Hospital Topics

Overview

CDPH Licensing & Enforcement

The California Department of Public Health’s (CDPH) Licensing and Certification Division (L&C) is responsible for the licensure, regulation, inspection, and certification of health care facilities and certain health care professionals in California. The division is organized into 14 district offices and Los Angeles County, which operates under a contract with the division. L&C staff conduct periodic inspections and investigation of complaints to ensure health care facilities comply with state and federal laws and regulations, conducting roughly 27,000 complaint investigations annually.

The federal Centers for Medicare & Medicaid Services (CMS) — which provides federal funding to ensure that facilities accepting Medicare and Medi-Cal payments comply with federal laws and regulatory requirements — contracts with L&C to perform federal surveys. In addition to facility oversight, L&C oversees the certification of nurse assistants, home health aides, hemodialysis technicians, and the licensing of nursing home administrators.

CHA News Article

Provider Alert Reports No Statewide Shortage of Antiviral Medications

The California Department of Public Health has issued a provider alert on influenza antiviral recommendations and strategies to obtain influenza antivirals, reporting there does not appear to be a nationwide antiviral shortage. Pharmacies are encouraged to contact their wholesaler’s customer service desk to request drop shipments of antivirals from the manufacturers if the wholesaler is unable to supply needed medications in a timely manner. More information about influenza activity is available at www.calhospital.org/infection-control.

CHA News Article

Guidance Available for New Law on Pain Management and Schedule II Drugs

The California Department of Public Health has released All Facilities Letter 17-25, providing guidance on compliance with Assembly Bill 1048 (Chapter 615, Statutes of 2017). Under the new law, which takes effect Jan. 1, health facilities licensed by the department are no longer required to assess pain concurrently with the collection of patient vital signs. Although providers are still required to assess pain, the bill allows facilities to create their own policies and procedures related to pain assessment and management, consistent with clinical practice. In addition, effective July 1, 2018, licensed pharmacists are authorized to dispense Schedule II drugs as a partial fill prescription at either the patient or prescriber’s request. This bill also establishes storage, reporting and recording requirements.

CHA News Article

Guidance Issued on Long-Term Care Facility Residents’ Rights in California
New law takes effect Jan. 1

The California Department of Public Health has released the attached All Facilities Letter notifying long-term care facilities that Senate Bill 219 (Chapter 483, Statutes of 2017) will take effect Jan. 1. The bill prohibits facility staff from discriminating against or denying care to seniors based on a person’s actual or perceived sexual orientation, gender, gender identity, gender expression or HIV status. Facilities are also required to post a notice, detailed in the letter, with their current nondiscrimination policy. Existing law requires long-term care facilities to protect residents’ rights; this bill enhances and reiterates existing protections.

CHA News Article

Health Care Personnel Flu Vaccination Rates Published

The California Department of Public Health has released the attached report on influenza vaccination rates among health care personnel. The data reflect the 2016-17 influenza season and show that, overall, California hospitals reached 83 percent vaccination – a steady increase since 2010. The highest vaccination rates are among employees paid by the hospital (average 87 percent), while the lowest are among licensed independent practitioners (average 67 percent); this category includes physicians, advance practice nurses and physician assistants. The department will follow up with hospitals that had a large increase, defined as over 20 percent, in vaccination compared to last season, as well as hospitals with over 90 percent vaccination rates, to identify best practices that could be applied statewide.

CHA News Article

CDPH Issues Guidance for Hospitals on Submitting Plans of Correction

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.

Overview

Community Benefit Programs
Hospitals give back to their communities

Health care is undergoing tremendous change and uncertainty as California implements the federal Affordable Care Act (ACA). Hospitals are working to ensure there will be enough beds and an adequate supply of health care professionals to meet the demands of the millions of Californians who are signing up for health insurance coverage under the ACA. In addition, California hospitals are meeting the needs of their communities through locally developed community benefit plans by supporting health care programs that provide preventative care to those in need.

Tax-Exempt Status of Nonprofit Hospitals

The tax-exempt status of nonprofit hospitals is being reviewed by policymakers, regulators and public interest groups. There are various proposals to impose burdensome and inflexible standards on nonprofit hospitals in order to obtain tax-exempt status and financing. CHA supports the development of appropriate guidelines that are not unduly burdensome and will allow sufficient flexibility to ensure nonprofit hospitals are able to carry out their mission. They must be based on broad measures of community benefit without establishing rigid formulaic thresholds.

CHA News Article For Members

CHA Releases Brochure Highlighting California’s Community Benefit History

CHA has released the attached educational brochure highlighting California’s community benefit history. For more than 20 years, California’s not-for-profit (NFP) hospitals have led the nation in ensuring that vulnerable populations have access to much needed health care services and health improvement programs. Each year, they contribute an estimated $12 billion to their communities through community benefit programs and activities, including mobile units serving disadvantaged families, classes on disease management and violence prevention, health professions education programs that train the next generation of health care providers, research in clinical and community health that contributes to evidence-based practices, leadership development and training for community members, and much more.

The brochure highlights the ways NFP hospitals partner with their communities to assess community health needs, and explains why flexibility in program development is critical.

Overview

Clinical Care

Clinical care touches every aspect of hospital operations. Policies and procedures surrounding clinical care are of the utmost importance in meeting regulatory, legal and licensing requirements. CHA has numerous area-specific groups — including specialty centers and committees — that address the many aspects of clinical care. Some areas of clinical care are subject to rapid changes in public policy and regulations, creating additional challenges for hospitals. In addition to providing representation and advocacy to address these challenges, CHA focuses on the unique needs of certain facilities, and the services and programs they offer their communities.

Education event

EMTALA — Essentials and Trouble Spots Webinar
EMTALA principles, updates, psychiatric services and compliance tips

February 28, 2018
10:00 a.m. – 12:00 p.m., Pacific Time

Despite being on the books for nearly 30 years, the Emergency Medical Treatment and Labor Act (EMTALA) continues to be a source of confusion for staff and a public relations nightmare. Fines have recently doubled, and may result in sanctions – recently for one hospital in excess of $1 million. 

