy services. More details are available in this CHA News article.

Recordings Available of CDPH Vaccination Calls; Next Call Jan. 29

CDPH has posted recordings and slides from its January office hours call and provider webinars on the Vaccination Program website. Links are also below:

CDPH continues to hold Friday office hours and webinars from 9 to 10 a.m. (PT), with the next one on Jan. 29. Visit this link to participate. CDPH distributes the link to enrolled COVID-19 vaccinators by email (from COVIDCallCenter@cdph.ca.gov) and posts them online to the Archived Communications portion of its Vaccination Program website.

Webinars Available to Assist Behavioral Health Providers

The Substance Abuse and Mental Health Services Administration provides regular training and technical assistance related to the COVID-19 impact on mental health and substance use disorders. Webinars and other provider resources address coping with the effects of widespread public health crises, improving services capability in response to COVID-19, specific guidance for clinicians, supporting communities as the COVID-19 crises evolve, and more.

Next CDPH Call for Health Care Facilities: Feb. 2, 8-9 a.m. (PT)  

Dial: (844) 721-7239  

Passcode: 7993227 

Summary of Jan. 19 CDPH Call

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

Media Highlights of Vaccine Coverage

See recent stories about California making changes to its vaccine eligibility framework and the latest on additional vaccine supply:

Surge-Related Data Resources

  • State Resources: Monitor ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.

News for January 19

State Asks Hospitals to Submit Vaccine Administration Data

The state Health and Human Services Agency has asked any organization with as-yet-unreported COVID-19 vaccine administration data to submit that data as soon as possible. While the original deadline was Jan. 18, there is still time to submit and help close what may be a significant gap between doses received in California and doses administered. The California Department of Public Health (CDPH) reports that, as of Jan. 17, vaccine providers have reported administering roughly 1.3 million of the 3.2 million doses (first and second doses) shipped to vaccine providers statewide.

The concern is that the administered doses may not yet have been reported to — and recorded in — the California Immunization Registry (CAIR). As a reminder, vaccinators are asked to record doses administered in the patient record within 24 hours and to use their best efforts to report administration data to CAIR as soon as practicable and no later than 72 hours after administration. Hospitals that have questions about or difficulties with reporting can get assistance at the CDPH Reporting Requirement Site.
 

Providers Advised to Stop Administering One Lot of Moderna Vaccine

On Jan. 17, CDPH issued a recommendation to providers that they pause the administration of lot 41L20A of the Moderna COVID-19 vaccine due to possible allergic reactions. The recommendation came after a higher than usual number of allergic reactions were reported at one community vaccination clinic; fewer than 10 individuals required medical attention over the span of 24 hours. More than 330,000 doses from this lot, which arrived in California between Jan. 5 and 12, have been distributed to 287 providers across the state. The state has not been notified of any other cluster or individual events related to this lot.

The manufacturer, Centers for Disease Control and Prevention, and the Food and Drug Administration are reviewing the lot and related medical information. A follow-up investigation of outcomes of the affected individuals is underway, and the state will release additional information when it is available.

Key Messages on Vaccinations for Hospitals

These key messages are available for hospital use/customization when responding to questions about vaccination challenges and process.

DHCS Issues Reminders for Behavioral Health Providers

The Department of Health Care Services (DHCS) has issued a reminder that behavioral health providers and staff are prioritized with other health care workers for vaccines. Additionally, staff working in correctional facilities are tier 1 and should be prioritized. As local public health departments are actively working to adapt to new vaccine guidance and facilitate mass vaccination, some counties are offering online vaccination scheduling, including Alameda, Alpine, Butte, El Dorado, Inyo, Lake, Los Angeles, Mono, Riverside, San Benito, San Bernardino, San Diego, San Luis Obispo, Sutter, Tehama, Ventura, and Yuba.

DHCS also hosts weekly calls on Wednesdays at 8 a.m. (PT) for behavioral health providers to share updated information from CDPH and DHCS. Visit the DHCS Webex site to join the meetings, and see notes from previous calls on the DHCS website.

Recent Media Coverage on Crisis Care Standards

Below is a sample of some media coverage from CHA’s Jan. 14 media call about crisis care:

Surge-Related Data Resources

  • State Resources: Monitor the regional stay home order and ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.

News for January 16

State Revises Health Order on Hospital Surge

The state has revised its Jan. 5 State Health Officer Order as a result of advocacy efforts by CHA. The original order prohibited some surgical procedures and allowed the state to direct the interfacility transfer of patients to avoid overwhelming some hospitals. The revisions include:

  • The only procedures that must be delayed are “ESAS Tier 1 and 2 surgical procedures as triaged by the clinical judgment of the physician” in impacted counties (children’s hospitals are exempted). Although all hospitals and ambulatory surgery centers are required to categorize all elective procedures by tier using the Elective Surgery Acuity Scale (ESAS), the California Department of Public Health (CDPH) has clarified that this step is intended only to prompt the physician to at least consider postponement in a highly impacted county. Only inpatient ESAS Tier 1 and 2 surgical procedures are required to be postponed. This new language also emphasizes the importance of the physician’s clinical judgment in determining which inpatient surgical procedures must be postponed.
  • The Jan. 5 order required a hospital to notify its Medical and Health Operational Area Coordinator (MHOAC), local health officer, and CDPH when it reached crisis care. The revised order instead requires hospitals to notify these entities when hospital leadership determine/declare the following (these determinations/declarations are within the discretion of hospital leadership):
    • Declares an internal disaster
    • Determines it is transitioning from contingency care to crisis care
    • Determines it is operating under crisis care standards
  • The state can require a hospital that has made the above notification to transfer patients to other facilities. The state can also require a hospital to transfer patients when the MHOAC determines the hospital is transitioning from contingency care to crisis care, even if hospital leadership has not reached this determination.
  • The MHOAC may not make a unilateral decision that a receiving hospital has the capability to accept a transfer patient. Both the MHOAC and hospital leadership must agree that the receiving hospital has this capability. CDPH has told CHA that the availability of a physician to accept the transfer patient and adequate nurse staffing are integral to the determination of a hospital’s capability to accept a transfer patient.
  • CDPH will post on its website a list of counties that are required to delay inpatient elective surgeries – that is, counties experiencing less than 10% ICU capacity in regions with 0% ICU capacity. CHA will inform members when this list is available. The order to delay inpatient elective surgeries will take effect at 11:59 p.m. (PT) the day after CDPH makes the determination that a county meets this criterion.

The revised State Health Order is effective through at least Jan. 26 unless earlier terminated.

News for January 15

Hospitals Must Post Crisis Care Guidelines on Website

Effective Jan. 6, all California hospitals are required to publicly post their crisis care continuum guidelines, another facility’s guidelines, or the state’s guidelines on their website, per All Facilities Letter (AFL) 20-91. Additionally, hospitals must notify their local California Department of Public Health (CDPH) district office and their local public health department via email that they have adopted and publicly posted this policy – including a link to the website posting. Hospitals are expected to have plans that best fit their facility and regional needs and processes, while following ethical principles, health equity goals, and civil rights laws. CHA urges all hospitals to post their guidelines in an easy-to-find location on their website.

HHS Adds Optional Data Reporting Fields for Health Care Personnel and Patient Vaccinations

The federal Department of Health & Human Services (HHS) recently announced updates to COVID-19 hospital reporting. HHS added seven new optional fields related to health care personnel and patient vaccinations that hospitals can report on each Wednesday. While currently optional, the fields are likely to become mandatory in the future. An interim final rule added collecting and reporting COVID-19 data to the Medicare and Medicaid conditions of participation.

As detailed by this new guidance, the new fields that are available for optional reporting through the CHA COVID-19 Tracking Tool beginning Jan. 20 are:

  • Previous Week’s COVID Vaccine Doses
  • Unvaccinated Personnel
  • Personnel Receiving a Partial Series
  • Personnel Receiving a Complete Series
  • Total Personnel
  • Previous Week’s First COVID Vaccine Doses
  • Previous Week’s Final COVID Vaccine Doses

CHA will provide hospitals and systems currently using the data upload feature with a revised template in advance. The revised data dictionary includes these new optional fields highlighted in blue. In addition, to assist with data reporting, CHA worked with CDPH to update the data reporting guidance document. Questions can be directed to COVIDTracker@calhospital.org.

HHS Updates Provider Relief Fund Reporting Requirements

On Jan. 15, HHS updated its Provider Relief Fund (PRF) reporting requirements to reflect changes required by the recently passed Consolidated Appropriations Act of 2021 (CAA). In addition to calculating lost revenue attributable to coronavirus based on the difference between 2019 and 2020 actual patient care revenue, PRF recipients may now choose from two other methodologies using:

  • Budgeted Revenue: The difference between 2020 budgeted and 2020 actual patient care revenue. If a provider elects this method they must use a budget that was established prior to March 27, 2020.
  • Alternative Reasonable Method: Any reasonable method of estimating lost revenue. If a recipient uses an alternative reasonable method for calculating lost revenues attributable to coronavirus, the recipient must submit a description and an explanation of why the methodology is reasonable, and establish how the identified lost revenues were attributable to coronavirus. The updated guidance also states that the use of an alternative reasonable method will increase the likelihood of an audit.

Also, as required by the CAA, the guidance clarifies that a parent organization may transfer targeted distribution funds received by a subsidiary. However, the original targeted distribution recipient remains responsible for reporting on the use of funds.

HHS has opened the PRF reporting portal for recipients to register. However, it has delayed reporting to give recipients ample time to familiarize themselves with the updated reporting requirements in advance of required submission deadlines. HHS did not announce new reporting deadlines as part of this update.

DMHC Proposes Emergency Regulations on Patient Transfers

On Jan. 12, the Department of Managed Health Care proposed to adopt emergency regulations on the transfers of enrollees per state or local public health orders. Once approved by the Office of Administrative Law and filed with the Secretary of State, the regulations will be effective and remain in effect for 180 days. The draft regulations state the following:

  • An order issued by the state public health officer or a local health officer that directs or allows hospitals or other health care facilities to transfer patients to other facilities is covered by these regulations.
  • Plans shall not require prior authorization or prior notice for a transfer and shall cover the medically necessary costs of moving an enrollee between facilities.
  • Plans must reimburse the receiving facility for all medically necessary services provided during the first 72 hours the enrollee is treated at the receiving facility.
  • After 72 hours, the plan shall continue to reimburse the receiving facility for all medically necessary services if:
    • The facility notifies the health plan that it is treating their enrollee within 72 hours of receiving the enrollee.
    • The plan does not disapprove the facility’s request to continue providing medically necessary care to the enrollee.
  • If the plan disapproves the request to continue providing care after 72 hours, it shall reimburse the facility for services up to the time the plan effectuates the enrollee’s transfer or is discharged from the receiving facility.

State Revises Vaccine Allocation Guidelines

California has revised its vaccine allocation guidelines to allow vaccination of all persons 65 and over, if vaccine is available. In addition, CDPH now recommends the use of 50% of doses providers have received as second doses.

Biden Announces Pandemic Relief Legislative Package

In a speech to the nation on Jan. 14, President-elect Biden announced his first legislative initiative (see fact sheet and summary). His first priority is a $1.9 trillion proposal that provides economic stimulus, support for state and local governments, expanded federal support for vaccine distribution, and other measures. It is not clear if there is specific relief directed at hospitals, but CHA will continue to work with the California congressional delegation to ensure that hospitals’ needs are addressed. 

CDPH Announces Residential Care Sites as Discharge Option for Some COVID-19 Patients

CDPH has issued AFL 21-02, which announces that the California Department of Social Services has developed residential alternate care sites as a potential discharge option for COVID-19-positive patients needing a residential level of care and intermittent incidental medical support. The goal of these residential alternate care sites is to care for COVID-19 patients who reside in residential care facilities for the elderly or adult residential facilities that can no longer care for them, as well as to support the decompression of hospitals. 

As noted in the AFL, the residential alternate care sites are low-acuity sites that provide some nursing and medical services. Individuals admitted must be at a residential care level and may require some “health related assistance” but not 24-hour skilled nursing. The admission criteria for each site may vary based on the staffing level, equipment available, and physical space.  

Valencia Branch Lab Testing Extended for Hospitals

The state has announced that the use of the Valencia Branch Lab (VBL) for testing capacity of hospital health care personnel has been extended indefinitely. There are two partnership pathways for hospitals choosing to use the VBL: using the lab to test hospital personnel only or using it to test hospital personnel and community members. The indefinite extension applies to both options. 

For more information on partnering with the Valencia Branch Lab, see the updated Expanded COVID-19 Testing Capacity in Partnership with the State (new link) summary or visit the state’s testing website.

Cal OES Issues Letter on Decedent Management

The Governor’s Office of Emergency Services (Cal OES) has notified hospitals, medical examiners, county sheriff coroners, and others about the resources and support available through the Coroners’ Mutual Aid and Mass Fatality Management System. While recognizing that California has not experienced a mass fatality situation as a result of COVID-19, the letter instructs stakeholders — should the situation arise — to follow specific provisions on the Cal OES website.  

The letter also reminds hospitals to immediately assign an individual to continually assess capacity management and outreach if they have not yet done so.

CDPH Issues Guidance for SNFs on Using Salesforce to Request Fit Testing for Staff

CDPH has issued AFL 21-05, which explains the process skilled-nursing facilities should use for requesting resources through Salesforce to support fit-testing of respiratory protection for staff. Under the new process, which took effect Jan. 13, the state has contracted with Concentra to provide training and fit testing for nursing facility staff who must wear respiratory protection to safely perform their essential duties. Facilities will now be able to enter fit-testing requests into Salesforce for their MHOAC to consider and coordinate. Additional information about the Salesforce platform is available in AFL 20-79.   

On-Demand Webinar Offers Tools to Help Care for the Caregiver

As the COVID-19 surge extends into the winter and continues to stretch front-line 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.

Summary of Jan. 12 CDPH Call

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

Surge-Related Data Resources

  • State Resources: Monitor the regional stay home order and ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.

News for January 12

CDC Allocates $22 Billion in Funding to Support Expanded Testing, Vaccination Distribution

The Centers for Disease Control & Prevention (CDC) has allocated $22 billion in funding for states, localities, and territories in response to the pandemic, as authorized by the Coronavirus Response and Relief Supplemental Appropriations Act. California will receive $1.696 billion for testing activities and $357 million for vaccine activities. The CDC will distribute funding by Jan. 19.  

