The California Department of Public Health has released the attached All Facilities Letter 18-18 outlining the new online licensing and certification application process for certain facilities, including skilled-nursing facilities. The new online process should be used only for initial licensing approval; reports of changes and change of ownership applications must still be submitted by hard copy. More details, including instructions for registering and submitting an application, are available in the attached letter.
The Office of Statewide Health Planning and Development has released quality ratings for the 126 California-licensed hospitals that performed isolated heart bypass graft surgeries in 2015. Coronary artery disease is the leading cause of adult non-maternal admissions to California hospitals, representing nearly 9 percent of admissions. The surgery is the most common surgical procedure for treating coronary artery disease and is one of the most expensive cardiac surgeries performed in California. Hospital performance ratings are based on operative mortality, post-operative stroke and unplanned hospital readmission within 30 days; all measures are risk-adjusted. Because the surgery relies on using a vein or artery from another part of the body to create a new path for blood to flow to the heart, bypassing the blocked artery, hospitals are also rated on their utilization rates for the internal mammary artery.
A new state law requires health care providers diagnosing or treating Parkinson’s disease patients to report each case to the California Department of Public Health (CDPH) beginning July 1. The state is establishing the California Parkinson’s Disease Registry, a statewide population-based registry that will measure the incidence and prevalence of Parkinson’s disease. CDPH intends to use the information to improve the lives of those affected by the disease.
CDPH recently issued an implementation guide that includes the necessary specifications for reporting Parkinson’s disease data and outlines who is required to report, the timing of reporting and the methods for transmitting data. CHA is seeking clarification on some of the elements in the implementation guide and will share more information with members when available. CDPH will host informational meetings in May. For more information, visit the CDPH website.
Yesterday, two bills sponsored by CHA successfully passed the Assembly Health Committee.
Assembly Bill 1795 (Gipson, D-Carson), CHA’s co-sponsored bill with Los Angeles County, passed on a 12-0 vote. The bill would authorize a local emergency medical services agency to allow specially trained paramedics to transport patients who meet specific criteria to a locally designated behavioral health treatment facility or sobering center, allowing for more direct access to appropriate care and increased efficiency for local emergency response systems. The California Office of Statewide Health Planning and Development has supported a paramedic alternate destination pilot project since 2015. At the hearing, representatives from several pilot sites — Kevin Mackey, MD, medical director, Sacramento Regional Fire Department; Clayton Kazan, MD, medical director, Los Angeles County Fire Department; and Shannon Smith-Bernardin, PhD, RN, CNL, director of clinical services, Los Angeles County Department of Health Services, Housing for Health — testified about the results of their work. CHA thanks the members and partners who participated in a special lobby day on April 4, as well as those who responded to CHA’s Advocacy Alert.
Assembly Bill 2798 (Maienschein, R-San Diego), which would establish time frames for the California Department of Public Health (CDPH) to process hospital applications for new or modified services, unanimously passed the Assembly Health Committee on a 15-0 vote. If CDPH does not meet its time frames, the bill would allow hospital applications for expanding existing services — in compliance with existing requirements for that service — to be considered approved and licensed for 18 months, allowing CDPH to complete its review.
The California Department of Public Health has issued the attached All Facilities Letter 18-14 to explain the requirements of a new law that allows the Medical Board of California to impose fines of $50,000-$100,000 on individuals at health facilities if they fail to file a Health Facility/Peer Review Reporting Form. The new law, effective Jan. 1, applies to administrators of peer review bodies, health facility chief executive officers or administrators, and others required to file the form. The law does not change the requirement to submit the report within 15 days after making a final decision or recommendation to take disciplinary action, regardless of whether a hearing is held.
The AFL explains circumstances that require reporting, who is responsible for reporting and which disciplinary actions must be reported.
The California Department of Public Health has issued the attached All Facilities Letter 18-13 clarifying the scope of practice for pharmacy technicians and intern pharmacists. Senate Bill 1039 (Chapter 319, Statutes of 2014), which took effect Jan. 1, 2015, expanded the scope of practice for professionals. The letter states that facilities do not need to request program flexibility to allow pharmacy technicians and intern pharmacists to operate within their scope of practice and outlines the various duties each is authorized to perform.
The California Department of Public Health has released the attached All Facilities Letter 18-05.1, clarifying the process for referring low and medium non-immediate jeopardy entity-reported incidents (ERIs) to accrediting organizations. The department advises hospitals to continue reporting ERIs to their district office for triage and prioritization. If the district office determines that the ERI is eligible for referral to an accrediting organization, it will inform the entity that it may contact the applicable accrediting organization for further action. This letter supersedes All Facilities Letter 17.11.
This week, the California Department of Public Health (CDPH) released its 2018 Fee Report, which proposes to increase hospital fees by 5 percent (from $515.04 to $540.79 per licensed bed) and add a supplemental facility fee of $50.53 per bed for hospitals in Los Angeles County.
Historically, the department has contracted with Los Angeles County to use county employees, rather than state workers, to perform facility licensing and certification duties for facilities in that area. The budget proposal asserts that the cost of doing business is higher there than in other parts of the state, and that licensing fees are commensurate with Los Angeles County’s costs to complete the workload. This increase coincides with a proposal to extend the current Los Angeles County contract for one year, and then negotiate a three-year contract beginning in July 2019. The proposal includes a “pay-for-performance” program.
CHA is analyzing the proposal, but generally supports using performance metrics for improvement across the entire state, rather than in only one jurisdiction.