Education event

New Law and Updates for Physician Reporting Webinar
Learn new reporting parameters to avoid hefty penalties

February 13, 2018
1:30 – 3:00 p.m., Pacific Time

Learn how SB 798, and updates to California Business & Professions Code Section 805.01 and NPDB policy impact the reporting process. Plus, learn when reporting is necessary, who is required to complete a report and what can happen if there is failure to submit a report to the NPDB or Medical Board of California.

General Information

Emergency Department Toolkit
Behavioral health resources for the emergency department

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

CHA News Article

CMS Provides Resources on Post-Acute QRP ‘Review and Correct’ Reports

The Centers for Medicare & Medicaid Services (CMS) has posted resources from its recent webcast training on post-acute care quality reporting program (QRP) review and correct reports. Among the resources are a video recording and post-training materials, including a question and answer document. The materials are accessible on the CMS QRP training pages for inpatient rehabilitation facilities, long-term care hospitals and skilled-nursing facilities

Recording

The End of Life Option Act Webinar
Understanding the law, considerations for developing and implementing policies

Webinar recorded live April 18, 2016

The End of Life Option Act is one of the most important bills the Governor signed into law this year. Individuals who have a terminal illness and meet certain qualifications may now ask their physician for prescription medication to end their life. The law is complicated and not without controversy.

Overview

Construction / Renovation

In the area of construction and renovation, CHA assists hospitals by reviewing and commenting on proposed regulations, attending all Hospital Building Safety Board (HBSB) meetings, nominating hospital representatives to the HBSB Board and serving as liaison between hospitals and the Office of Statewide Health Planning and Development’s (OSHPD) Facility Development Division when issues need to be resolved.

CHA News Article

New Law Clarifies Diesel Backup Generator Testing

The California Department of Public Health has released the attached All Facilities Letter 18-02, informing facilities that AB 1014 (Chapter 145, Statutes of 2017) took effect Jan. 1. The new law continues to clarify that facilities are required to test and maintain each of their diesel backup generators and standby systems in conformance with the National Fire Protection Association 110: Standard for Emergency and Standby Power Systems, which is an extension of a current requirement. The bill does not change the regulation of diesel backup generator testing by the state’s Air Resources Board or local air quality districts.

CHA News Article

Hospital Building Safety Board Posts 2018 Meeting Schedule

The Office of Statewide Health Planning and Development Hospital Building Safety Board has released its meeting schedule for 2018. Dates for Education and Outreach, Structural and Nonstructural Regulations, and Energy Conservation and Management committee meetings are among those included in the schedule. The agency’s next full board meeting is June 21 in Sacramento. For more information, including a complete list of committees and a board roster, visit www.oshpd.ca.gov/Boards/HBSB/.

CHA News Article

Hospital Input Sought on Potential Changes to Structural, Nonstructural Building Requirements

At the recent Structural and Nonstructural Committee meeting of the Hospital Building Safety Board, the Office of Statewide Health Planning and Development (OSHPD) proposed changes to structural and nonstructural code requirements for the 2019 California Building Standards Code, which will become effective Jan. 1, 2020. OSHPD seeks input from the hospital industry on its proposals, including:

  • The Hospital Facilities Seismic Safety Act requires hospitals to be capable of continuing operations after a seismic event, insofar as practical. What nonstructural anchorage, bracing of equipment and systems are practical in hospital buildings constructed prior to 1983?
  • What physical plant building standards should OSHPD adopt for outpatient observation units as created by Senate Bill 1076, such as room sizes, support spaces, etc.?
  • What changes, if any, should be incorporated into the building code to ensure elevator operation is maintained post-earthquake?

OSHPD must submit its proposed code changes to the Building Standards Commission by March 2018. OSHPD also presented on this activity at the recent CHA OSHPD Workgroup meeting. The OSHPD PowerPoint slides from these meetings are available at www.calhospital.org/construction-renovation.

CHA News Article

Proposed Energy Regulations for Hospitals Addressed in CHA Forum
Comment period open through Oct. 20

CHA hosted a member forum on Oct. 11 —  presented by Gabriel Taylor from the California Energy Commission (CEC) and Diana Scaturro from the Office of Statewide Health Planning and Development (OSHPD) Facilities Development Division — on new proposed energy regulations. Effective Jan. 1, 2020, all new health care facility construction will be subject to California Energy Code regulations that may affect an array of features, including the building envelope, lighting and controls, energy efficiency ratings, commissioning and performance modeling. The two state departments have been collaborating on the development of these regulations, given OSHPD’s role as the state building official for hospitals. In addition, OSHPD established a Hospital Building Safety Board energy subcommittee, with industry and other key stakeholders, as a forum for the development process. The CEC also presented the proposed regulations to the California Society of Healthcare Engineering Executive Committee and other hospital engineers for feedback. In this pre-rulemaking phase, the proposed regulations are open for public comment through Oct. 20; comments may be submitted online.

Overview

Emergency Preparedness
Is your hospital prepared?

Visit CHA’s Emergency Preparedness website at calhospitalprepare.org

About

Through the Office of the Assistant Secretary for Preparedness and Response, Office of Preparedness and Emergency Operations, Hospital Preparedness Program (HPP) grant, CHA has created a web site specifically devoted to Emergency Preparedness at www.calhospitalprepare.org.

   
CHA News Article

Guidance Focuses on Preparing for, Responding to Disease Outbreaks

The Society for Healthcare Epidemiology of America and the Centers for Disease Control and Prevention have published guidance for health care epidemiologists on disease outbreaks. Designed for acute care hospitals, but adaptable for other health care settings such as long-term care facilities and free-standing emergency departments, the guidance outlines key roles for epidemiologists ranging from advising incident response leaders on specific pathogens to fine-tuning communication with the public.

The guidance calls on health care epidemiologists to lend their medical and technical expertise to prevent and respond to outbreaks by:

  • Offering scientific guidance to other response staff
  • Helping to assess risks posed by pathogens or other factors in a crisis
  • Ensuring that information given to other health care personnel and the public is accurate
  • Contributing to the institution’s policies on surveillance of infectious disease threats as well as policies on outbreak measures such as patient isolation and treating vulnerable patient populations
  • Influencing staff training on infection prevention and control
CHA News Article

Public Health Emergency Declared in Southern California Due to Wildfires

The U.S. Department of Health and Human Services has declared a public health emergency in California because of the Southern California wildfires and issued a waiver under Section 1135 of the Social Security Act. The 1135 waiver covers Los Angeles, Riverside, San Diego, Santa Barbara and Ventura counties, as listed in President Trump’s Dec. 8 emergency declaration, and became effective at 1 p.m. (PT) on Dec. 13, retroactive to Dec. 4.