OSHPD Releases High Flow Medical Oxygen Best Practices Guide

On Jan. 8, the Office of Statewide Health Planning and Development (OSHPD) released a guide titled Health Facility Medical Oxygen Systems Best Practices During Covid-19 Pandemic. It notes the demand on existing oxygen systems is being stressed during the pandemic due to patient treatment needs and provides best practices OSHPD has observed. The intended audience for the guide is hospital facility engineering and maintenance staff, and any other staff with authority over the use of the medical oxygen system.

FAQs Help Hospitals Prepare for Jan. 15 PPE Reporting Deadline

As reported previously, California’s general acute care hospital personal protective equipment (PPE) stockpile bill – Assembly Bill (AB) 2537 – requires hospitals to be prepared to report specified PPE data as of Jan. 15. CHA continues its discussions with the administration in an effort to obtain further guidance on many aspects of AB 2537. However, in the absence of guidance from Cal/OSHA, CHA developed and has updated frequently asked questions to assist hospitals with implementation. There remains much ambiguity with this law; CHA will continue to provide updates as they develop.

Web-Based Tool Shows Locations That Offer Monoclonal Antibody Therapeutics

The U.S. Department of Health and Human Services (HHS) announced it has a developed a web-based locator for COVID-19 outpatient treatment sites offering monoclonal antibody therapeutics. The COVID-19 therapeutics distribution page shows locations, including facility name and address, and which monoclonal antibody therapeutic has been delivered to the sites. Only facilities that are open to the general public are listed. The locator does not include facilities that receive the monoclonal antibody therapeutics for outpatient treatment of specific groups, such as for patients in long-term care facilities, skilled-nursing facilities, psychiatric facilities, or prisons.

CHA to Hold Series of Regional Calls With State Legislators

CHA has scheduled a series of regional briefings for legislators and their chiefs of staff on the COVID-19 crisis, to be held between Jan. 13 and Jan. 27. The briefings will include updates from CHA President & CEO Carmela Coyle and local hospital leaders sharing a ground-level of what’s happening in their communities. Topics to be covered are:

  • Caseload (and projections for the coming weeks and months)
  • Hospital capacity data
  • Vaccine distribution
  • Hospital financial position
  • How legislators can use their voices to help the state get through the imminent danger of the next six weeks

Briefings will be held for the following regions: San Diego/Imperial /Orange Counties, Los Angeles/Los Angeles coastal suburbs, Riverside/San Bernardino Counties, Bay Area/Coastal, Central Valley, Northern California (including Sacramento).

CHA Webinar Will Detail New Data Reporting Requirements

To explain the new COVID-19 data reporting requirements that took effect Jan. 8 – including reporting ICU surge beds – CHA will hold a complimentary, members-only webinar Jan. 14 from 1:30 to 2:30 p.m. (PT). The webinar will examine how to submit COVID-19 data accurately and avoid mistakes, address the new field that captures ICU surge bed data, share lessons learned from the reporting process, and discuss how to use the updated data dictionary and reporting guide. Experts from CHA and the California Department of Public Health (CDPH) will be available to clarify definitions, offer insights, and confirm requirement effective dates. Participants are asked to register in advance.

CDPH Vaccination Program Office Hours: Jan. 15

CDPH will hold a COVID-19 Vaccination Office Hours call on Jan. 15 from 9 to 10 a.m. (PT). Use this link and the password “Immunize2021!” to participate.

Weekly DHCS Weekly Provider Call Covers Timely Behavioral Health Issues 

The Department of Health Care Services (DHCS) is hosting weekly calls on Wednesdays at 8 a.m. (PT)  for mental health and substance use disorder treatment facilities and providers. The calls, which feature subject matter experts from CDPH and the California Department of Social Services, provide updates on emergency surge response, and answer questions about licensing and certification flexibilities, alternative sites, testing, vaccination, isolation and quarantine, and more. CHA participated in the Jan. 6 call with the California Health & Human Services Behavioral Health Secretary, DHCS, and the County Behavioral Health Directors Association; highlights from the call are available on the CHA website.

Next CDPH Call for Health Care Facilities: Jan. 19, 8-9 a.m. (PT)  

Dial: (844) 721-7239  

Passcode: 7993227 

Surge-Related Data Resources

  • State Resources: Monitor the regional stay-at-home order and ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.

News for January 8

State Health Order on Hospital Surge Released

The State Health Order, released by the California Department of Public Health (CDPH) Jan. 5 and amended Jan. 6, is in effect through at least Jan. 26 and unless rescinded, primarily does two things:

  1. In Section 1, delays Tier 1 (low acuity) and Tier 2 (intermediate acuity) elective surgical procedures (exempting children’s hospitals) for counties experiencing less than 10% ICU capacity in regions with 0% ICU capacity. This is a measure that many hospitals in highly affected areas have already undertaken to accommodate the massive influx of COVID-19 patients. However, the State Health Order only includes one set of criteria by which hospitals can determine which procedures to postpone, and that is the Tier 1, 2, and 3 framework of the Elective Surgical Acuity Scale. CHA is seeking clarifications from CDPH about other considerations hospitals can use in making these decisions, including clinical judgment and impact on hospital inpatient capacity.
  2. Allows the state to direct the transfer of patients, requiring hospitals to accept transfers from hospitals in crisis care “when capable and clinically appropriate.” While well-intended, CHA has concerns that shifting patients during a pandemic will not address the underlying capacity issues that are hitting in so many areas right now. The remaining Sections 2, 3, and 4 of the order are about patient transfers. These apply to all hospitals in California.

Currently, hospitals located within scope of the order for Section 1 (on elective surgical procedures, hospitals in crisis care) of the State Health Order are:

  • In the San Joaquin Valley Region: Fresno, Kern, Kings, Madera, Merced, San Benito, San Joaquin, and Stanislaus counties
  • In the Southern California Region: Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego counties and — as of Jan. 8 — Santa Barbara and Ventura counties (CDPH to issue press release).

To be within scope, a county must be in a region with 0% ICU capacity and be in a county with less than 10% ICU capacity. Region ICU data are posted here. CHA has asked CDPH to publicly post its calculations of ICU percent capacities by county so hospitals can plan and know when they will be affected.

State Issues Recommendations to Accelerate Safe Vaccine Administration Statewide

On Jan. 7, CDPH issued recommendations to maximize COVID-19 vaccine administration and reduce the potential for vaccine waste. According to the recommendations, “local health departments and providers should immediately administer COVID-19 vaccines to individuals in all tiers of Phase 1a.”  The recommendations further encourage providers offering vaccines to consider partnering with other providers or organizations to provide vaccinations for individuals in the prioritized tiers. 

The recommendations encourage that special efforts be made to administer the vaccine to vaccinators. CDPH also clarified that local health departments and providers may allocate doses on the assumption that immunization will be accepted by some, but not all, of those who are offered it, and then continue to offer vaccinations to all individuals in progressive priority tiers. Finally, if a county has maximized use of the vaccine to administer to individuals in Phase 1a, it should move to Phase 1b, Tier 1 while continuing to offer vaccines to those in higher priority groups.

DMHC Issues All Plan Letters in Response to Public Health Order

On Jan. 6, the Department of Managed Health Care (DMHC) released All Plan Letters (APL) 21-003 and 21-004 in response to the public health order issued and amended earlier this week by CDPH. This accompanies the State Health Order described above. APL 21-003 states that health plans may not prevent or delay the transfer of a plan enrollee pursuant to the order. The APL directs health plans to cover the medically necessary costs associated with the transfer and states that plans may not require prior authorization on a hospital’s transfer of plan enrollees under the order. 

APL 21-004 is a reminder to plans of their continuing obligations to cover emergency services and care provided to enrollees and that such coverage includes reimbursement for appropriate transfers of unstable enrollees between hospitals in conformance with the requirements of the federal Emergency Medical Treatment and Labor Act. More details about both APLs are available on CHA’s website.

HHS Renews Public Health Emergency

On Jan. 7, the U.S. Department of Health and Human Services (HHS) formally renewed the COVID-19 public health emergency declaration, effective Jan. 21, for 90 days.

Revised Travel Advisory Clarifies Quarantine Requirements for Health Care Staff

CDPH has revised its travel advisory for individuals entering or returning to California from another state or country. The updated advisory clarifies that those who are needed to meet urgent critical health care staffing needs or to otherwise engage in emergency response do not need to quarantine. CHA had identified to CDPH that the travel advisory did not make this explicit, and given the staff coming in from other states and potentially countries wanted to make clear they do not need to quarantine.

CDPH, DHCS Issue Updates on Acute Hospital Care at Home

CDPH and the Department of Health Care Services (DHCS) have issued additional information and guidance for hospitals that are interested in participating in the Acute Hospital Care at Home program. 

The Centers for Medicare & Medicaid Services (CMS) recently introduced a provider waiver for this program, expanding on its Hospital Without Walls waiver to provide regulatory flexibility for hospitals to treat patients in locations outside the hospital, including their homes.  

CDPH has issued All Facilities Letter (AFL) 20-90, explaining that general acute care hospitals (GACH) seeking to provide acute hospital care at home services must also meet applicable GACH licensing requirements and obtain approval for appropriate program flexibilities from CDPH. DHCS has announced that Medi-Cal will reimburse participating hospitals for acute inpatient care in both fee-for-service and managed care for Medi-Cal beneficiaries. See CHA’s website for additional information.

AHA Tools Help Hospitals Plan, Communicate, Administer Vaccinations

The American Hospital Association (AHA) has developed several new resources on vaccine planning and administration for hospitals and health systems, as well as public-facing educational campaigns. These include:

  • Advocacy: A letter that AHA sent to HHS asking for more federal leadership on vaccine rollout.
  • New Ad Council Public Service Announcement: The Ad Council launched an AHA-supported COVID-19 Vaccine Education Effort, a multichannel campaign with four videos, several of which feature AHA Board Chair Melinda Estes, M.D. In addition to the Ad Council-developed videos, hospitals and health systems have access to a host of downloadable materials.
  • New Toolkit: The Society for Healthcare Strategy and Market Development members developed a new communications toolkit to guide hospitals and health systems through the steps involved in planning, designing, and executing a vaccine communications plan and campaign.
  • #MyWhy: A social media campaign that amplifies health care workers’ voices on the importance of getting vaccinated.
  • AHA Vaccine Website: Developed in coordination with the Centers for Disease Control and Prevention (CDC), the site features a vaccine candidate scorecard, a vaccine primer, CDC’s communications and distribution resources, and an allocation framework.

CA Notify App Tracks COVID-19 Exposure

Last month, the state launched an app called CA Notify that is designed to quickly notify individuals when they’ve been in sustained contact (per CDC guidelines) with someone who tested positive for COVID-19. To assist hospitals and other partners in communicating about the new exposure notification tool, CDPH has developed this toolkit, which includes handouts in multiple languages, videos, and banners for social media platforms. Additionally, CHA hosted a webinar to explain the app and its benefits on Dec. 9; a recording of that webinar is also available.

Surge-Related Data Resources

  • State Resources: Monitor the regional stay home order and ICU capacity by region or by county.
  • CHA Resource: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.

Next CDPH Call for Health Care Facilities: Jan. 12, 8-9 a.m. (PT)  

Dial: (844) 721-7239  

Passcode: 7993227 

Summary of Jan. 5 CDPH Call

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

News for January 5

ICYMI: Deadline for Hospitals to Post Crisis Care Continuum Guidelines Is Jan. 6

The California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 20-91, which addresses the need for all health facilities to have crisis care continuum Guidelines and to implement those guidelines if they are experiencing surge as a result of the current increase in COVID-19 cases. The AFL outlines new expectations for hospitals during the current surge and includes links to the CDPH Crisis Care Continuum Guidelines and its new Crisis Care Guidelines Pre-Implementation Checklist

Notably, the AFL states that, by Jan. 6, all facilities must notify their local CDPH district office and local public health department via email that they have adopted and publicly posted (including a link to the posting) their own crisis care continuum Guidelines, another facility’s guidelines, or California’s Crisis Care Continuum Guidelines. According to the AFL, hospitals are expected to have plans that best fit their facility’s and regional needs and processes, while following ethical principles, health equity goals, and civil rights laws. Additionally, hospitals that need to implement crisis care, including triage of critical care resources, must notify their local public health department and local CDPH district office via email and phone call immediately.

Facilities that do not have current guidelines should consult with their Medical Health Operational Area Coordinators for technical assistance.

To assist hospitals during the winter surge, CHA has prepared several resources that highlight the guidelines’ key concepts and planning considerations for allocating scarce medical resources during surge operations. These include:

  • A checklist for preparing for the possibility of moving to crisis standards of care
  • A step-by-step guide for implementing crisis standards of care
  • FAQs about crisis standards of care 
  • Key messages for use or customization with the media or public

CHA has also posted a recording of its webinar reviewing the Crisis Care Guidelines.

Revised Infection Control Survey Tool Includes Updated CDC Recommendations for Employee Screening

The Centers for Medicare & Medicaid Services (CMS) has issued a revised COVID-19 focused infection control survey tool for acute and continuing care providers. Among the revisions, CMS aligns the survey tool with recent updates from the Centers for Disease Control and Prevention (CDC) related to screening and triage of those entering health care facilities. Specifically, the survey tool assesses whether the facility has a screening process for all staff to complete prior to or at the beginning of their shift that reviews for exposure to others with known or suspected COVID-19, signs/symptoms of illness, and includes whether fever is present (screened upon arrival or self-reported absence of fever).

In accordance with QSO-20-35-All, related to the revised survey prioritization, surveyors will continue to use the COVID-19 infection control survey tool as part of any survey conducted during the public health emergency. The survey tool will generally not be used for investigations where a complaint allegation is not related to infection control concerns.

Data Reporting Updates Include ICU Surge Beds, Therapeutic Fields

With the surge in COVID-19 cases and the decreasing ICU capacity across California, the state finds it necessary to track ICU surge beds. To capture this data, CHA will update the CHA COVID-19 Tracking Tool to include a new field called ICU Surge Beds (a subset of the Total Surge Beds field) on Jan. 8. Following are updates to data reporting:

  • The addition of one new field: ICU Surge Beds
  • The four weekly therapeutic fields below will become mandatory on Wednesday, Jan. 13
  • Current Inventory: casirivimab/indevimab
  • Courses Used in Past Week: casirivimab/indevimab
  • Current Inventory: bamlanivimab
  • Courses Used in Past Week: bamlanivimab
  • The U.S. Department of Health and Human Services recently provided clarifications on therapeutic reporting (see page 7 of this Q & A document). Courses used/administered should be counted for locations including an inpatient, ED, overflow, or outpatient location, such as an urgent care, infusion center, or outpatient clinics.