The California Department of Public Health has released the attached All Facilities Letter 18-11, clarifying a new law that increases — from a maximum of $20,000 to a maximum of $75,000 — the fine for a health facility that discriminates or retaliates against a patient, employee or other health care worker for presenting a complaint against or cooperating in an investigation of the facility. This letter supersedes All Facilities Letter 17-28 and clarifies that the new law does not apply to long-term health care facilities.
The California Department of Public Health has released the attached All Facilities Letter 18-07, informing health care facilities that Assembly Bill 1456 (Chapter 151, Statutes of 2017) extends the maximum duration of waivers issued to unlicensed psychologists gaining qualifying experience toward their license from three to four years. The law, which took effect July 31, 2017, makes no changes to waiver eligibility requirements. Questions about requesting a waiver should be directed to the department’s State Facilities Section at (855) 804-4205 or firstname.lastname@example.org.
The Medical Board of California has released guidelines for providers recommending cannabis for medical purposes. The guidelines emphasize the importance of collaboration between physicians and their patients, noting that — prior to authorizing or recommending cannabis — physicians should document an established physician-patient relationship with mutual understanding of shared responsibility for the patient’s care. The board also recommends that physicians document a medical examination of the patient, including the patient’s history of present illness, social history, past medical and surgical history, alcohol and substance use history, and diagnosis requiring the cannabis recommendation.
Importantly, the guidance notes that Business & Professions Code Section 2525.3 states that recommending cannabis to a patient without appropriate examination and medical indication constitutes misconduct. The guidance goes on to detail treatment agreements, outlines qualifying conditions, and provides information on monitoring and adapting the treatment plan. The board’s guidance is not intended to mandate the standard of care.
A new program supported by the California HealthCare Foundation and led by Zuckerberg San Francisco General Hospital aims to help hospitals start medication-assisted treatment services for opioid use disorder. The program, called Project SHOUT (Support for Hospital Opioid Use Treatment), offers free resources for clinicians to use in starting or maintaining patients on buprenorphine and methadone. In addition to evidence-based guidelines, toolkits, expert coaching and grand-rounds presentations, the program will offer a weekly webinar series beginning Nov. 15. For more information, see the attached flyer or email email@example.com. To receive program updates, register online.
The California Department of Public Health (CDPH) has released the attached All Facilities Letter with new guidance for submitting plans of correction. Earlier this year, the Centers for Medicare & Medicaid Services (CMS) expanded the ways in which providers may submit plans. While previously required to submit plans of correction written on on the right side of CMS Form 2567, providers now have the option of instead including their plan as a separate attachment. CDPH has extended this practice to state-issued 2567 forms. More details are available in the attached letter.
The California Department of Public Health has issued the attached All Facilities Letter stating that health facilities affected by recent California wildfires — including those in Butte, Lake, Napa, Orange, Mendocino, Nevada, Sonoma, Yuba and Solano counties — are eligible to apply for waivers of certain licensing requirements. The waivers are intended to expedite recovery efforts and ensure that hospitals and other health facilities remain open. Details on obtaining a waiver are included in the attached letter; requests should be submitted to firstname.lastname@example.org.
A recent All Facilities Letter (AFL 17-20) from the California Department of Public Health (CDPH) states that, as of Oct. 1, home health agencies may expedite the licensing process by hiring a Centers for Medicare & Medicaid Services approved accreditation organization to conduct the initial state licensing survey, avoiding the current delay of three months to two years in initial application survey completion. If a home health agency chooses to hire its own accreditation organization and passes its initial survey, the CDPH Centralized Applications Unit will issue a six-month provisional license. More details on the process, as well as a list of approved accrediting organizations, are available in the attached AFL.
Under AB 2325 (Chapter 354, Statutes of 2016), pathologists will be required to electronically report cancer diagnoses to the California Cancer Registry (CCR) beginning Jan. 1, 2019. To help providers meet this requirement, the CCR has released an implementation guide defining reporting requirements as well as a standardized format for reporting. Pathologists and pathology software providers will need to review the guide and register through the CCR online portal to meet reporting requirements. More information is available at www.ccrcal.org/AB2325.shtml.
The California Department of Public Health has released the attached All Facilities Letter (AFL 17-17) notifying providers that its San Francisco District Office is transferring oversight of certain facilities in Santa Clara County to the San Jose District Office. Effective Oct. 1, all facilities listed in the AFL should report complaint and entity-reported incidents to the San Jose office.
The California Department of Public Health (CDPH) requests stakeholder input in revising regulations related to general acute care hospital clinical laboratory service. In the attached All Facilities Letter (AFL 17-18), CDPH outlines the specific areas in which it is requesting feedback, including anticipated costs imposed by requiring certain approvals in writing, whether hospitals have differing lab procedures for inpatients versus outpatients and who determines whether a pathologist candidate’s qualifications are equivalent to those required for certification. Responses are due Sept. 29 and may be submitted either online or via email; more details are included in the AFL.
The Centers for Medicare & Medicaid Services has released its annual report to Congress on Medicare’s review, validation and oversight of approved accrediting organizations (AOs). The report identifies nine approved Medicare AOs, as well as seven approved under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), and outlines their actions during fiscal year 2015 as compared to previous years. The report also analyzes CLIA Validation Program results.
The California Department of Public Health (CDPH) has released its fiscal year 2017-18 health care facility license fee schedule. As outlined in the attached All Facilities Letter, renewal notices and applications will be sent to facilities’ licensees 45-120 days prior to license expiration. To complete the license renewal, licensees should validate the number of beds listed on the renewal fee page; print applicable health care facility license numbers on the front of the payment; include the bottom portion of the renewal notice fee page with the payment; and mail the application portion of the notice as indicated on the last page of the application. License fee questions should be directed to RCollection@cdph.ca.gov.