As a result of the public health emergency declaration, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced several actions to support California and residents impacted by the wildfires.

CMS issued a skilled-nursing facility (SNF) waiver pursuant to Section 1812(f) of the Social Security Act. SNF care without a three-day inpatient hospital stay will be covered for beneficiaries evacuated from a nursing home in the emergency area, discharged from a hospital in the emergency or receiving locations in order to provide care to more seriously ill patients, or who need SNF care as a result of the emergency, regardless of whether that individual was in a hospital or nursing home prior to the disaster. CMS will also provide coverage for beneficiaries in the disaster area who were recently discharged from a SNF after utilizing all of their available SNF benefit days.

CHA News Article

Free National Call Services Available in California

2-1-1 is a free, confidential service that helps people across the U.S. find access to local resources, including crisis and emergency services, housing and utilities, food, jobs and support, and disaster assistance. Calls to 2-1-1 are routed by the local telephone company to a local or regional calling center. The 2-1-1 center’s referral specialists receive requests from callers, access databases of resources available from private and public health and human service agencies, match the callers’ needs to available resources, and link or refer them directly to an agency or organization that can help. For more information, visit the California Public Utilities Commission website

CHA News Article

Statewide Medical and Health Exercise Tests Hospital Readiness

This year’s annual Statewide Medical and Health Exercise, held Nov. 16, emphasized hospital readiness for different types of external attacks. Participating hospitals tested organizational readiness, plans and internal policies, and established procedures with local, regional and state partners (photo gallery).

Each year, the exercise provides a venue to improve hospitals’ understanding of response procedures, build collaborative relationships and identify areas for improvement. Questions tested this year included working with local law enforcement, active shooter and explosive incident plans, responding to violent extremism, and behavioral health practices to be used for incoming victims and staff. As previously reported in CHA News, hospitals that participated in this exercise may count it toward requirements under the new emergency preparedness conditions of participation. Additional information on the exercise can be found at www.swmhe.com.

CHA News Article

Association Fire Relief Fund Helps Employees Impacted by Current Fires

In October, following the devastating wildfires that decimated numerous Northern California communities and destroyed the homes of more than 300 hospital employees, CHA and the Regional Associations established the Hospital Workers’ Fire Relief Fund. As new fires now threaten tens of thousands in the Los Angeles, Santa Barbara and Ventura County areas, we encourage additional donations from hospitals, hospital employees and other organizations to support the hospital employees in Southern California.

To date, the fund has collected more than $200,000 through the California Health Foundation & Trust (CHFT), a 501(c)(3) charitable organization (tax ID 94-1498697). One hundred percent of donations will be disbursed to hospitals that request assistance for their employees who were affected by the wildfires. 

Donations can be made online or by check — payable to “CHFT: Hospital Workers’ Fire Relief Fund” and mailed to CHFT, 1215 K Street, Suite 800, Sacramento, CA 95814. All donations are tax deductible, and donors will receive a receipt for tax purposes.

Overview

Environmental Health & Safety

CHA assists hospital environmental health and safety (EH&S) officers and other hospital personnel regarding compliance with the many — and frequently overlapping — state and federal EH&S requirements, including those related to  managing medical, hazardous and low-level radioactive waste. CHA also monitors EH&S legislation and regulation on behalf of hospitals and acts as their liaison with government agencies.  

CHA News Article

New Guidance Available on PPE for First Responders Exposed to Opioids

A new publication from the InterAgency Board establishes guidance on personal protective equipment (PPE) for first responders exposed to synthetic opioids. While the guidance notes that most routine encounters between patients and emergency medical services (EMS) staff or law enforcement do not present a significant threat of toxic exposure, the recent rise of synthetic opioid use poses increased risk. The guidance seeks to proactively address that risk by establishing standards for PPE selection and use, decontamination, detection and medical countermeasures. Though the guidance is written for EMS staff, its recommendations are also applicable to hospital settings.

CHA News Article

Health Care Facilities Reminded to Meet Requirements for Fire, Smoke Door Annual Testing
CMS extends compliance deadline to Jan. 1, 2018

The Centers for Medicare and Medicaid Services (CMS) has issued the attached memo reminding health care providers of requirements for fire and smoke door annual testing. Under the 2012 edition of the National Fire Protection Association (NFPA) Life Safety Code, facilities must meet certain requirements for the maintenance, inspection and testing of fire doors and smoke doors in certain certified health care facilities. In health care occupancies, annual inspection and testing in accordance with the 2010 NFPA 80 is required for all fire door assemblies. Although non-rated doors, including corridor doors to patient care rooms and smoke barrier doors, are not subject to those requirements, they should still be routinely inspected as part of the facility maintenance program. Facilities were originally required to comply prior to July 6, 2017. However, due to reported misunderstanding of the requirements, CMS has extended the deadline for full compliance to Jan. 1, 2018.

CHA News Article

CDC Highlights Hospital Patients’ Risk of Exposure to Legionella Bacteria

The Centers for Disease Control and Prevention (CDC) has released a new Vital Signs report highlighting patients’ risks of exposure to Legionella bacteria in health care facilities, including hospitals and long-term care facilities. According to the report, one in four people who contract Legionnaires’ disease as a health care-associated infection will die. Effective water management is key to preventing health care-associated outbreaks. The CDC has made available resources and tools to assist providers in reducing the threat from this bacteria. The American Society of Healthcare Engineers has also released tools to assist its members in managing water systems. Additionally, the Centers for Medicare & Medicaid Services has released the attached guidance providing more information about infections, tips for prevention and expectations of health care facilities.