CHA will provide hospitals and systems currently using the data upload feature with a revised template in advance. The revised data dictionary includes updates highlighted in blue. In addition, CHA is working with CDPH to update the data reporting guidance document. Questions can be directed to COVIDTracker@calhospital.org.

CalVax to Replace COVIDReadi as Vaccine Provider Enrollment System

CDPH has announced a new vaccine management system, CalVax, which will launch on Jan. 11. CalVax will replace the existing COVIDReadi system and be a statewide centralized system for health care providers enrolled in the California COVID-19 Vaccination Program. CalVax allows providers to enroll in the California COVID-19 Vaccination Program, order vaccines, update account information, and manage vaccine reporting tasks. Providers enrolled in COVIDReadi, or that have completed part A of the COVIDReadi enrollment process and at least some of part B by Jan. 8, will not need to re-enroll in CalVax. CDPH will provide a demo of this new system during its Jan. 8 webinar, from 9 to 10:30 a.m. (PT), for providers (link to register here; details below).

CDPH Issues Guidance on Vaccine Distribution, Management

CDPH has issued a Vaccination Program update that includes details on redistribution of the Moderna vaccine, how to return vaccine shippers, how to minimize wasted doses, and information on the VaccineFinder tool. Key information is as follows:

  • Redistributing the Moderna vaccine: What to do after a vial has been thawed, storing and distribution temperatures, and links to a guide to redistribution, repositioning and transfers; redistributing vaccines; guidance for satellite, temporary, and off-site clinics; and transporting the vaccine
  • Vaccine shippers: The Pfizer thermal shipper and temperature monitoring device should be returned within 30 days of delivery. Return instructions are provided in the Shipping & Handling Guidelines brochure, which ships with vaccines.
  • Minimizing waste:
    • For the Pfizer vaccine, room temperature hold time is up to two hours prior to dilution, then use or discard after six hours.
    • For the Moderna vaccine, room temperature hold time is up to 12 hours total (including prior to and after puncture). After puncture, use or discard within six hours.
    • Preventive measures include counting eligible persons and doses in advance before thawing or removing from storage and creating standby lists of prioritized persons to use in case of unused doses.
  • VaccineFinder: What to expect as a newly enrolled provider, what to do if provider registration is incomplete, inventory reporting requirements, links to fact sheets and training documentation, reporting responsibilities for providers that plan to use a hub-and-spoke model for vaccine distribution, and more.

CDPH has posted this and other California COVID-19 Vaccination Program Updates on the archived communications section of its COVID-19 Vaccination Program website.

Weekly DHCS Behavioral Health Provider Calls Start Jan. 6, 8 a.m. (PT)

The Department of Health Care Services will begin holding weekly calls for mental health and substance use disorder treatment facilities and providers every Wednesday at 8 a.m. (PT) beginning on Jan. 6. The calls will feature subject matter experts from CDPH and the California Department of Social Services, provide updates on emergency surge response, and answer questions about licensing and certification flexibilities, alternative sites, testing, vaccination, isolation and quarantine, and more. To join, go to the meeting webex site.

CMS, CDC to Host Jan. 6 Fireside Chat on Vaccine Safety for Nursing Home Staff, CNOs

CMS and the CDC will hold a fireside chat webinar for providers on vaccine safety Jan. 6 at 1 p.m. (PT), targeted for nursing home front-line staff and chief nursing officers. The second in a special series addressing staff questions and concerns, the webinar will focus on myths surrounding vaccine danger and include panelists from CMS and the CDC, as well as a certified nursing assistant. Questions for the panelists can be sent in advance to COVID-19@cms.hhs.gov. Registration is available online; after registering, a confirmation email will be sent with details for joining the webinar.

CDPH Webinar for Providers on Vaccination Program Is Jan. 8

CDPH will host a webinar for hospitals and other providers with COVID-19 vaccination updates on Jan. 8 at 9 a.m. (PT). This webinar will include a demo of the new CalVax system. Visit this link to participate. Future webinars for providers are expected to continue weekly on Fridays from 9 to 10 a.m. (PT).

Data Resources During the Winter Surge

State Resources: Monitor the regional stay at home order and ICU capacity by region here. Monitor the ICU capacity by county here.

CHA Resources: Hospitals can access county dashboards through the CHA COVID Tracking Tool here, which includes hospital-specific data on ICU capacity.

FEMA Rule Continues Export Limitations on Certain PPE, Adds Syringes and Hypodermic Needles

On Dec. 31, 2020, the Federal Emergency Management Agency issued a temporary final rule that extends, through June 30, the designation that certain medical resources are limited to domestic use. The rule continues to apply to surgical masks, N-95 respirators, nitrile surgical and exam gloves, and level 3 and 4 surgical and surgical isolation gowns. The temporary final rule also adds specific syringes and hypodermic needles to the designated list. While the rule is in effect, subject to limited exceptions, no shipments of designated medical supplies may be exported from the United States. 

Next CDPH Call for Health Care Facilities: Jan. 12, 8-9 a.m. (PT)   

Dial: (844) 721-7239 

Passcode: 7993227 

Summary of Dec. 29 CDPH Call

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

News for December 29

CDPH Issues AFL on Crisis Standards of Care

The California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 20-91, which addresses the need for all health facilities to have crisis care continuum guidelines and to implement those guidelines if they are experiencing surge as a result of the current increase in COVID-19 cases. The AFL outlines new expectations for hospitals during the current surge and includes links to the CDPH Crisis Care Continuum Guidelines and its new Crisis Care Guidelines Pre-Implementation Checklist

Notably, the AFL states that, by Jan. 6, 2021, all facilities must notify their local CDPH district office and local public health department via email that they have adopted and publicly posted (including a link to the posting) their own crisis care continuum guidelines, another facility’s guidelines, or the state’s California Crisis Care Continuum Guidelines. According to the AFL, hospitals are expected to have plans that best fit their facility and regional needs and processes, while following ethical principles, health equity goals, and civil rights laws. Additionally, hospitals that need to implement crisis care, including triage of critical care resources, must notify their local public health department and local CDPH district office via email and phone call immediately.

Facilities that do not have current guidelines should consult with their Medical Health Operational Area Coordinators for technical assistance.

To assist hospitals as the winter surge continues to grow, CHA has prepared several resources that highlight the guidelines’ key concepts and planning considerations for allocating scarce medical resources during surge operations. These include:

  • A checklist for preparing for the possibility of moving to crisis standards of care
  • A step-by-step guide for implementing crisis standards of care
  • FAQs about crisis standards of care 
  • Key messages for use or customization with the media or public

Update on State COVID-19 Supplemental Paid Sick Leave

Earlier this week, the President signed a bill that partially extends the paid leave provisions in the Families First Coronavirus Response Act (FFCRA). While the federal bill does not extend the mandatory leave entitlement, it does allow private employers covered by the FFCRA that voluntarily provide the leave to receive payroll tax credits until March 31, 2021.

California’s COVID-19 Supplemental Paid Sick Leave is set to expire on Dec. 31, unless the FFCRA was extended. It is unclear whether the partial extension of the FFCRA is sufficient to trigger an extension — to March 31, 2021 — of California’s COVID-19 Supplemental Paid Sick Leave. CHA is seeking clarification on this from the California Labor & Workforce Development Agency and will share updates in Coronavirus Response

As of last week, there were no certain plans to extend California’s COVID-19 Supplemental Paid Sick Leave if the FFCRA was not extended, but this is an evolving situation. If the agency determines that the partial extension does not extend it, the Legislature or the governor could step in and extend the COVID-19 Supplemental Paid Sick Leave or wait to see whether the Biden administration takes any action. CHA will continue to provide updates as they develop.

FAQs to Assist with New PPE Law

With California’s general acute care hospital personal protective equipment stockpile bill (Assembly Bill 2537) taking effect on Jan. 1, 2021, CHA has developed these frequently asked questions to assist hospitals with implementation. There remains much ambiguity with this law; CHA will continue to provide updates as they develop. Questions can be directed to Gail Blanchard-Saiger.

Summary of Dec. 22 CDPH Call

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

News for December 22

CHA Resources on Planning for Crisis Standards of Care

In June, the California Department of Public Health (CDPH) issued its California SARS-CoV-2 Pandemic Crisis Care Guidelines: Concept of Operations/Health Care Facility Surge Operations and Crisis Care, providing a framework to help health care facilities plan for an overwhelming medical surge due to the pandemic. The guidelines include an overview of surge capacity and crisis care operational considerations, as well as a decision-making framework for allocating ventilators and pandemic patient care strategies for scarce resource situations.

Importantly, while the Guidelines provide information to support individual health care facilities or health system operations, CDPH makes clear that the Guidelines do not replace the judgment of operational management, medical directors, legal advisors, or clinical staff or consideration of other relevant variables and options. To assist hospitals as the winter surge continues to grow, CHA has prepared several resources that highlight the guidelines’ key concepts and planning considerations for allocating scarce medical resources during surge operations. These include:

  • A checklist for preparing for the possibility of moving to crisis standards of care
  • A step-by-step guide for implementing crisis standards of care
  • FAQs about crisis standards of care 
  • Key messages for use or customization with the media or public

CHA recommends that when hospitals implement the crisis care guidelines they notify the local CDPH district office as a way of communicating the change in operations at the hospital.

Updated Vaccination Primer Includes New Information for Hospitals

CHA has updated its COVID-19: Vaccination Primer for California Hospitals  with new information released by the state on additional doses being distributed statewide, who may issue vaccine orders and who may administer vaccines, provider enrollment approval considerations, and more.

FAQs Answer Key Questions About Nurse Staffing Shortages, Link to Helpful Resources

To assist with hospitals’ nurse staffing shortages during the current surge – particularly in critical care environments – CHA has compiled a quick-reference set of FAQs that address the expedited option for nurse staffing ratio flexes recently issued by CDPH; how to request a program flex for nursing documentation; samples of team nursing models currently in use by other hospitals; how to use nursing students to supplement care and for administering vaccines; and available critical care training specific to COVID-19 ICU patients.

Congress Passes Year-End Legislation That Includes COVID-19 Relief

The House and Senate leadership reached an agreement Dec. 21 on a year-end legislative package that extends funding for the federal government through the end of the federal fiscal year, provides additional relief for small businesses, workers and health care providers suffering from the COVID-19 pandemic, and addresses the issue of surprise medical bills.

CHA worked closely with the California congressional delegation and the leadership to help shape this legislation. While all our priority issues were not completely addressed, the bill includes important provisions on relief from Medicare and Medicaid cuts and adjustments to Provider Relief Fund  reporting. CHA will continue to work with the next Congress and the Biden administration to secure additional funds for hospitals and their front-line workers. Details of the stimulus package are available on the CHA website.

DHCS Seeks Federal Approval for No-Cost COVID-19 Vaccines for Medi-Cal Beneficiaries

With the recent Food and Drug Administration approval of COVID-19 vaccines, the Department of Health Care Services (DHCS) is seeking federal approval to help support delivery of the vaccine to all Medi-Cal beneficiaries.

DHCS will follow CDPH’s California’s COVID-19 vaccination plans. They call for implementation in several phases: pre-vaccine; limited doses available; larger number of doses available; and sufficient supply of doses available for the entire population. DHCS expects to issue initial guidance on COVID-19 vaccine administration and reimbursement policy by Dec. 25.

CMS Issues Guidance on Infection Control in Psychiatric, Intermediate Care Facilities

The Centers for Medicare & Medicaid Services (CMS) has issued guidance to psychiatric hospitals, psychiatric residential treatment facilities, and intermediate care facilities for individuals with intellectual disabilities that aims to improve infection control practices and help prevent the transmission of COVID-19. The guidance also seeks to avoid the need for use of seclusion and restraint, specifically as an infection control intervention.

The guidance includes a set of FAQs in the following areas:

  • Promising practices, measurement, and mitigation strategies for infection control during the public health emergency (PHE)
  • Use of isolation, cohorting, and personal protective equipment
  • Intervention, mitigation, and training strategies
  • Transition and discharge during the PHE
  • Engaging family, caregiver, support personnel, and community resources
  • Available local, state, and federal resource guides and web links

Toolkit Offers Help Complying with COVID-19 Workplace Notice Requirements

CHA has released a toolkit to help hospitals comply with the COVID-19 workplace notice requirements in a new California law — Assembly Bill 685 — that takes effect Jan. 1, 2021. The law, which is enforced by Cal/OSHA, requires employers to notify employees that they may have been exposed to COVID-19 in the workplace. The toolkit covers key provisions of the law and includes a sample notice for employees.  

While CHA convened a member workgroup to develop the toolkit to address the law’s most relevant components and issues, it is not legal advice and hospitals are encouraged to consult with counsel on any questions or concerns. CHA has also developed an on-demand educational video that provides a summary of the law.  

CHA Board Honors Health Care Workers With Award of Merit

At its Dec. 15 meeting, the CHA Board of Trustees gave the organization’s highest honor – the Award of Merit – to California’s COVID-19 caregivers. The award, which recognizes outstanding contributions to the health care community, recognizes the 500,000 men and women of California’s hospitals who wake up every day, selflessly leave their families, and arrive at our hospitals to care for patients during the pandemic. This short tribute video from CHA recognizes hospital workers’ selfless contributions over the past year. 

Hospitals Have a Message for the Public: Don’t Share Your Air

During a statewide, virtual press conference on Dec. 22, leaders, physicians, and front-line workers from three hospital systems — stretched to their limits by the COVID-19 surge — pleaded with Californians to take stringent, common-sense precautions in the coming weeks to avoid getting or spreading the virus.

In conjunction with California Health and Human Services Secretary Mark Ghaly, MD, they issued a “prescription” for Californians to avoid spreading the virus during the Christmas, Kwanzaa, and New Year’s holidays: Don’t share your air. This includes keeping your face covered with a mask, keeping the air flowing (turn on fans and open windows if indoors), and keeping your in-person interactions with others short.

Resources to amplify these messages are available in English and Spanish.

Next CDPH Office Hours: Dec. 29

CDPH will hold a COVID-19 Vaccination Office Hours  for hospitals on Dec. 29 from 9 to 10 a.m. (PT). The link to participate at the time of the event is here. Webinar dates will resume on Jan. 8.