CHA News Article

CDPH Approves Medical Waste Treatment Facilities

The California Department of Public Health (CDPH) has approved two California pyrolysis treatment facilities — managed by Aemerge and Medical Waste Services, LLC — to treat all types of medical waste. Additional alternative medical waste treatment technologies approved by CDPH are available online. Hospitals that have questions can contact Alison Dabney, CDPH supervisor, medical waste, at alison.dabney@cdph.ca.gov.

CHA News Article

Draft Air Pollution Guidelines Developed
Hospitals should work with local AQMD to develop district standards

The California Air Pollution Control Officers Association has developed the attached draft guidelines updating procedures for public notification of air pollution risks and incorporating advances in the field of risk assessment. Current law requires regulated facilities, including hospitals (under certain conditions), to report the types and quantities of toxic air pollutants they routinely emit. For hospitals, this includes emissions from back-up diesel generators. The law, known as the “Hot Spots” Act, also requires air quality management districts (AQMDs) to determine which facilities must conduct health risk assessments using the California Air Resources Board’s Emission Inventory Criteria and Guidelines. The draft guidelines, developed with assistance from the California Office of Environmental Health Hazard Assessment and the California Air Resources Board, are intended to be used by local districts in evaluating their Hot Spots programs. Hospitals should work with local AQMDs to learn how these guidelines will be implemented at the district level and whether their district will also update its pollution emission standards.

Overview

Finance

Hospital finance is complicated, and California hospitals operate in a challenging environment. Hospital executives are faced with the task of developing financial strategies that contain costs yet allow for the provision of health care to the state’s large uninsured population.

CHA News Article

Governor Releases 2018-19 State Budget

Totaling $190 billion for fiscal year 2018-19, Gov. Brown emphasizes fiscal prudence by continuing to build the state’s Rainy Day Fund and keeping spending in line with revenues.

CHA News Article

Clarification Issued on Revised Worksheet S-10 Instructions

In response to several questions submitted by CHA and others, as well as questions asked during a recent open door forum, the Centers for Medicare & Medicaid Services has released the attached document clarifying its recently revised instructions for Worksheet S-10 of the Medicare cost report. CHA reminds hospitals that the deadline to submit amended cost reports for federal fiscal years 2014 and 2015 is Jan. 2. Worksheets received by Dec. 2 will be reflected in the cost report data file used to develop federal fiscal year proposed rules. Hospital data submitted after Dec. 2 but by Jan. 2 will be reflected in the cost report data file that is typically used to develop the federal fiscal year final rules. Additional resources for Worksheet S-10 are available on CHA’s website. CHA expects the agency to post this document to its website in the coming days. 

CHA News Article

Details of Federal Spending Package to Be Issued in CHA News
Congress has until midnight tomorrow to finalize

Although Congress has finished its work on the tax bill, members have one remaining fiscal responsibility to address because the federal government runs out of spending authority at midnight tomorrow, Dec. 22. CHA has been advocating for the spending package to include a five-year reauthorization of the Children’s Health Insurance Program (CHIP), the Medicare policy extensions, and delays in cuts to the Medicaid disproportionate share hospital and 340B programs.

The House and Senate plan to vote today and tomorrow on a short-term extension of spending authority through Jan. 19, 2018, which includes a three-month extension of CHIP and an important waiver of a budget provision that would have triggered deep cuts in Medicare spending due to the deficit increase created by the new tax bill. It does not include CHA’s other priorities. CHA will issue a detailed report of all the final actions via a special edition of CHA News as soon as Congress adjourns.

Education event

Mastering Medi-Cal Managed Care Webinar
Medi-Cal Managed Care 101, Contracting and Accountability

January 30, 2018
10:00 a.m. – 12:00 p.m., Pacific Time

Over the past two years, the Medi-Cal program has grown significantly and now serves approximately one-third of Californians, with nearly 80 percent enrollment in managed care.

CHA News Article For Members

CHA Provides Overview of Federal Legislation Critical to Hospitals

As the calendar year winds down, Congress is grappling with a wide range of issues, most of which have implications for California’s hospitals and the patients they care for. CHA is actively engaged with the congressional delegation on broad issues such as tax reform, funding for the federal government and spending caps, as well as hospital-focused legislation — including Medicare payments for small and rural hospitals, post-acute care providers and participants in the 340B program. The Children’s Health Insurance Program, telehealth and the Deferred Action for Childhood Arrivals program are also on the congressional docket; the disposition of these issues will impact hospitals’ patients and employees.

To help member hospitals follow these issues, CHA has prepared the attached chart with helpful links to CHA Advocacy Alerts, letters and legislative language. 

Overview

Health Care Reform

Our nation’s health care system has entered a new era with the enactment of federal health care reform. This landmark legislation is resulting in many changes in how health care is financed and delivered for years to come. For nearly two decades, CHA has been at the forefront in advocating for meaningful health care reform — and we will continue to help shape the future of hospital care far into the future. CHA’s vision of an “optimally healthy society” is now a reality within reach.

This section provides materials to help hospitals understand and comply with the law, plan for the future, and communicate with their patients and communities about the impacts of health care reform.

CHA News Article

Covered California Issues Q&A on Elimination of ACA Individual Mandate Penalty

Covered California has released the attached document answering frequently asked questions related to recent federal action eliminating the Affordable Care Act’s individual mandate penalty in 2019. The document answers some of the questions consumers may have and includes a table outlining the timeline for when the individual mandate penalty applies, as well as links to numerous resources to assist consumers.

Highlights include:

  • Consumers will see no change in their Covered California health benefits or financial assistance in 2018.
  • The individual mandate penalty will remain in place in 2018.
  • Individuals who do not buy insurance in 2018 because it would be “unaffordable” may still apply for an exemption through www.healthcare.gov/exemptions.
  • The individual mandate penalty will no longer be assessed beginning in January 2019.
  • Financial assistance will remain in place in 2019.
  • Open enrollment for Covered California runs through Jan. 31, 2018.  
CHA News Article

Covered California Looks Ahead to 2019

This week, Covered California shared its latest open enrollment data, showing that more than 220,000 new consumers signed up for coverage through Dec. 15 — about 10 percent more than last year. In addition, approximately 1.2 million existing Covered California consumers have had their coverage renewed for 2018. While the open enrollment period has ended in most states, uninsured consumers in California have until midnight tonight to sign up for coverage beginning on Jan. 1.

With the continued health care policy debate at the federal level, Covered California also noted that the individual market faces significant uncertainty in 2019. According to Covered California, the three main causes of this uncertainty are repeal of the individual mandate penalty, lack of federal marketing and the president’s recent executive order allowing the sale of “association health plans” or “short-term plans.” 

CHA News Article

California’s Uninsurance Rate Drops to 6.8 Percent
Lowest rate since 2013

According to a new survey from the Centers for Disease Control and Prevention, California’s uninsurance rate has dropped to 6.8 percent. Prior to the Affordable Care Act, California’s uninsured rate for all ages was higher than the national average: 17 percent compared to 14.4 percent. Since that time, California’s uninsured rate has dropped by more than 10 percentage points, while the national average has dropped by 5.4 percentage points.

The CDC survey shows wide variation across the nation in the extent to which states have lowered their rates of the uninsured, with particularly striking differences between states that manage their own marketplaces and expanded Medicaid, and those that did not.

CHA News Article

CHA Develops Community Snapshots for Each of California’s 58 Counties

CHA has developed downloadable and printable infographics comparing key demographic information for each of California’s 58 counties to the state of California as a whole. Titled Community Snapshots, the resource is intended to provide members with a snapshot of their communities’ health needs. The infographics include data on population size, median age, percentage of adults with high school degrees, median household income, unemployment rate, rental costs as a percentage of income, percentage of individuals below poverty level, uninsured rate, percentage of Medi-Cal and Medicare enrollment, number of primary care physicians per 100,000, and percentage of individuals with at least two chronic conditions.

CHA News Article For Members

CHA Provides Overview of Federal Legislation Critical to Hospitals

As the calendar year winds down, Congress is grappling with a wide range of issues, most of which have implications for California’s hospitals and the patients they care for. CHA is actively engaged with the congressional delegation on broad issues such as tax reform, funding for the federal government and spending caps, as well as hospital-focused legislation — including Medicare payments for small and rural hospitals, post-acute care providers and participants in the 340B program. The Children’s Health Insurance Program, telehealth and the Deferred Action for Childhood Arrivals program are also on the congressional docket; the disposition of these issues will impact hospitals’ patients and employees.

To help member hospitals follow these issues, CHA has prepared the attached chart with helpful links to CHA Advocacy Alerts, letters and legislative language. 

Overview

Health Information Management & Technology

CHA supports the capture and availability of secure patient-care data through the use of health information technology (HIT) across the continuum of care. CHA believes HIT serves as a tool to enhance patient safety, promote information sharing for preventative health services and reduce health care costs.

Hospitals face a number of challenges with HIT such as security and interoperability. The development of industry standards is crucial to successful interoperability and the safe and effective exchange of patient data. Certification of vendor systems, for example, involves compliance with industry-accepted data and technical standards.

CHA News Article

Draft Trusted Exchange Framework Released for Electronic Health Information

The U.S. Department of Health and Human Services’ Office of the National Coordinator (ONC) for Health Information Technology has released its draft Trusted Exchange Framework. As required by the 21st Century Cures Act, the proposed framework outlines policies, procedures and technical standards for the trusted exchange of health information between networks. Under the proposal, ONC would recognize a private sector coordinating entity to incorporate the framework into a common agreement, to which qualified health information networks and their participants voluntarily agree to adhere. Qualified health information networks would need to upgrade their technology to support an expanded core data set for interoperability, require participants and end users to provide proof of identity, and could charge reasonable allowable costs to other qualified health information networks. Comments on the draft framework are due Feb. 18 by 8:59 p.m. (PT).

CHA News Article

Providers Should Use QualityNet for Attestation in 2018

The Centers for Medicare & Medicaid Services reminds providers that, as of Jan. 2, they must use the QualityNet Secure Portal for calendar year 2017 attestation under the Electronic Health Record Incentive Program. This change, which also applies to future reporting periods, is intended to streamline the attestation process by migrating it to the system already used for clinical quality measure reporting. Medicaid-eligible hospitals should contact their state Medicaid agencies for specific information on how to attest. Dually eligible hospitals and critical access hospitals will register and attest for Medicare on the QualityNet portal and update and submit registration information in the Registration and Attestation System. Questions should be directed to the QualityNet Help Desk at qnetsupport@hcqis.org or (866) 288-8912.

CHA News Article

Governor Signs Bills Amending Medical Records, Privacy Laws

Gov. Brown signed three bills this legislative session related to health information privacy and medical records. All three take effect Jan. 1, 2018. Hospital privacy officers and health information managers should update their policies and procedures and train staff accordingly.

Senate Bill 575 (Leyva, D-Chino) requires hospitals, physicians and other health care providers to give a free copy of the relevant portion of the medical record to a patient if needed to support a claim or appeal regarding eligibility for a public benefit program, including Medi-Cal; In-Home Supportive Services; California Work Opportunity and Responsibility to Kids (CalWORKs); Social Security disability, Supplemental Security Income/State Supplementary Program for the Aged, Blind and Disabled (SSI/SSP) benefits; federal veterans service-connected compensation and nonservice-connected pension disability benefits; and CalFresh.

CHA News Article

Electronic Clinical Quality Measures Transitioning to Clinical Quality Language in 2019

As previously reported in CHA News, the Centers for Medicare & Medicaid Services (CMS) earlier this month released draft electronic clinical quality measure (eCQM) specifications using the clinical quality language (CQL) standard for logic expression. This week, CMS announced that it would begin transitioning to reporting CQL-based measures with the calendar year 2019 reporting period for eligible hospitals and critical access hospitals, and the calendar year 2019 performance period for eligible professionals and clinicians. To support the transition, CMS will publish CQL-based eCQMs in Spring 2018 for potential inclusion in the Hospital Inpatient Quality Reporting Program, the Medicare Electronic Health Record Incentive Program, the Medicaid EHR Incentive Program, and the Merit-based Incentive Payment System and alternative payment models under the Quality Payment Program.