Coronavirus Response Returns Jan. 5

Coronavirus Response will not be published on Dec. 29. The next issue will be Jan. 5, 2021.

News for December 21

Moderna Vaccine Shipments to Begin Today

In a Dec. 18 webinar for hospitals and other vaccinators, the California Department of Public Health (CDPH) indicated that it anticipates having 40% of the first doses needed to vaccinate Phase 1-A populations for California by Dec. 28. These total 1.2 million doses and are for the 3 million individuals who meet Phase 1-A criteria (front-line health care workers and long-term care residents). The 1.2 million doses are arriving in four tranches:

  • Pfizer first shipment (scheduled to have arrived by Dec. 16): 327,600
  • Moderna first shipment (scheduled to arrive Dec. 21-27): 672,600
  • Pfizer Centers for Disease Control and Prevention Long-Term Care Partnership: 45,825
  • Pfizer second shipment: 187,200

The first shipment of Moderna vaccines is scheduled to arrive today through Dec. 27 at hospitals, local health departments, and other vaccinators. Hospitals with questions about how much they are being allocated should contact their local health department, unless they have been designated as a multi-county entity by CDPH (for health systems with hospitals in three or more counties that agreed to be designated), in which case they should contact CDPH.

Pfizer COVID-19 Vaccine Vials May Contain Additional Doses

As the initial doses of the Pfizer COVID-19 vaccine were administered last week, immunizers observed additional volume in the five-dose vials. In an update to Pfizer COVID-19 vaccine recipients on Dec. 17, CDPH reiterated guidance from the Food and Drug Administration (FDA) from Dec. 16 that, given the public health emergency, the FDA is advising that there is the potential to obtain a sixth or seventh dose from each of the vials. To determine whether an additional dose can be obtained from a vial, the following should be considered:

  • The remaining liquid in a vial must make up a full dose.
  • Multiple vials should not be pooled to create an additional dose, as the product is preservative free.

Requesting a Program Flex to Implement Surge Standards of Nursing Documentation

Many hospitals have asked how they can request a program flex for nursing documentation. To do this, the hospital must complete  CDPH Form 5000A and submit it to CHCQdutyofficer@cdph.ca.gov and copy the local CDPH District Office. CHA has developed instructions and sample language to help hospitals complete the form. Note that if a hospital needs CDPH to approve the request within eight hours, it should put the word “URGENT” in the email subject line. CHA is additionally advocating with CDPH to allow such a flex statewide; in the absence of that, hospitals may wish to request individual program flexes now.

AFL Addresses Transfers to Low-Acuity Alternate Care Sites

On Dec. 16, CDPH released All Facilities Letter (AFL) 20-48.3 on transferring patients to low-acuity alternate care sites. The state is currently operating alternate care sites in Sacramento, Fairview (Orange County), and Porterville (Tulare County).

While the AFL defines the alternate care sites and the process for transfers, it does not provide the specific admission criteria for the three locations. As of Dec. 17, the Emergency Medical Services Authority in Orange County has circulated admission criteria for Fairview, which is also being used for the other locations. However, for admission information, hospitals should contact the local Medical Health Operational Area Coordinator.

DMHC All Plan Letter Directs Health Plans to Support Hospitals

CHA continues to advocate with the Department of Managed Health Care (DMHC) for assistance with hospitals’ response to the pandemic, providing information to the department about what hospitals need, and the challenges they are facing. On Dec. 16, DMHC released All Plan Letter (APL) 20-042, which directs health plans to remove administrative barriers on hospitals during the COVID-19 surge, including taking immediate steps to reduce or remove hurdles to the efficient admission, transfer, and/or discharge of health plan enrollees. By Dec. 29 and again by Jan. 12, 2021, health plans must report to DMHC the steps they are taking to support hospitals in removing barriers to providing efficient care during this unprecedented time.

In April, CHA urged DMHC to direct health plans to remove administrative barriers, support providers by offering advanced payment programs, and resolve unpaid claims. As a result, the department released an APL asking plans to describe the actions they have taken to support providers. In light of the most recent surge of COVID-19 individuals needing hospital care, CHA identified a number of steps that DMHC could take. While this APL does not incorporate these requests, the information it will gather is a step in the right direction.

CDPH Rescinds Requirement for Hospice Prior Authorization During Public Health Emergency

CDPH has issued AFL 20-47.1, which provides updated information about the temporary suspension of regulatory enforcement of hospice requirement during the public health emergency. The AFL rescinds prior authorization to begin operations based solely on submission of an application and clarifies that a hospice provider seeking initial licensure must receive approval before providing care.

CHA Provides Summary of CMS Acute Hospital Care at Home Program

On Nov. 25, the Centers for Medicare & Medicaid Services (CMS) introduced the Acute Hospital Care at Home Program, significantly expanding the existing Hospital Without Walls waiver. Program details are available in a summary prepared by CHA. 

CHA is in communication with CDPH about state policies and procedures for the establishment and oversight of the Acute Hospital Care at Home Program. CDPH reports it is reviewing the program and will issue an AFL in the near future.

News for December 16

HHS Begins Distributing Phase 3 COVID-19 Provider Relief Funds

The U.S. Department of Health and Human Services (HHS) began distribution of $24.5 billion in Phase 3 Provider Relief Funds to 70,000 providers today. Recipients were required to apply for this Phase 3 general distribution. The application process allocates these payments first to providers that have not received a payment of 2% of annual operating revenue and then to providers based on actual expenses and lost revenue attributed to COVID-19. Payments to qualifying providers will occur over the next several weeks. 

Originally, HHS intended to allocate $20 billion in the Phase 3 general distribution but increased the amount by $4.5 billion. The increase is intended to cover up to 88% of providers’ reported losses. In its announcement, HHS stated that 35,000 providers who applied for the Phase 3 general distribution will not receive additional funds because they either did not experience a change in net expenses or revenue attributed to COVID-19 or have already received Provider Relief Funds equal to or in excess of 88% of reported losses. 

HHS Webinar Dec. 17 on Hospital Data Reporting Requirements

The HHS Office of Intergovernmental and External Affairs will host a webinar on Dec. 17 at 1 p.m. (PT) to provide an overview of changes to the hospital data reporting FAQ, automation projects, and Project Greenlight — an interagency initiative to validate health care facility data submitted to HHS. Online registration is required.

The webinar will include time for questions and answers, but an inbox has also been established — Protect-ServiceDesk@hhs.gov — to answer hospitals’ questions. 

CDC Webinar Dec. 17 on Crisis Standards of Care

On Dec. 17 from 11 a.m. to 1 p.m. (PT), the Centers for Disease Control and Prevention (CDC) will host a webinar titled Making Practical Decisions for Crisis Standards of Care at the Bedside During the COVID-19 Pandemic. A few minutes before the webinar starts, please follow this Zoom link to join. Advanced registration is not required.

Changes in Quarantine Guidance Affect Labor and Employment Law

Recent changes to federal and state quarantine recommendations have labor and employment law implications, touching on both Cal/OSHA’s Emergency Temporary Standard (ETS) and California’s COVID-19 supplemental paid sick leave.  

Following guidance from the CDC and subsequent guidance from the California Department of Public Health (CDPH) to local public health officers revised on Dec. 14, the Governor issued an Executive Order on Dec. 15 modifying the quarantine requirement in Cal/OSHA’s ETS addressing COVID-19 in the workplace. While the ETS does not apply to employees covered by the Aerosol Transmissible Disease (ATD) Standard, it does apply to some health system employees (see the recent CHA News article). 

The Executive Order modified ETS sections 3205(c)(10) and (c)(11) to suspend the periods set forth in those sections and instead adopts any applicable quarantine or isolation period recommended by CDPH, including in its Dec. 14 COVID-19 Quarantine Guidance; or any applicable quarantine or isolation period recommended or ordered by a local health officer who has jurisdiction over the workplace. For employees covered by the ATD Standard, this updated guidance would appear to allow for adoption of these shorter quarantine periods.

These shorter quarantine periods may also have implications for employees using COVID-19 supplemental paid sick leave, as that leave is available for situations where the employee is advised to quarantine by a health care provider or directed not to report to work by the employer.  

Summary of Dec. 15 CDPH Call

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

News for December 15

CHA Request for State Support on COVID-19 Response 

As part of our ongoing work to secure support from the state to maximize hospitals’ ability to treat patients needing acute and intensive care during the ongoing COVID-19 surge, CHA sent a formal request to the Governor’s Office and the California Health and Human Services Agency on Dec. 13. CHA requested specific steps in four areas:

  • Supplies
  • Coordination
  • Hospital Decompression
  • Regulatory Flexibility

Conversations at the highest levels are already underway. As the state responds to our most recent request, we will keep members informed.  

HHS Updates Hospital Data Reporting Requirements 

The U.S. Department of Health and Human Services (HHS) recently updated its COVID-19 hospital reporting requirements (see #39 in the HHS FAQs). The new requirements add data fields related to therapeutic treatment and make influenza reporting mandatory. These reporting requirements are a Medicare Condition of Participation under the Centers for Medicare & Medicaid Services’ (CMS) interim final rule released earlier this month. Changes in data reporting include: 

  • The addition of four new fields, which are currently optional and will become mandatory starting Jan. 8, 2021: 
    • Current Inventory: casirivimab/indevimab  
    • Courses Used in Past Week: casirivimab/indevimab 
    • Current Inventory: bamlanivimab 
    • Courses Used in Past Week: bamlanivimab 
  • The six influenza fields, which are currently optional and will become mandatory beginning Dec. 18 

On Thursday, Dec. 17, CHA will update its COVID-19 Tracking Tool to incorporate the new fields related to therapeutics and will provide hospitals and systems currently using the data upload feature with a revised template. In addition, CHA will work with the California Department of Public Health (CDPH) to update the data dictionary and the jointly created data reporting guidance document. 

CHA will also update its county dashboards to include only counts of adult ICU beds rather than adult, pediatric, and neonatal ICU beds. Questions can be directed to COVIDTracker@calhospital.org.

CDPH Provides Questions and Answers, States in Writing Deadline for Testing Plans as Dec. 14

In its weekly COVID-19 health facilities call today, CDPH clarified that it will not release any FAQs on testing recommendations All-Facilities Letter (AFL) 20-88. However, the department provided a few commonly asked questions and answers in the notes from its Dec. 8 weekly COVID-19 health facilities call.

The notes include responses about how the general acute care hospital COVID-19 mitigation testing plans are required, and how other elements in the AFL are recommended. It also states that the deadline for testing plans from general acute care hospitals to their local CDPH licensing district office was Dec. 14. While CDPH had stated this verbally on the call, the notes now provide it in writing. 

CDPH Webinar, Guidelines for Vaccination Program

CDPH will host a webinar Dec. 18 from 9-10 a.m. (PT) for hospitals, long-term care facilities, and local health departments about its COVID-19 Vaccine Program. The meeting will cover vaccine program updates, updates on provider enrollment and post-enrollment, updates from the Community Vaccine Advisory Committee and the Drafting Guidelines Workgroup, Vaccine Finder, and other details. It will also allow time for questions and answers. To join, go to the event login site.

As a reminder, as hospitals begin vaccinations, on Dec. 5 CDPH released its recommended guidelines for prioritizing the COVID-19 vaccine during this first phase, 1-A, of statewide distribution.

CMS Provides Coverage Guidance for Vaccines and Antibody Treatments

On Dec. 14, CMS reported that, during the COVID-19 public health emergency, Medicare will cover and pay for the administration of vaccines (when furnished according to emergency use authorizations). The agency’s updated payment and HCPCS Level I CPT code structure includes specific COVID-19 vaccine information. Providers are instructed to only bill for the vaccine administration codes when submitting claims to Medicare, and not to include the vaccine product codes when vaccines are free.

CMS has also provided information about coverage for monoclonal antibodies to treat COVID-19. CMS’ FAQs have been updated with Section BB addressing billing and reimbursement for these treatments, as well as an infographic with key information about expected Medicare payment.    

OSHPD Releases Vaccine Freezer Checklist, Provides Expedited Review 

The Office of Statewide Health Planning and Development (OSHPD) has posted a Vaccine Freezer Checklist to its COVID-19 Resources page. The checklist is intended to be used for the expedited review and installation of ultra-low temperature freezers used for the storage of COVID-19 vaccines in California health care facilities. It summarizes and references the applicable requirements from OSHPD and should be completed by the project architect or engineer based on the design reflected in plans at the time of completion of the checklist. Hospitals can use the checklist to determine whether an OSHPD permit is necessary. If so, hospitals should submit the completed checklist with the permit application through the OSHPD eServices Portal. OSHPD is internally expediting review of vaccine freezer permit applications.

State Changes Reservation Process for Acquiring Hotel Rooms for Employees

The state’s Non-Congregate Sheltering for California Healthcare Workers Program will undergo significant changes to the reservation process beginning Jan. 12, 2021. To meet the criteria established by the Hotels for Healthcare Workers program, all certified health care facilities are required to assign a designated point of contact to assist and oversee the reservation process, to serve as the approver for all lodging reservations, and to submit and/or approve all hotel reservation requests. 

As of Jan. 12, the points of contact are the only individuals who can submit and approve reservation requests. The facility point of contact is expected to respond promptly, preferably within 24 hours, to approve or reject each hotel reservation request if contacted by CalTravelStore or Department of General Services staff. Failure to do so may result in delays and/or a lapse in the reservation. Health care facilities can identify as many points of contact as they deem necessary. Additional details are in this memo from the Department of General Services and in CHA’s Human Resources FAQs

CHA, Hospitals Push Hard-Hitting Message Imploring Californians to Stay Home

CHA has partnered with the United Nurses Associations of California (UNAC) to deliver a hard-hitting message from the front lines: Health care workers are tired, strained, and need everyone to do their part to stop the COVID-19 surge. Last week, CHA released this downloadable video, produced in partnership with UNAC, in which an ICU nurse shares her experience from the front lines and implores Californians to take this virus seriously by staying home and wearing a mask when going out. CHA expects to produce several more videos in the next couple weeks and will share them as they are completed.