In anticipation of this transition, CMS will offer general and targeted educational sessions to share how CQL is used to support eCQMs. For more information on upcoming webinars, visit CMS’ eCQI Resource Center Events page. For resources and information on CQL, visit https://ecqi.healthit.gov/cql.

CHA News Article

CMS Issues Draft eCQM Specifications Using Clinical Quality Language

The Centers for Medicare & Medicaid Services (CMS) has released draft electronic clinical quality measure (eCQM) specifications using the clinical quality language (CQL) standard for logic expression. CQL is a Health Level 7 international standard for trial use and aims to unify the expression of logic for eCQMs and clinical decision support. CQL is intended to allow better expression of logic defining measure populations to improve eCQMs accuracy and clarity. The official timeline for the incorporation of CQL depends on outcomes of further CQL testing. More information about CQL is available on the eCQI Resource Center website. CMS notes that the draft specifications are for informational review only and are not intended for submission of 2017 or 2018 eCQM reporting. The draft specifications will be available for review until Nov. 13.

Overview

Human Resources

California hospitals and health systems employ more than half a million people, from entry-level positions to senior executives. Many health care human resources (HR) departments are responsible for a wide range of issues, such as recruitment, staffing, compensation, benefits, labor/employee relations and employee health. Navigating the complex regulatory environment, while monitoring how it applies to HR in the health care setting, can be a challenging and dynamic task.

Representing hospitals and health systems in California, CHA provides leadership in HR policy at state and federal levels. In addition, CHA advocates on behalf of hospitals and health systems before the federal and state legislatures, federal and state administrative agencies and the public. CHA also provides educational opportunities, such as the annual Labor & Employment Law seminar, to help hospital leaders sharpen their skills and knowledge in health care HR. CHA members also participate on an HR executive e-mail list and receive periodic informational memoranda. 

CHA News Article

New Law Increases Fines for Retaliation Against Whistleblowers

The California Department of Public Health has released All Facilities Letter 17-28 notifying health facilities that a new law increases the maximum penalty to $75,000 for health facilities that are found to have discriminated or retaliated against patients, employees, medical staff or other health care workers for presenting a complaint against the facility or cooperating in an investigation of a facility. The law became effective Jan. 1. Questions should be directed to hospitals’ local Licensing and Certification district offices.

CHA News Article

UHW Files Initiative to Set Staffing Requirements, Limit Charges for Dialysis Clinics

The Service Employees International Union – United Healthcare Workers West today filed a ballot initiative — the Kidney Dialysis Patient Protection Act — with the attorney general for the 2018 General Election. 

The initiative would establish minimum staffing requirements for nurses, hemodialysis technicians, social workers and registered dietitians in chronic dialysis clinics. In addition, it would create a minimum transition time between patients and limit charges to 115 percent of “reasonable treatment cost,” as defined in the initiative. The initiative would also establish reporting requirements and penalties for violations. 

Although the initiative aims to impose these provisions on for-profit dialysis corporations, some hospitals that operate chronic dialysis clinics may also be impacted. The attorney general will prepare and issue a title and summary in October 2017, which can be used to circulate the petition for signatures. The initiative’s sponsors must collect and submit an estimated 366,000 verified signatures in April 2018 to qualify the initiative for the Nov. 6, 2018, General Election.

CHA News Article

CDPH Seeks Comment on Criminal Record Clearance Regulations

The California Department of Public Health has issued the attached All Facilities Letter requesting comments on criminal record clearance regulations for certified nurse assistants and home health aides. The regulations are intended to implement procedures for processing criminal record clearances for these providers. Comments should be submitted by close of business on May 22.

CHA News Article

New Criminal Background Regulations Approved
Rules will take effect July 1

The Office of Administrative Law (OAL) has approved new regulations, adopted by the California Fair Employment and Housing Council (FEHC), concerning employers’ use of criminal background information when making employment decisions. The regulations, which take effect July 1, require employers to demonstrate that any criminal history information sought is job-related and consistent with a business need. To meet this obligation, employers may either 1) conduct an individual assessment of circumstances and qualifications of applicants excluded by the conviction screen and determine whether an exception is warranted, or 2) demonstrate that its conviction disqualification policy, though not based on individual assessment, nonetheless properly distinguishes between those who do and do not pose an acceptable level of risk.

Any policy that is not based on individual assessment and is seven or more years old will be presumed not to meet the standards of the new regulations; employers must rebut this presumption proactively. Additionally, prior to taking any adverse action, employers who obtain criminal information from a source other than the applicant must notify the individual and provide him or her an opportunity to challenge the information’s accuracy.

Overview

Legal

CHA’s legal department advocates vigorously before the courts on behalf of California hospitals, both as a party in litigation and as amicus curiae in important appellate cases. In addition, the CHA legal department prepares legal memoranda and manuals to help hospitals understand and comply with state and federal laws. The CHA legal department also supports CHA staff in their advocacy efforts before the state legislature and regulatory agencies.

CHA News Article

Registration Open for Emergency Medical Treatment and Labor Act Webinar
Will address recurring EMTALA trouble spots and offer compliance tips

Registration is now open for CHA’s EMTALA – Essentials and Trouble Spots webinar, scheduled for Feb. 28 from 10 a.m. to noon (PT). The webinar will focus on Emergency Medical Treatment and Labor Act (EMTALA) principles, updates, psychiatric services and compliance tips. Featured speakers include Hooper, Lundy & Bookman, PC Partner  M. Steven Lipton, author of CHA’s recently updated EMTALA Manual.

Despite being on the books for nearly 30 years, the act continues to be a source of confusion for staff, with the potential for negative public relations. Fines have recently doubled and may result in sanctions — for one hospital, in excess of $1 million. 

CHA encourages health care professionals to attend the webinar to gain insights on the law’s scope and application, learn updated information, explore recurring problems and delve into the intersection of the law and emergency psychiatric services. The session will include ample time to address tough questions.