Next CDPH Call for Health Care Facilities: Dec. 22, 8-9 a.m. (PT)  

Dial: (844) 721-7239  

Passcode: 7993227 

News for December 11

CDPH Announces Expedited Process for Nurse Staffing Ratio Waivers 

The California Department of Public Health (CDPH) is now offering an expedited option for hospitals to flex the nurse staffing ratios. This process, which took effect immediately with the release of All-Facilities Letter 20-26.4, means hospitals can use certain alternative measures as soon as they submit the waiver request form.   

These alternative measures are that, for hospitals with patient surges or staffing shortages, the state will allow nurses to care for one additional patient in the ICU and in step-down units, and two additional patients in telemetry, ED, and med/surg units. As a result, this will flex nurse-to-patient ratios as follows: 

  • ICU — from 1:2 to 1:3 
  • Step-down units — from 1:3 to 1:4 
  • ED and telemetry — from 1:4 to 1:6 
  • Med/surg — from 1:5 to 1:7 

Hospitals that meet these criteria will be presumptively approved. CDPH will have 10 working days to ask the hospital any questions, largely for line of sight into surge activity, and these waivers will be in place for 60 days from the date of the request. 

This expedited process is an important addition to the current waiver process, in which hospitals individually submit ratio waivers for review and approval by CDPH surveyors. In many cases, this current waiver process has resulted in significant delays as hospitals wait for approval and does not provide the certainty hospitals need. 

Hospitals that need additional relief beyond the ratios or units of the hospital outlined in the expedited process can continue to submit waiver requests through the current process. CDPH will consider these on a case-by-case basis.  

For both the expedited process and the current process, a hospital seeking a waiver must submit CDPH form 5000A and supporting documentation to the CDPH Center for Health Care Quality (CHCQ) Duty Officer at CHCQDutyOfficer@cdph.ca.gov and copy the local CDPH District Office

News for December 8

Initial Vaccine Allocation Guidelines Released; CDPH to Hold Office Hours Dec. 11 

On Dec. 5, the California Department of Public Health (CDPH) released its recommended guidelines for allocating the COVID-19 vaccine during Phase 1-A of statewide distribution. The guidelines were developed by California’s COVID-19 Drafting Guidelines Workgroup and Community Vaccine Advisory Committee using a phased approach to allocating the initially limited vaccine supply among prioritized populations.  

California anticipates having 327,000 doses of the Pfizer vaccine between approximately Dec. 12 and Dec. 15, with an additional 700,000 to 1 million doses in late December. The guidelines provide that during the first allocation phase, known as Phase 1-A, the vaccine should be offered as follows: 

  • Persons at risk of exposure through their work in any role in direct health care or long-term care settings. This group includes not only direct care providers such as doctors and nurses, but people at direct risk of exposure in their non-clinical roles, such as environmental services, patient transport, or interpretation staff. 
  • Residents of skilled-nursing facilities, assisted living facilities, and similar long-term care settings for older or medically vulnerable individuals 
  • Paramedics, EMTs, and others providing emergency medical services 
  • Dialysis center employees 

Because the amount of vaccine available is expected to be insufficient for the number of people in these prioritized populations during Phase 1-A, the guidelines recommend that local health departments sub-prioritize the doses allocated to them as needed to match the level of available supplies. The recommended categories for sub-prioritization are: (1) type of facility or role, which is divided into three tiers; (2) location of the facility; and (3) attributes of the individuals.    

Allocation guidelines for prioritizing populations for later phases of the vaccine distribution are being developed. CHA will distribute these additional guidelines as they are released. Hospitals with questions about vaccine allocation are encouraged to contact their local health department.  

Vaccination Planning Office Hours Session on Dec. 11 
CDPH will host an Office Hours call for hospitals on COVID-19 vaccination Dec. 11 from 9 to 10 a.m. (PT). The Office Hours will include information about vaccine allocation and provider enrollment. Visit this link to participate.  

Updated Vaccination Primer Includes Additional Details for Hospitals  
CHA has updated its COVID-19: Vaccination Primer for California Hospitals with new information released by the state on timing and number of initial doses statewide, prioritization of those receiving the vaccine in Phases 1-A and 1-B, distribution during Phase 1-A, required training for hospitals, and more.  

Valencia Branch Lab Offers Additional Testing Capacity 
The Valencia Branch Lab (VBL) is offering additional testing capacity for hospitals under a new fast-track opportunity. Hospitals have been offered ongoing enrollment for testing if they meet specific community health equity goals; the new fast track opportunity will allow any hospital to use the VBL without meeting specific health equity goals for a limited time, until Jan. 31, 2021. Questions can be directed to testing.taskforce@state.ca.gov.  

The VBL onboarding document will soon be available on the COVID-19 Testing Task Force website and the VBL website, which also includes a comprehensive playbook, FAQs, and a collection site interest form. Of note, hospitals are responsible for: 

  • Collecting specimens and transporting to the lab within 24 hours of collection (collection kits are provided by the VBL, while other collection costs are absorbed by the hospital) 
  • Using the Color software (at no cost) to gather patient data, submit, and receive results 
  • Accepting that results will not interface with their electronic medical record (EMR) but through the Color software that will have to be re-entered into their EMR    

State Launches Service to Support Critical Care Telemedicine in Hospitals 
The California Health and Human Services Agency has announced a service, in partnership with the Emergency Medical Services Authority (EMSA) and Vituity, to provide telemedicine critical care support to hospital patient care teams. The service offers three tiers of consultation by tele-intensivists: telephonic consultation, formal critical advisory consultation, and active attending physician clinical management. To participate, hospitals should submit this online form.   

Upon receipt of the form, Vituity will contact the hospital to coordinate service. Vituity is a physician-owned organization that provides emergency medicine, hospital medicine, anesthesiology, critical care, acute psychiatry, neurology, telehealth, urgent care, and post-acute care services for 15 states and the District of Columbia. Details about the service provided and process for securing them are here.  

CMS Announces Acute Hospital Care at Home Waiver Process, Will Host Call Dec. 9 
The Centers for Medicare & Medicaid Services (CMS) has announced a new Acute Hospital Care at Home program to provide support for a model of at-home hospital care. The program builds on the regulatory flexibility provided by the existing Hospital Without Walls waiver and could be used to provide appropriate and safe treatment for certain acute conditions in home settings with proper monitoring and treatment protocols. CMS is accepting hospital waiver requests at its online portal and has developed FAQs.  

On Dec. 9 from 1 to 2 p.m. (PT), CMS will host a stakeholder call featuring two leading organizations that will walk participants through their programs, as well as a question-and-answer session. To join the call, dial (833) 614-0820 and enter passcode 1235939. The webcast link is here.   

California RN Education and Training for COVID-19 Critical Care 
EMSA has partnered with Elsevier to develop a two-day continuing education training that includes skills training preceptor modules and extensive knowledge-related modules on vital aspects of caring for critically ill COVID-19 patients in intensive care. California-licensed registered nurses can earn up to 16 continuing education units at no cost.   

Next CDPH Call for Health Care Facilities: Dec. 15, 8-9 a.m. (PT)   
Dial: (844) 721-7239  
Passcode: 7993227   

Summary of Dec. 1 CDPH Call 
CDPH has provided a summary of its recent weekly call with health care facilities.  

News for December 5

Testing Plan Deadline Extended by CDPH until Dec. 14
As CHA continues to work with CDPH to address the many questions members have, the department is developing FAQs on the testing recommendations that it released in All-Facilities Letter 20-88. CDPH has notified CHA that those FAQs, which had been slated for release by end of day Dec. 3, will not be released until Dec. 7.
 
Given the delay, CDPH is extending the deadline of the required General Acute Care Hospital COVID-19 Mitigation Testing Plans due from hospitals to the department from no later than Monday, Dec. 7 to no later than Monday, Dec. 14. 
 
CDPH will formally announce this in the FAQs when it releases them on Monday. Note that CDPH has stated it will not be revising the other dates in the All-Facilities Letter. It continues to recommend weekly testing of high-risk hospital health care personnel, as defined in the AFL, beginning Dec. 7 and all hospital health care personnel beginning Dec. 14.  
 
In case you missed it, here are several resources available to hospitals to support them in developing these plans and communicating about them:
 
1.    The slide deck and recording from CHA’s Thursday webinar on these testing recommendations.
2.    An infographic to help educate about the supply challenges for testing materials and PPE.
3.    CHA’s key messages on the testing recommendation
4.    CHA’s statement on the governor’s recent announcement and op-ed published this week in Capitol Weekly.

News for December 1

CDPH Issues Weekly Testing Recommendation for Hospital Health Care Staff; CHA Members-Only Webinar Dec. 3

Despite CHA’s request to postpone a weekly testing recommendation for hospital health care personnel, the California Department of Public Health (CDPH) released that recommendation in All-Facilities Letter (AFL) 20-88 on Nov. 25. CDPH expects general acute care hospitals to submit a testing plan to their District Office by Dec. 7, using the template in the AFL. CHA expects to that CDPH will follow up with hospitals that don’t submit a plan.

CHA to host webinar this week with more details

All member hospitals are encouraged to join CHA on Dec. 3 from 10 to 11:15 a.m. (PT) for a special webinar that will help hospitals understand their options in how to respond to the AFL given the testing capacity and staffing challenges they are facing.

Topics will include:

  • Overview and framework for understanding
  • Interpretation of the key AFL elements
  • Guidance on testing plan submission
  • Open questions and considerations for hospitals
  • Compliance and CDPH expectations of hospitals
  • Testing resources 

CHA Advocating for Hospitals on Staffing, Other Needs During Surge Preparation

In follow up to its list of hospitals’ most pressing needs for surge preparations, CHA has met with the

California Health and Human Services Agency and staff from its departments (CDPH and the Emergency Medical Services Authority). CHA continues to push for clarifications and changes in three areas:

  • Relief on nurse-staffing ratio waivers
  • If and when the state’s All-Access Transfer Center will be used for patient transfers
  • Transparency into the state’s personal protective equipment stockpile for hospitals

CDPH to Host Calls on Vaccination Planning for Hospitals

At CHA’s request, CDPH will host two all-hospital calls on COVID-19 vaccination planning — on Dec. 4 from 9 to 10:30 a.m. (PT) and Dec. 18 from 9 to 10 a.m. (PT). To join the Dec. 4 call, click here, enter your name and email address, enter the password Immunize2020!, and click “join now.”

In case you missed it, to help hospitals get ready, CHA has prepared a five-page COVID-19: Vaccination Primer for California Hospitals, summarizing the latest information from the California Department of Public Health (CDPH) and the steps that hospitals will need to take to participate as vaccinators. 

CDPH is also posting information on the California COVID-19 Vaccination Program and COVID-19 Vaccine Planning sections of its website. Hospitals can direct questions to CDPH on these upcoming calls or to their local health departments.

Upcoming Webinar Examines Crisis Standards of Care

The Office of the Assistant Secretary for Preparedness and Response will host a webinar Dec. 3 at 9 a.m. (PT) titled “Crisis Standards of Care: What’s Working and What Isn’t?” Speakers will discuss clinical consultation versus triage support, systems-level information sharing, coalition-level coordination activities, and recent resources to help with planning efforts. There will also be significant time provided for participant Q&A.

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

Dial: (844) 721-7239  

Passcode: 7993227 

Summary of Nov. 24 CDPH Call

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

News for November 24

Vaccine Updates: CHA Issues Primer, CDPH to Host Hospital Calls, Statewide Advisory Committee Announced

  • Vaccination Primer for Hospitals: A COVID-19 vaccine could be available for hospitals to offer their employees and staff — and, if the hospital volunteers, to other front-line health care workers — as early as mid-December, assuming the Pfizer vaccine candidate is authorized for emergency use by then. The Moderna candidate, which can be refrigerated rather than stored at ultra-low temperatures, is expected to follow within a few weeks; however, hospitals may be asked to use the Pfizer candidate since they have greater ability to manage the ultra-low temperature storage and handling requirements than other vaccinators. To help hospitals get ready, CHA has prepared a five-page COVID-19: Vaccination Primer for California Hospitals, summarizing the latest information from the California Department of Public Health (CDPH) and the steps that hospitals will need to take to participate as vaccinators.
  • CDPH Calls for Hospitals, Vaccination Websites: At CHA’s request, CDPH will host two all-hospital calls on COVID-19 vaccination planning — on Dec. 4 and Dec. 18, both from 9 to 10 a.m. (PT) — and will distribute the call-in number and meeting materials via the California Health Alert Network. CHA will distribute the number via Coronavirus Response. CDPH is also posting information on two areas of its website: the California COVID-19 Vaccination Program and the COVID-19 Vaccine Planning sections. Hospitals can direct questions to CDPH on these upcoming calls or to their local health departments.
  • Vaccine Advisory Committee: CDPH has established a Community Vaccine Advisory Committee, on which CHA is represented by President & CEO Carmela Coyle. The committee will provide input and feedback for CDPH’s ongoing planning and engagement efforts to ensure equitable vaccine distribution and allocation. According to CDPH, it will build on the Scientific Safety Review Workgroup and the California COVID-19 Drafting Guidelines Workgroup. Information on how to listen to meetings, which begin Nov. 25, will be posted here.

Regeneron Treatment Receives Emergency Use Authorization

The Food and Drug Administration has authorized the use of monoclonal antibodies casirivimab and imdevimab together to treat COVID-19 outpatients at risk of developing severe disease. Weekly allocations to state and regional health departments will begin immediately and are anticipated to continue through January 2021. Doses will be delivered to acute care hospitals, as determined by the regional Medical Health and Operational Area Coordinator. 

Patient criteria for this infusion treatment is similar to that of the previously approved monoclonal antibody treatment, bamlanivimab; both treatments have been demonstrated to be most beneficial for outpatients with certain conditions who are at high risk for disease progression. As compared to bamlanivimab, the newly authorized regeneron treatment is more complex to administer, requiring one dose of each of two antibodies and more extensive preparation by the pharmacist prior to infusion. Additional information about the recent approval is available here, and more information about monoclonal antibodies and their administration can be found in the Operation Warp Speed playbook issued on Nov. 23.

Process for Requesting Staffing Waivers from CDPH Has Not Changed

Many hospitals have asked if the process for requesting nursestaffing ratio waivers has changed; it has not. The same process for requesting waivers of nursestaffing ratios that has been in place since June 30 continues. Hospitals should continue to submit requests individually via CDPH form 5000A and email it to chcqdutyofficer@cdph.ca.gov. Hospitals should mark it urgent if they need approval within eight hours. For more details, see All Facilities Letter (AFL) 20-26.3.