CHA News Article

New Legal Requirements, Policy Changes Impact Physician Reporting
Feb. 13 webinar will explain new reporting parameters

New physician reporting requirements established in California Business & Professions Code Section 805.01 by Senate Bill 798 (Chapter 775, Statutes of 2017) expand the scope of liability for hospital leadership and significantly increase potential fines — up to $100,000 per incident — for failure to report specific physician professional review actions and findings, and certain privilege-related actions, when imposed or voluntarily accepted for a medical disciplinary cause or reason. CHA will hold a webinar Feb. 13 from 1:30-3 p.m. (PT) to discuss how these new requirements, as well as updates to National Practitioner Data Bank (NPDB) policy, impact physician reporting obligations.

Program faculty include representatives from the Medical Board of California, NPDB and Arent Fox LLP, who will discuss how the new law and policy changes affect the reporting process; the legal implications for hospitals and their leadership; when reporting is necessary; and what can happen if a report is not submitted to the NPDB or the medical board.

For more information and to register, visit www.calhospital.org/physician-reporting-web.

CHA News Article

Hospital Compliance Seminar to Address Critical Timely Topics

Registration for CHA’s annual Hospital Compliance Seminar is now open. This year’s program will address recent changes in state and federal law and provide critical information to protect hospitals and their staff. Featured topics include:

  • When civil actions can turn criminal — implications of increased federal focus on punishing individuals for fraud and abuse violations, instead of “just” fining organizations
  • Managing the self-audit process, reporting and refunding obligations
  • Privacy issues surrounding health information exchange
  • Updates to the California Department of Public Health privacy breach investigation process
  • Emerging trends in managed care and increased claims scrutiny
  • Updates to Medicare and Medicaid programs

This hands-on program is a must for all hospital compliance professionals. Events will be held Feb. 6 in Pasadena and Feb. 21 in Sacramento. Attendees will receive a complimentary copy of CHA’s 2018 Hospital Compliance Manual.

For more information and to register, visit www.calhospital.org/hospital-compliance.

CHA News Article

New Law Increases Fines for Retaliation Against Whistleblowers

The California Department of Public Health has released All Facilities Letter 17-28 notifying health facilities that a new law increases the maximum penalty to $75,000 for health facilities that are found to have discriminated or retaliated against patients, employees, medical staff or other health care workers for presenting a complaint against the facility or cooperating in an investigation of a facility. The law became effective Jan. 1. Questions should be directed to hospitals’ local Licensing and Certification district offices.

CHA News Article

Hospital Compliance Seminar Registration Now Open
Program begins Feb. 6 in Pasadena, attendees receive free copy of CHA’s 2018 Hospital Compliance Manual

Registration for CHA’s annual Hospital Compliance Seminar is now open. Events will be held Feb. 6 in Pasadena and Feb. 21 in Sacramento. This one-day seminar will review recent changes in state and federal law and provide the necessary information to protect hospitals and their staff. Attendees will receive a complimentary copy of CHA’s 2018 Hospital Compliance Manual.

The stakes surrounding compliance issues have been raised. The federal government is increasing its focus on punishing individuals for fraud and abuse violations, instead of “just” fining organizations. Federal penalties have increased across the board for fraud and abuse, Health Insurance Portability and Accountability Act and Emergency Medical Treatment and Labor Act violations — and annual adjustments now in place ensure fines will continue to increase.

This hands-on program is a must-attend for all hospital compliance professionals. For more information and to register today visit www.calhospital.org/hospital-compliance.    

Overview

Patient Rights

California and federal laws give hospital patients many rights. Hospitals must notify patients of these rights by giving patients a handout and/or by putting posters up in the hospital.

CHA has developed a sample handout that hospitals may use to notify patients of their rights under state hospital licensing regulations, the Medicare Conditions of Participation, and The Joint Commission. In addition, CHA publishes a corresponding poster.

CHA News Article

Hospitals Should Review Child Abuse Reporting Policies

Effective Jan. 1, a hospital’s internal child abuse reporting policy may not direct employees to allow their supervisor to file or process a mandated report under any circumstances. The law was enacted because of concerns that supervisors at private foster family agencies had impeded social workers and teachers from making reports when they suspected child abuse.

Publication

Principles of Consent and Advance Directives Guidebook
A guidebook on patient consent for treatment and other health care decisions, including the End of Life Option Act

This guidebook guides you through the basic principles of patient consent for health care treatment. In clear, simple terms this publication explains why and when consent is necessary, who may give consent, how consent for minors is different, and procedures that require special consent. It also describes the hospital’s obligations when dealing with complicated issues such as advance health care directives, California’s POLST form, refusal of treatment, and end-of-life decisions, including California’s End of Life Option Act .

Publication

2017 Consent Manual
The trusted resource for consent and related health care law

From basic principles to specific procedures, the Consent Manual is your one-stop resource for all legal requirements related to patient consent for medical treatment, release of medical information, reporting requirements and more. Learn exactly what the law requires and what you need to do to comply.

Recording

The End of Life Option Act Webinar
Understanding the law, considerations for developing and implementing policies

Webinar recorded live April 18, 2016

The End of Life Option Act is one of the most important bills the Governor signed into law this year. Individuals who have a terminal illness and meet certain qualifications may now ask their physician for prescription medication to end their life. The law is complicated and not without controversy.

General Information

Population Health Management
Listen to podcasts and webinar recordings to master PHM

Overview

A major transformation is underway in health care to enhance patient care quality, access and experience, and reduce costs. Because population health management (PHM) is the direction in which health care is moving, the California Hospital Association is pleased to provide member hospitals with comprehensive and substantive podcasts and webinar recordings designed to enhance the knowledge and skills needed to succeed under a PHM construct.