The increase in hospital inquiries about this issue underscores why CHA has requested that the waiver be reinstated statewide. CHA is in active discussions with CDPH and the Administration about this and will continue to keep hospitals updated.

CDPH Releases Guidance on SNF Admissions from Hospitals

CDPH has issued AFL 20-87, which provides guidance on admission and readmission of skilled-nursing facility (SNF) residents following hospitalization. The AFL, which was requested by CHA and developed by CDPH with input from CHA and the California Association of Health Facilities , also provides guidance on working in coordination with local health departments to ensure appropriate and safe care transitions from hospital to SNF. 

The new AFL will be the topic of the Dec. 2 webinar conducted in coordination with the Health Services Advisory Group (HSAG), from 3 to 4 p.m. (PT). For additional information and to register, visit the HSAG website. A recording will be available the day following the webinar.

HHS Clarifies Provider Relief Fund Reporting Requirements

On Nov. 18, the U.S. Department of Health and Human Services updated its FAQs for the Provider Relief Fund and clarified two key points related to reporting requirements:

  • Expenses for capital equipment, inventory, and facilities projects may be fully expensed if the purchase was directly related to preventing, preparing for, and responding to the coronavirus. Examples of these types of equipment and inventory expenses, as well as facilities projects, can be found here.
  • Providers should not include payments received from or made to third parties related to care provided outside the reporting period (2019-20) when reporting net patient revenue. 

Cal/OSHA Adopts Emergency COVID-19 Standard

On Nov. 19, the California Occupational Safety and Health Board (Cal/OSHA) adopted an emergency temporary standard focused on COVID-19 in the workplace. This new, extremely broad regulation is in addition to the employee notice requirements encompassed in Assembly Bill (AB) 685, COVID supplemental paid sick leave adopted in AB 1867, and Senate Bill 1159’s workers’ compensation presumption requirements.

Before it goes into effect, the emergency temporary standard must be approved by the Office of Administrative Law (OAL) and was expected to be filed on Nov. 20. The OAL has 10 days to review the regulatory package. If approved, it would go into effect when it is filed with the Secretary of State and would remain in effect for 180 days, unless it is extended. Additional details about the emergency temporary standard are here.

OSHPD Clarifies Grace Period for Temporary Work for COVID-19 Until March 1

The Office of Statewide Health Planning and Development (OSHPD) has posted to its COVID-19 Resources web page the clarification that an OSHPD permit is not required for temporary changes or use of modifications to the physical environment for COVID-19 during the period of CDPH AFL 20-26.3, which is in place until March 1, 2021, unless extended. Hospitals only need to notify the OSHPD compliance officer responsible for their hospital. To determine the OSHPD compliance officer responsible for your hospital, select your hospital on OSHPD’s Facility Detail web page. Examples of the types of temporary work done by hospitals to date without prior OSHPD permit approval include erecting surge tents, repurposing rooms, and installing temporary barriers.

New CDPH Guidance Requires a Mask When Outside the Home

CDPH guidance issued Nov. 16 explains that Californians are now required to wear a mask, including at all times when outside their homes, and even if they are more than six feet apart when they are indoors. See the guidance for limited exceptions. Hospitals may want to review these requirements, as they relate to mask requirements for their break rooms, cafeterias, and other indoor spaces.

CMS Urges SNFs to Complete Free On-Demand COVID-19 Training

The Centers for Medicare & Medicaid Services (CMS) has issued an urgent call to action, encouraging SNFs to take advantage of free training designed to help staff combat the spread of COVID-19. CMS reports that over 125,000 individuals from 7,313 nursing facilities have completed the training, which represents about 12.5% of the nursing home staff in the country.  

The on-demand training, developed in coordination with the Centers for Disease Control and Prevention, includes multiple modules with emphases on topics such as infection control, screening and surveillance, personal protective equipment (PPE) usage, nursing home disinfection, and cohorting and caring for individuals with dementia. It also includes separate sets of modules for front-line staff and management staff. Instructions on how to create an account and take the training are available here.

CHA Continues Advocacy for Hospitals on New PPE Stockpile Law

CHA recognizes that with the Jan. 15, 2021, reporting requirement for Assembly Bill 2537 and its accompanying April 1, 2021, PPE stockpile deadlines right around the corner, hospitals are struggling with how to meet the new law’s obligations. More information about CHA’s advocacy efforts with Cal/OSHA, which began shortly after the bill was signed, is available here.   

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

Dial: (844) 721-7239  
Passcode: 7993227 

Save the Date: CDPH COVID-19 Vaccination All-Hospitals Call — Dec. 4, 9-10 a.m. (PT)

Call-in number to be determined.

Summary of Nov. 17 CDPH Call

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

News for November 17

CDPH Sends Hospitals Enrollment Instructions for COVID-19 Vaccination Program

On Nov. 16, the California Department of Public Health (CDPH) notified general acute care hospitals via email that its COVID-19 vaccination provider registration system, COVIDReadi, is available for hospitals to complete the registration process. All providers that plan to receive and administer COVID-19 vaccines must be enrolled. To assist with the multi-step enrollment process, CDPH has provided these instructions and a step-by-step guide.

Due to expected limited vaccine availability during initial phases of the program, vaccination provider enrollment is currently prioritized for settings where the vaccine will be administered in Phase 1a. Additional providers that are likely immunizers for Phase 1a will be invited by their local health departments. CDPH and local health departments are currently determining which multi-county entities will receive vaccine allocations directly from the state versus through the local health departments; more information will be forthcoming as those decisions are made. In the meantime, the department asks that all general acute care hospitals enroll in the vaccination program now so that all are prepared when vaccines become available. Questions can be directed to COVIDCallCenter@cdph.ca.gov

CHA Releases  Follow-Up Questions from Nov. 13 CDPH Vaccination Call

On Nov. 13, CDPH hosted a call for general acute care hospitals to discuss various aspects of COVID-19 vaccine planning and implementation. Follow-up questions submitted by hospitals to CHA, along with answers from CDPH, are available here. For those who were unable to participate, CDPH has communicated that it was not recorded. However, CHA has posted this slide deck from the call.

CDPH Issues Fact Sheet, Allocation Plans for Monocolonal Antibody Treatment

CDPH has issued a distribution fact sheet about bamlanivimab, the monoclonal antibody therapy produced by Eli Lilly and Company that was approved for emergency use authorization by the U.S. Food and Drug Administration (FDA). CDPH also issued a hospital-by-hospital and county-by-county allocation spreadsheet, showing its proportional distribution of the drug to counties based on the number of hospitalized patients with COVID-19 infection in the previous seven days.

CMS Takes Steps to Ensure Medicare Beneficiaries Have Wide Access to COVID-19 Antibody Treatment

Following the FDA’s emergency use authorization of bamlanivimab, the Centers for Medicare & Medicaid Services (CMS) announced it will cover monoclonal antibody therapies, with no beneficiary cost-sharing for the duration of the COVID-19 public health emergency. Bamlanivimab is authorized to treat certain patients with mild-to-moderate COVID-19 diagnosis and must be administered in settings where health care providers have immediate access to medications to treat a severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system if necessary. More details about the CMS announcement are available here.

CDPH Issues Infection Control Guidance for SNFs During Holidays

CDPH has issued All Facilities Letter  20-86, which provides recommendations for COVID-19 infection control during holiday celebrations for skilled-nursing facilities. The letter includes guidance for communal activities, private gatherings, and resident placement upon return to the facility. 

Next CDPH Call for Health Care Facilities: Nov. 24, 8-9 a.m. (PT)  

Dial: (844) 721-7239  
Passcode: 7993227 

Summary of Nov. 10 CDPH Call

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

News for November 13

On its 9 a.m. call this morning with hospitals, the California Department of Public Health will present planning considerations for COVID-19 vaccine implementation. Please refer to this slide deck for the discussion, which will include an overview of the state’s plan, allocation framework, general acute care hospital data, vaccine storage/handling, and provider registration. Please see the call-in details below:

Toll-free: (844) 291-6360
Access Code: 5961358

News for November 12

Update on Monoclonal Antibody Therapy Authorized for Emergency Use
On Nov. 9, the Food and Drug Administration granted emergency use authorization (EUA) to a monoclonal antibody therapy called bamlanivimab, produced by Eli Lilly and Company, for the treatment of mild to moderate COVID-19. The federal government has purchased 320,000 doses through the end of 2020; the first allocation to California will be 4,040 doses. California is expected to receive allocations each week.

AmeriSource Bergen, which distributes remdesivir, will begin distributing bamlanivimab to hospitals as early as today (Thursday) or tomorrow (Friday).

Many hospital leaders have questions about the drug and what they and their patients can expect. CHA has been in regular communication with the California Department of Public Health (CDPH). Here’s what we know so far:

How is it being allocated within California?
For the first phase, the state can direct the doses only to hospitals and their affiliated locations. A second phase is anticipated to allocate the doses to a broader range of settings.

How many doses should hospitals expect to receive?
CDPH will allocate doses among the counties. County Medical Health Operational Area Coordinators will determine how much hospitals in their county will receive. AmeriSource Bergen will then distribute the doses directly to hospitals

What should hospitals to do prepare?
Hospitals should review the EUA fact sheet for health care providers and determine how they might best be able to provide access with the least disruption to other services. 

Where can the drug be administered?
This one-hour infusion with at least a one-hour observation for adverse events can occur in a number of settings. In its final outpatient administration playbook for monoclonal antibodies issued by Operation Warp Speed, the federal government notes that, as part of the Centers for Medicare & Medicaid Services Hospital Without Walls initiative, hospitals can provide services outside of standard hospital settings, as long as the alternate site of care is linked to the hospital to allow for reimbursement of medical services.

Who should receive it?
This is for outpatients with mild-to-moderate symptoms of COVID-19. In the clinical trials, the groups that benefited were people 65 and older and people with a body mass index of 35 or more. CDPH is interested in providing access to this medication to people in skilled-nursing facilities and is interested in any ideas hospitals have to help provide this access.

To learn more about the federal government’s allocation plans and EUA, see CHA’s Coronavirus Response article from Nov. 10.

News for November 11

CDPH to Host COVID-19 Vaccination Call for Hospitals This Week
The California Department of Public Health will host a call with general acute care hospitals on Nov. 13 from 9 to 10 a.m. (PT) to discuss various aspects of COVID-19 vaccine planning and implementation. Discussion will include an overview of the state’s plan, allocation framework, general acute care hospital data, vaccine storage and handling, and provider registration. To join the call:

Dial: (844) 291-6360
Access Code: 5961358

Background on the State’s COVID-19 Vaccination Planning
On Oct. 19, the state of California released its interim draft plan for administering COVID-19 vaccinations. Many hospital and health system health care personnel are anticipated to be in the first phase, 1-A, of those offered the vaccine when doses are initially limited. The document describes this first phase as including both health care personnel likely treating patients with COVID-19 and likely to be exposed to COVID-19.

Allocation is described in the plan as flowing first from the federal government to the state; then from the state to large multi-jurisdictional entities such as health providers and systems with locations in multiple counties; and finally, to local health departments, which will allocate to health care providers and other entities within their counties.

The plan also discusses cold chain storage capacity, how providers will be enrolled to serve as vaccination sites, and data reporting requirements for vaccinators, among other issues.

CHA has convened a COVID-19 Vaccine Workgroup to inform its policy advocacy in this area and, along with other statewide associations, participates in weekly meetings with state leadership on its COVID-19 planning.

News for November 10

CHA Submits Hospital Surge Preparation Recommendations to State Leadership
The recent increases in COVID-19 cases and hospitalizations statewide mean hospitals must be ready for surges of patients in need of care during the fall and winter. In anticipation of COVID-19 patient surges, CHA submitted a list of hospitals’ most pressing needs to the California Health and Human Services Agency (CHHS) today. The recommendations identify flexibilities and resources hospitals need to meet the most significant demands they will face as there are surges — including patient transfers and discharges, staffing, testing, personal protective equipment (PPE), and alternate care sites. CHA is seeking to meet with state officials from CHHS to resolve these critical issues as quickly as possible.

CDC Updates Employee and Visitor Screening Guidance
On Nov. 4, the Centers for Disease Control and Prevention issued updated infection control guidance for the COVID-19 pandemic. It provides additional options for screening employees and visitors for COVID-19 – including implementing a system for employees to take their temperature prior to arrival at the facility and report the absence of fever and other COVID-19 symptoms electronically. The California Department of Public Health (CDPH) has expressed to CHA that it has no concerns with the changes. The updated guidance also:

Provides information on factors that could impact thermometer readings

Provides resources for evaluating and managing ventilation systems in healthcare facilities

Links to frequently asked questions about the use of PPE

HHS Announces Allocation Plans for Newly Approved Therapeutic Drug
The U.S. Department of Health and Human Services (HHS) has announced its plans to allocate initial doses of Eli Lilly and Company’s investigational monoclonal antibody therapeutic, bamlanivimab. The drug received emergency use authorization from the Food and Drug Administration on Nov. 9 for the treatment of non-hospitalized patients with mild or moderate COVID-19. Having purchased 300,000 doses on Oct. 28, HHS will now allocate them to state and territorial health departments which, in turn, will determine which health care facilities receive the drug. The federal government can purchase up to 650,000 additional doses, if needed, through June 30, 2021, for distribution across the country. HHS has posted additional information about the distribution process and state-by-state allocation. California will receive approximately 4,000 doses statewide in the first allocation.

Operation Warp Speed Releases Draft Playbook for Monoclonal Antibody Treatments
In anticipation of the issuance of emergency use authorizations for monoclonal antibody therapeutic drugs developed to treat certain COVID-19 positive patients (see latest information on the Eli Lilly and Company’s therapeutic bamlanivimab above), Operation Warp Speed released an initial playbook to assist providers in planning. The playbook lays out important information for hospitals and health systems to consider and includes information on administering the drugs, the two available options, when a patient is considered a candidate, a site checklist, and shipping and distribution information.

Biden Announces COVID-19 Task Force
President-elect Joe Biden has announced a COVID-19 advisory board, underscoring that his administration’s priority will be controlling the COVID-19 pandemic. The 13-member task force, which includes three Californians, will advise the incoming Biden administration as it prepares to orchestrate a federal response to the COVID-19 pandemic. The task force members will be led by three physicians:

David A. Kessler, professor of pediatrics at the University of California, San Francisco, and former Food & Drug Administration commissioner, who served under presidents George H.W. Bush and Bill Clinton

Vivek Murthy, surgeon general in the Obama administration

Marcella Nunez-Smith, professor of medicine at Yale University, who focuses on equity in health care for disadvantaged populations

Missing an Issue of Coronavirus Response?
Some Coronavirus Response recipients were inadvertently removed from the distribution of the Oct. 20, Oct. 27, and Nov. 3 issues. CHA apologizes for any inconvenience; all previous issues can viewed here.

Next CDPH Call for Health Care Facilities: Nov. 17, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227

Summary of Nov. 3 CDPH Call
CDPH has provided a summary of its recent weekly call with health care facilities.

Upcoming CMS Calls
The Centers for Medicare & Medicaid Services will host two calls next week, one for hospitals and health systems and one for nursing homes. Call details are as follows:

Hospitals and Health Systems: Nov. 17 at 2 p.m. (PT)
Dial: (833) 614-0820
Passcode: 2491556
Audio webcast

Nursing Homes: Nov. 18 at 1:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 1335116
Audio webcast

News for November 3

 CHA/CDPH Guide Designed to Assist Hospitals in Submitting COVID-19 Data
CHA and the California Department of Public Health (CDPH) have collaborated on a data reporting guide to assist hospitals in submitting data to the CHA COVID-19 Tracking Tool. The guide includes data submission instructions and data dictionary clarifications that can help hospitals comply with changes to the state and federal COVID-19 data reporting requirements and avoid mistakes in their reporting. Proper reporting is especially important now that the Centers for Medicare & Medicaid Services (CMS) has formalized the enforcement processes around COVID-19 data submissions, which are part of the Conditions of Participation for Medicare and Medi-Cal. The guide includes:

  • Step-by-step instructions for reporting data to the CHA CHOVID-19 Tracking Tool
  • General reporting guidance, including how to avoid common mistakes
  • Clarifications for the recently updated data dictionary
  • CDPH calculations done prior to uploading data to TeleTracking

The guide also serves as a companion document to the upcoming CHA and CDPH data reporting webinars (see article below for more information).

Upcoming Webinars Explain COVID-19 Data Reporting Requirements
CHA and CDPH will host webinars from 1 to 2 p.m. (PT) on Nov. 5 and Nov. 17 to clarify the requirements for submitting data into the CHA COVID-19 Tracking Tool, as well as to help hospitals comply with changing state and federal COVID-19 data reporting requirements. CMS recently formalized penalties and outlined the enforcement processes around COVID-19 data reporting and has modified the reporting requirements. Because some fields that have been optional are now mandatory and vice versa, these webinars will provide insight and guidance for submitting COVID-19 data accurately and aims to help hospitals avoid costly mistakes. The program will include time for participant questions.

California’s COVID-19 Vaccine Allocation Drafting Guidelines Workgroup Named, Scientific Review Workgroup Broadened to Western States
On Oct. 27, CDPH announced the composition of California’s COVID-19 Drafting Guidelines Workgroup, which will develop California-specific guidance for prioritizing and allocating a COVID-19 vaccine. The guidance will be based on several national frameworks from the National Academies of Sciences, Engineering, and Medicine, the Advisory Committee on Immunization Practices, and the Centers for Disease Control and Prevention. The workgroup held its first meeting on Oct. 30 and will distribute drafts publicly for review and comment.

Also on Oct. 27, the Governor’s Office announced that Washington, Oregon, and Nevada have joined California’s COVID-19 Scientific Safety Review Workgroup. This workgroup will review any vaccine approved by the Food and Drug Administration and verify its safety before California, Washington, Oregon, and Nevada make the vaccine available to the public.

Provider Relief Fund Phase 3 Application Deadline Coming
As a reminder, hospitals that wish to apply for Phase 3 Provider Relief Funds must do so by Nov. 6. Additional information on the application process is available on the U.S. Department of Health and Human Services website.

CMS Interim Final Rule Establishes Additional COVID-19 Policies, Regulatory Flexibilities
CMS – along with the Departments of Labor and the Treasury – has issued its fourth interim final rule with comment period on policies and regulatory flexibilities available for the duration of the COVID-19 public health emergency. The rule includes a number of policies related to vaccine coverage and payment, enhanced payments for treatments, state Medicaid program requirements, price transparency requirements for diagnostic tests, and an extension of the comprehensive care for joint replacement model. More details about the finalized policies and flexibilities are available here.

Next CDPH Call for Health Care Facilities: Nov. 10, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227

Summary of Oct. 27 CDPH Call
CDPH has provided a summary of its recent weekly call with health care facilities.

News for October 27

Federal Law Allows Pharmacy Staff to Administer COVID-19 Vaccinations, Prevents Lawsuits
The U.S. Department of Health and Human Services (HHS) has issued guidance allowing pharmacists, pharmacy interns, and pharmacy technicians to administer COVID-19 vaccines when available — if certain training, recordkeeping, reporting, and other requirements are met. HHS previously used its authority under the Public Readiness and Emergency Preparedness Act (PREP Act) to prohibit lawsuits against health care providers who provide COVID-19 vaccinations.

As a reminder, the PREP Act authorizes the HHS Secretary to issue a declaration (which he has done here) that provides immunity from liability for the manufacture, distribution, administration, or use of “medical countermeasures,” except for claims involving willful misconduct. A medical countermeasure is a drug, device, or biological product that is manufactured, used, designed, developed, modified, licensed, or procured to diagnose, mitigate, prevent, treat, or cure a pandemic or epidemic. To be a covered countermeasure, a product must be approved, cleared, or authorized for emergency use by the Food and Drug Administration or licensed under the Public Health Service Act.

Immunity covers claims under tort or contract law, as well as claims related to compliance with state/local laws. Any lawsuit alleging an exception to PREP immunity must be brought before a special three-judge court in U.S. District Court in Washington, DC. To win, the plaintiff must prove that willful misconduct was the proximate cause of death or serious injury by clear and convincing evidence. The PREP Act also establishes a program to compensate individuals for serious physical injury or death caused by a covered countermeasure.

HHS Makes Hospitals’ COVID-19 Reporting Compliance Public
In an ongoing effort to publicize data related to COVID-19, HHS has released a report on hospital reporting compliance. For most California hospitals, the compliance reports are based on data they enter daily into the CHA COVID-19 Tracking Tool, which the state then uploads on hospitals’ behalf into TeleTracking. More information and key points hospitals should be aware of are available here.

CDPH Revises Hospital Visitation Recommendations, SNF Visitation Requirements
On Oct. 23, the California Department of Public Health (CDPH) released revised recommendations for hospital visitors and support person policies in All Facilities Letter (AFL) 20-38.5. CDPH recommends that health facilities, including hospitals, in red, orange, and yellow tier counties under the Blueprint for a Safer Economy framework allow one visitor per patient at a time. These are not requirements, but rather recommendations. To learn more about hospitals’ options for visitation guidelines — including state and federal laws related to hospital visitation as well as these CDPH recommendations — register for CHA’s member webinar, COVID-19: Hospital Visitor and Support Person Laws and Guidelines Webinar, Oct. 30 from 1 to 2 p.m. (PT).

Also on Oct. 23, CDPH released AFL 20-22.5, which updates the agency’s visitation guidance for skilled-nursing facilities to align with the Centers for Medicare & Medicaid Services’ QSO-20-39-NH. This includes skilled-nursing facility requirements to facilitate visitation of residents.

New Federal Action Network to Provide Support and Resources to SNFs
Skilled-nursing facilities are encouraged to enroll in the ECHO National Nursing Home COVID-19 Action Network, an interactive community-of-practice network that aims to advance improvements in COVID-19 preparedness, safety, and infection control. Nursing facilities are eligible to receive a $6,000 payment for participation in the program, which will launch nationwide the week of Nov. 9. Health Services Advisory Group  and the Stanford School of Medicine are partnering to deliver the program, which is supported by the federal Agency for Healthcare Research and Quality in collaboration with the Institute for Healthcare Improvement.

Weekly sessions will provide practical information, skills, and resources needed to protect residents and staff from COVID-19. A minimum of two staff members must participate in weekly Zoom sessions for 13 of the 16 weeks to be eligible for the $6,000 payment. Interested facilities must sign up here by Nov. 3. Additional information is available in these FAQs.

Next CDPH Call for Health Care Facilities: Nov. 3, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227

Summary of Oct. 20 CDPH Call
CDPH has provided a summary of its recent weekly call with health care facilities.

News for October 20

COVID-19 Vaccination Plan Released by State of California
On Oct. 19, the state of California publicly released its plan for administering COVID-19 vaccinations. The plan responds to questions from the Centers for Disease Control and Prevention (CDC) for every state, describing how the California Department of Public Health (CDPH) will work within state government and with local health departments and health care providers to distribute and administer the vaccine. California has received $28 million from the CDC to administer this program.

The plan describes the state’s internal governance structure — the California Governor’s COVID-19 Vaccine Task Force — that has representation from multiple state departments and is co-led by CDPH and the Governor’s Office of Emergency Services (CalOES). Three external groups will be convened:

Drafting Guidelines Workgroup

Scientific Safety Review Workgroup (membership was announced on Oct. 19)

Community Vaccine Advisory Committee

Many hospital and health system health care personnel are anticipated to be in the first phase, 1-A, of those offered the vaccine when doses are initially limited. The document describes this first phase as including both health care personnel likely treating patients with COVID-19 and likely to be exposed to COVID-19.

Allocation is described in the plan as flowing first from the federal government to the state; then from the state to large multi-jurisdictional entities such as health providers and systems with locations in multiple counties; and finally to local health departments, which will allocate to health care providers and other entities within their counties.

The plan also discusses cold chain storage capacity, how providers will be enrolled to serve as vaccination sites, and data reporting requirements for vaccinators, among other issues. CHA has convened a COVID-19 Vaccine Workgroup to inform its policy advocacy in this area and participates in weekly meetings with state leadership on its COVID-19 planning, along with other statewide associations.

California Certified to Submit COVID-19 Data to Federal Government
On Oct. 6, the Centers for Medicare & Medicaid Services (CMS) released guidance — with accompanying FAQs from the U.S. Department of Health and Human Services (HHS) — on how it will enforce CMS’ interim final rule that requires hospitals to report COVID-19 data, in order to continue to participate in the Medicare and Medicaid programs.

The FAQs noted that hospitals could be relieved from reporting directly to the federal government if they receive a written release from the state indicating that the state is certified and will collect the data from the hospitals and take over the hospital’s federal reporting responsibilities. On Oct. 15, CDPH received that release. More information and a copy of the letter are available here.

HHS Webinar Oct. 22 on COVID-19 Data Reporting Interim Final Rule
HHS’ Office of Intergovernmental Affairs will host a webinar Oct. 22 at 10 a.m. (PT) about the CMS guidance on its interim final rule on COVID-19 data reporting. Registration is available here. Participating hospitals and health systems will have an opportunity to ask questions during the presentation.

CMS to Adjust Lab Payments for Faster Test Results
CMS has announced it will adjust Medicare payments to incentivize labs to deliver quicker results to patients undergoing COVID-19 diagnostic testing. Beginning Jan. 1, 2021, Medicare will pay $100 only to laboratories that complete high throughput COVID-19 diagnostic tests within two calendar days of the specimen’s collection. Laboratories that take longer than two days to complete these tests will receive a $75 Medicare payment.

New COVID-19 Website Designed to Support Hospitals
CHA and the Regional Associations have launched a new website — ourcovidresponse.org — to support hospitals and health systems as they continue to respond to ongoing COVID-19 challenges. All resources developed so far have been consolidated to make it easier to find what is needed via a browsable set of tools and information, including:

  • The latest on federal and state waivers
  • Updated news and FAQs
  • Details about federal financial relief
  • Our work with the Governor’s Office and administration
  • Regional work being done to help hospitals meet the needs of their communities
  • And much more

The site is anchored by a slideshow tribute featuring California hospital staff providing care over the past several months.

Suspension of Professional Certification Requirements for Certified Nurse Assistants
CDPH has issued All Facilities Letter 20-35.2 to allow a certified nurse assistant who remains in an “employable during the current state of emergency” status to complete in-service or continuing educations units and count them toward certificate renewal.

Next CDPH Call for Health Care Facilities: Oct. 27, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227

Summary of Oct. 13 CDPH Call
CDPH has provided a summary of its recent weekly call with health care facilities.

News for October 13

Survey for COVID-19 Vaccine Planning Due to CDPH Friday
On Oct. 12, the California Department of Public Health (CDPH) released All Facilities Letter (AFL) 20-81, which asks all hospitals, or health systems on behalf of their hospitals, to submit information for their COVID-19 vaccine planning.

In the survey, CDPH states that to determine fair and transparent allocations of scarce initial supplies of vaccines, which could begin arriving in the next few months, it needs detailed information about employees and staff. The information hospitals and health systems provide will assist state and local health departments in implementing a strategic vaccine allocation plan for the receipt, distribution, administration, and tracking of vaccines.

This strategic vaccine allocation plan includes an initial phase of limited vaccine availability, during which the state will be risk stratifying and prioritizing healthcare workers at greatest risk of exposure to COVID-19. And it includes a later phase of unlimited vaccine availability, during which large quantities of vaccine will need to be maintained at the proper temperature and administered as quickly as possible.

Today, CDPH posted the full list of survey questions in a two-page pdf file. The survey requests information on:

  • Hospital points of contact for COVID-19, vaccine planning, information technology, and logistics
  • The number of staff that are highest risk, high risk, moderate risk, and low risk for exposure to COVID-19
  • Vaccine storage capacity — both current and future, with advance notice
  • Administering the vaccine to staff
  • With additional resources and liability protection, willingness to provide closed clinics to first responders who are not staff, and open clinics to members of the public
  • Immunization registry (e.g., CAIR2, Healthy Futures, or San Diego Immunization Registry) identification, if one, employee health records vendor, and electronic medical records vendor

CDPH has requested responses be submitted online here by 5 p.m. (PT) this Friday, Oct. 16. Questions can be directed to the CDPH Center for Health Care Quality duty officer at chcqdutyofficer@cdph.ca.gov.

CMS Sending Hospitals Letters on COVID-19 Data Reporting, Adding Fields
Hospitals have begun receiving letters from the Centers for Medicare & Medicaid Services (CMS) indicating that they are not in compliance with Medicare conditions of participation, which now require daily hospital reporting to the U.S. Department of Health and Human Services (HHS). These letters were based on one week of data reporting in late September, and any hospital that did not have 100% reporting for all fields received a letter. Hospitals that received these letters should plan to report for all fields moving forward. There will be subsequent non-compliance letters prior to any termination from the Medicare program.

On Oct. 6, CMS released new guidance (with accompanying FAQs from HHS) that includes new reporting requirements as well as information on how it will enforce CMS’ interim final rule published in September. The interim final rule made collecting and reporting COVID-19 data part of Medicare and Medicaid conditions of participation.

As detailed by this new guidance, changes in data reporting include:

  • Six new fields related to influenza. These fields will be available for optional reporting beginning on Oct. 19 and will become mandatory reporting several weeks thereafter (CMS has not yet specified an exact date).
  • Modifications to reporting frequency for existing fields related to personal protective equipment and supply availability. These fields are now  required to be reported just once a week on Wednesdays.
  • A change in remdesivir reporting requirements. Reporting related to remdesivir will be optional, though not for several more weeks.

CHA will make changes to its COVID-19 Tracking Tool to incorporate the new fields related to influenza in the coming weeks. In addition, CHA will work with CDPH to update the data dictionary. Once these changes are implemented, CHA will provide hospitals and systems currently using the data upload feature with a revised template. Please send any questions to COVIDTracker@calhospital.org.

New Reporting Requirements for Provider Relief Fund Will Be Covered in CHA Webinar

CHA will hold a members-only webinar on Oct. 14 from 1 to 2 p.m. (PT) to explain important changes to reporting requirements in the HHS Provider Relief Fund (PRF). Specifically, the webinar will address the Sept. 19 guidance issued by HHS that included a new definition of lost revenue. This change is problematic for participating hospitals on multiple levels. The webinar will clarify the new reporting requirements and explain the impact on hospitals’ operations and accounting. Speakers will also discuss the upcoming Nov. 6 application deadline for PRF Phase 3 funding of $20 billion.

In addition, CHA has partnered with Toyon Associates to develop a data management workbook that will help hospitals track and organize data and maintain compliance with the PRF. Fred Fisher of Toyon Associates will provide a live demonstration of the workbook’s features and benefits.

Oct. 15 Webcast to Provide Information on Phase 3 Provider Relief Fund Application Process

The Health Resources and Services Administration (HRSA) will host an informational webcast on Oct. 15 at noon (PT) to provide additional information on the application process for the recently announced $20 billion PRF Phase 3 general distribution. Applications for this distribution are due by Nov. 6. Interested participants should register via HRSA’s web page.

CDPH Issues AFL on Managing Influenza in SNFs
CDPH has issued AFL 20-80, which notes the potential for concurrent COVID-19 and influenza outbreaks in skilled-nursing facilities. The AFL emphasizes that facilities should optimize all available effective influenza prevention and outbreak interventions, including vaccinations of residents and health care personnel and prompt treatment when indicated.

CDPH Guidance Aims to Protect Voting Rights of SNF Residents
CDPH AFL 20-78 encourages skilled-nursing facilities to ensure that as many residents as possible are able to vote while following public health guidelines. The AFL provides suggestions for how to support safe voting and encourages facilities to work with their local long-term care ombudsman. The AFL follows guidance recently issued by CMS, which affirms the continued right of nursing home residents to exercise their right to vote, and that skilled-nursing facilities must take steps to ensure each resident’s right to vote is not impeded.

Next CDPH Call for Health Care Facilities: Oct. 20, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227

Summary of Oct. 6 CDPH Call
CDPH has provided a summary of its recent weekly call with health care facilities.

News for October 6

CDPH Hospital Survey for COVID-19 Vaccine Distribution
The California Department of Public Health (CDPH) will soon release a COVID-19 vaccine hospital survey via an All Facilities Letter (AFL). The survey results will inform how the state allocates doses of the COVID-19 vaccine, which could be available as soon as Nov. 1. There will likely be a short turnaround time to respond to the survey (a week or less), which will require information from human resources, pharmacy, employee health, information technology, and potentially other departments. Hospitals may want to determine now who will respond on behalf of their hospital or health system.

CDPH has indicated that the hospital survey will ask about:

  • The numbers of hospital employees and staff based on risk level of exposure to COVID-19
  • Vaccine storage capacity
  • Logistical capacity to offer the vaccine to all employees, and capacity to support community vaccine initiatives
  • Information technology systems and data reporting

Health systems will have the ability to respond on behalf of all hospitals in their system. The actual survey and response deadline will be released by CDPH, and CHA will distribute widely once the information becomes available.

COVID-19 Public Health Emergency Declaration Extended
The Secretary of the U.S. Department of Health and Human Services (HHS) has announced the renewal of the COVID-19 public health emergency declaration. The renewal is effective Oct. 23 and will continue for an additional 90 days, ensuring flexibilities — like waivers and special rules tied to the public health emergency declaration — remain in place for providers.

HHS Announces Additional $20 Billion in New Phase of Provider Relief Funding
HHS, through the Health Resources and Services Administration, announced last week that $20 billion in new funding will be available for providers on the front lines of the COVID-19 pandemic. Providers that have already received Provider Relief Fund payments will be invited to apply for additional funding that considers financial losses and changes in operating expenses caused by COVID-19. Details about who is eligible, how to apply, and upcoming HHS webinars about the process are available here.

State to Factor in Equity in Determining County Tier Status
On Sept. 30, CDPH released a new equity metric that it will use as part of its calculation of each county’s tier in the Blueprint for a Safer Economy framework. In this framework, counties fall into one of four tiers based on risk of community transmission: Purple (widespread), Red (substantial), Orange (moderate), and Yellow (minimal). A county’s status determines the level of reopening for its indoor businesses.

To advance to the next less-restrictive tier, depending on its size, a county will need to meet the equity metric and demonstrate targeted investments to eliminate disparities in COVID-19 transmission. Additional details about the new equity metric are available here.

CMS Modifies Certain SNF Testing Requirements for Health Care Personnel
The Centers for Medicare & Medicaid Services (CMS) has announced an update to recently issued guidance for testing health care personnel in skilled-nursing facilities. This includes a provision that testing frequency be determined by the positivity rate of the county in which the skilled-nursing facility is located. The updated guidance also ties the requirements to the number of tests per county. These changes were made in response to feedback from rural facilities concerned that higher positivity rates in rural areas might be related to low amounts of testing volume and not necessarily indicative of greater COVID-19 presence.

The guidance calls for skilled-nursing facilities in counties with a positivity rate greater than 10% to test health care personnel twice a week. Facilities located in counties that administered fewer than 500 tests and fewer than 2,000 tests per 10,000 residents, with a positivity rate of greater than 10%, may now test once per week. CDPH requires all California skilled-nursing facilities to test health care personnel at least once per week.

CDPH Notifies SNFs About New Grant Opportunity to Help With In-Person Visitation
CDPH has issued AFL 20-77, which informs skilled-nursing facilities about the availability of a new grant opportunity to receive federal civil monetary penalty funds to purchase materials that aid with in-person visitation. Facilities may apply for up to $3,000 for tents, clear partitions, and installation costs. The AFL follows updated CMS guidance for visitation in skilled-nursing facilities during the pandemic.

Next CDPH Call for Health Care Facilities: Oct. 13, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227

Summary of Sept. 29 CDPH Call
CDPH has provided a summary of its most recent weekly call with health care facilities.

News for September 29

State Updates Testing Priority Guidance
On Sept. 22, the California Department of Public Health (CDPH) released Updated COVID-19 Testing Guidance. It states that California’s testing capacity and turnaround time have improved. As a result, and until further notice, CDPH advises that all four tiers in the Testing Prioritization Guidance dated July 14 will have equal priority for testing.

CDPH Releases COVID-19 Hospital, SNF Outbreak Reporting Thresholds
CDPH has issued All Facilities Letter 20-75, which sets thresholds for COVID-19 outbreaks in hospitals. Hospitals are required to report outbreaks and unusual infectious disease occurrences to their local health department and CDPH Licensing and Certification District Office. Under these definitions, acute care hospitals are to report an outbreak when they have:

In all counties: Two or more cases of confirmed COVID-19 in a patient seven or more days after admission for a non-COVID condition with epi-linkage. Epi-linkage among patients is defined as overlap on the same unit or ward for any duration or having the potential to have been cared for by common health care personnel within a 14-day time period of each other.

In purple or red tier counties: Two or more cases of confirmed COVID-19 in health care personnel with epi-linkage who do not share a household and are not close contacts outside of the workplace. Epi-linkage among health care personnel is defined as having the potential to have been within six feet for 15 minutes or longer while working in the facility during the 14 days prior to the onset of symptoms or a positive test. For example, the health care personnel worked on the same unit during the same shift.

In orange or yellow tier counties: Three or more cases of confirmed COVID-19 in health care personnel with epi-linkage who do not share a household and are not close contacts outside of the workplace. The same definition of epi-linkage in the bullet above applies.

The state’s Blueprint for a Safer Economy updates the color tiers and is searchable by county.

Long-term acute care hospitals and long-term care facilities are to report an outbreak to their local health department and CDPH District Office any time one or more residents has a confirmed COVID-19 diagnosis 14 days or more after admission for a non-COVID condition, without an exposure during the previous 14 days to another setting where an outbreak was known or suspected to occur.

Additional thresholds for a facility should investigate and report to the local health department are provided for acute care hospitals, long-term acute care hospitals, and long-term care facilities.

Next CDPH Call for Health Care Facilities: Oct. 6, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227

News for September 22

Provider Relief Fund Reporting Requirements Announced
The U.S. Department of Health and Human Services has issued detailed reporting requirements for recipients of more than $10,000 in Provider Relief Funds for health care-related expenses or lost revenues attributable to COVID-19. The reporting requirements apply to all distributions except nursing home infection control, rural health clinic testing, and payments under the Health Resources and Services Administration COVID-19 Uninsured Program. Notably, while the department announced in Aug.14 guidance that reporting would begin Oct. 1, it now states the reporting system will not be available until early 2021.

House Proposes Loan Extension, Reduced Interest Rate for Medicare Advanced Payments
Included in the House of Representatives’ proposal, released this week, to fund the federal government through Dec. 11 is a CHA-supported provision to modify the Medicare Accelerated and Advanced Payment Programs implemented during the COVID-19 public health emergency. These proposed modifications include revising the original repayment period for providers from 12 to 29 months from the date of the first payment and reducing the interest rate from 10.25% to 4%. Details about the proposed modifications are available here.

Congress must act to continue funding for the federal government to avoid a shutdown before Sept. 30, the end of the federal fiscal year. The House is expected to vote on the proposal, known as a continuing resolution, this week. The timing and content of a Senate proposal are less clear.

Advoque Safeguard N95 Respirators Recalled
Advoque Safeguard has issued a recall of its N95 particulate filtering respirator, model number ADV001, effective Sept. 10. Advoque masks with National Institute for Occupational Safety and Health approval number TC-84-A-PH02, including masks distributed prior to Sept. 10, may no longer be distributed and used as an N95-level respirator. Facilities that have masks with the above-referenced number should immediately stop using and distributing them. Additional details are available in the California Department of Public Health (CDPH) All Facilities Letter (AFL) 20-71.

CMS Updates Skilled-Nursing Facility Visitation Guidance
The Centers for Medicare & Medicaid Services (CMS) has issued updated guidance for visitation in skilled-nursing facilities during the pandemic. The revised guidance notes that previous restrictions, which focused on protecting residents from COVID-19 by limiting visitation, have taken a physical and emotional toll on residents. It provides reasonable ways that facilities can safely accommodate in-person visitation to address the psychosocial needs of their residents.

While CMS notes that skilled-nursing facilities may continue to restrict visitation (except virtual visits) based on the county’s positivity rate, the facility’s COVID-19 status, or other factors, they may not restrict visitation without a reasonable clinical or safety cause. The new guidance, which is effective immediately, also provides that communal activities and dining can occur with alterations to adhere to guidelines to prevent transmission. Additionally, CMS notes that facilities may apply to use civil money penalties funds to purchase tents for outdoor visitation or dividers to create physical barriers and reduce risk of transmission during in-person visits.

CDPH Issues Guidance for Skilled-Nursing Facilities, Home Health Agencies
CDPH has issued several AFLs for post-acute care providers, including:

  • AFL 20-72, which waives certain requirements for home health agencies during the COVID-19 public health emergency. This includes provisions related to licensing, staffing and services, and supervision.
  • AFL 20-73, which provides guidance to skilled-nursing facilities to support residents’ ability to express their treatment wishes through proactive advance care planning. The AFL includes recommendations for all residents, including those who have tested positive for COVID-19.
  • AFL 20-74, which provides recommendations for use of personal protective equipment, cohorting, and staffing for skilled-nursing facility residents. The AFL includes a chart with guidance for each category of COVID-19 status, including COVID-19-positive residents, symptomatic residents awaiting test results, exposed and non-exposed residents, and new admissions.

Board of Pharmacy Issues Waiver Update
The California Board of Pharmacy has not extended its waiver of the requirement for a consulting pharmacist to make quarterly visits to clinics, which will expire Sept. 22. The Board has extended the following waivers:

  • Remote Processing – Effective through Oct. 31
  • Signature Requirement for Receipt of Delivery of Drugs – Effective through Dec. 21
  • Prescriber Dispensing Beta-Agonist Inhalation Product to Emergency Room Patient – Effective through Dec. 21
  • Requirements Related to Personal Protective Equipment (PPE) – Effective through Dec. 21
  • Duty to Consult – Effective through Dec. 28
  • Use of PPE in Certain Compounding Aseptic Isolators or Compounding Aseptic Containment Isolators – Effective through Dec. 28

Details about all Board of Pharmacy waivers are available here.

Federal Task Force Issues Report on COVID-19 and Skilled-Nursing Facilities

The Coronavirus Commission for Safety and Quality in Nursing Homes was established April 30 to develop recommendations to protect nursing home residents. The Commission has issued its final report, which focuses on testing, PPE, and visitation. It includes 27 primary recommendations for CMS with a specific emphasis on a national testing strategy, providing operators with access to at least three months’ worth of PPE, continuing to facilitate proper cohorting of COVID-19 residents, and expanding visitation access to nursing facilities.

Next CDPH Call for Health Care Facilities: Sept. 29, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227

Summary of Sept. 22 CDPH Call
CDPH has provided a summary of its most recent weekly call with health care facilities.

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.healthequip.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