Master PHM
Based on CHA’s webinar series, Population Health Management: A comprehensive, five-part program for hospital leaders, the podcasts and recordings offer critical information for executives and professionals in a wide range of organizations. Five key areas are presented:

  • The PHM Framework
  • Business Considerations for PHM
  • Clinical Considerations for PHM
  • Technology for PHM
  • Leadership and Talent for PHM

Podcasts

Jan. 4, 2017 Podcast
A Framework for Population Health Management — From Providing Care to Managing Health
Jan. 11, 2017 Podcast
Drivers of the Population Health Management Imperative
Jan. 18, 2017 Podcast
Nine Population Health Management Key Competencies
Jan. 25, 2017 Podcast
Comprehensive Care Management — Clinical and Business Competencies
Feb. 1, 2017 Podcast
Types of Risk Assumed by Hospitals and Health Systems Under PHM
Feb. 8, 2017 Podcast
Provider Organization Roles Under PHM
Feb. 15, 2017 Podcast
A Framework for the Pursuit of PHM
Feb. 22, 2017 Podcast
Determining the Market’s Stage and Pace of Change
March 1, 2017 Podcast
Evaluating Organizational Position and Competence Gaps
March 8, 2017 Podcast
Identifying PHM Opportunities, Determining Scope and Scale
March 15, 2017 Podcast
Defining a Contracting Strategy to Support PHM Opportunities
March 22, 2017 Podcast
Identifying the Appropriate PHM Path for the Organization — Build, Buy or Partner

Webinar Recordings

Webinar 1: A Framework for Population Health Management
Webinar 2: Business Imperatives for Population Health Management
Webinar 3: Clinical Imperatives for Population Health Management
Webinar 4: Technology for Population Health Management
Webinar 5: Leadership and Talent for Population Health Management
Overview

Quality & Patient Safety

CHA is committed to helping hospitals improve quality, reduce medical errors and adverse events, and maximize patient safety. To further those efforts, CHA and the Regional Associations established the Hospital Quality Institute (HQI) in 2013 to realize statewide impact of improving patient safety and quality care for all Californians, to accelerate the rate of improvement and to advance California as a national leader in quality performance. HQI’s broad scope of work includes reducing patient harm, reducing health care-associated infections, reducing hospital readmissions, improving patient experience and improving maternal/child outcomes. Hospitals and health systems that belong to HQI — a voluntary organization — use it as an excellent source of performance data and analytics to focus improvement opportunities and take best practices to scale. In addition, CHPSO, the nation’s largest and longest operating patient safety organization, is a division of HQI.

CHA also regularly tracks and reports on important developments in the public reporting of hospital quality data, including OSHPD and Hospital Compare website data, and keeps members informed of regulations related to pay for quality reporting and performance.

CHA News Article

Hospitals Recognized for Reducing C-Sections
111 birthing hospitals to receive Smart Care California awards

California Health and Human Services Secretary Diana Dooley today recognized hospitals for reducing cesarean births for first-time mothers with low-risk pregnancies. The state named 111 hospitals to its 2017 Hospital C-Section Honor Roll, representing 45 percent of the 242 California birthing hospitals that achieved the Healthy People 2020 target of 23.9 percent or fewer low-risk, first-birth cesarean deliveries.

Dooley announced the achievement awards on behalf of Smart Care California, a coalition of public and private health care purchasers that collectively covers 16 million people statewide, or 40 percent of all Californians. Certificates will be mailed to CEOs of the recognized hospitals in early February.

The agency’s press release, which quotes Hospital Quality Institute President and CEO Julie Morath, is attached.

CHA News Article

Providers Should Use QualityNet for Attestation in 2018

The Centers for Medicare & Medicaid Services reminds providers that, as of Jan. 2, they must use the QualityNet Secure Portal for calendar year 2017 attestation under the Electronic Health Record Incentive Program. This change, which also applies to future reporting periods, is intended to streamline the attestation process by migrating it to the system already used for clinical quality measure reporting. Medicaid-eligible hospitals should contact their state Medicaid agencies for specific information on how to attest. Dually eligible hospitals and critical access hospitals will register and attest for Medicare on the QualityNet portal and update and submit registration information in the Registration and Attestation System. Questions should be directed to the QualityNet Help Desk at qnetsupport@hcqis.org or (866) 288-8912.

CHA News Article

CDC Issues Influenza A Health Advisory

The Centers for Disease Control and Prevention (CDC) has issued the attached official health advisory about seasonal influenza virus with treatment recommendations for patients, including those who are hospitalized. According to the advisory, influenza activity has increased nationwide and should be high on clinicians’ list of possible diagnoses. The predominant virus so far this season has been influenza A(H3N2), which has previously been associated with more hospitalizations and deaths in people over 65 and very young children. In addition, vaccines are less effective against A(H3N2) viruses than other influenza viruses.

The advisory recommends providers treat all hospitalized and high-risk patients suspected to have influenza with a neuraminidase inhibitor antiviral. It also includes detailed information about the clinical implications, antiviral drugs approved for treatment this season and background information for patients.

CHA News Article

Hospitals Urged to Increase HCAHPS Response Rate

CHA and the Hospital Quality Institute (HQI) are calling on California hospitals to increase their response rate on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

California leads the U.S. on many measures of health care quality. However, HCAHPS performance is an exception, with our state consistently placed in the bottom quartile of national performance. HQI analysis has revealed that response rates are strongly correlated with HCAHPS scores. In fact, each one percentage point increase in a hospital’s HCAHPS response rate is expected to result in a half point increase in the mean HCAHPS top-box score. 

CHA News Article

Hospitals Must Review Embargoed Maternity Data by Friday
New frequently asked questions document helps explain measures’ source and methodology

As previously announced in CHA News, Cal Hospital Compare released on Dec. 18 an embargoed data set of certain maternity measures for 2016 to the Hospital Quality Institute (HQI). These data were shared with birthing hospital contacts, including all CEOs; hospitals that did not receive a data set should contact HQI. The review period for these data concludes at 5 p.m. (PT) tomorrow, Dec. 22, and the data will be publicized on or around Jan. 18. This release includes data for measures on episiotomy rate; nulliparous, term, singleton, vertex (NTSV) cesarean delivery rate; vaginal birth after cesarean (VBAC) delivery rate; and VBACs routinely offered (Y/N). The breastfeeding rate will be released in early to mid-January.

Overview

Reimbursement

California hospitals’ revenue stream is critical to their overall mission of providing care and cures in the communities they serve. While over half of hospitals’ revenue, nearly $30 billion a year, is derived from government-funded programs, including Medicare, Medi-Cal, Healthy Families and county indigent programs – Private Insurance revenues are also significant.

CHA believes that hospitals should be reimbursed adequately to cover the cost of care for enrollees. CHA also believes every Californian who is eligible should be enrolled in the appropriate federal, state or local governmental program. Hospitals and private payers should not be responsible to pay for government underpayments. CHA dedicates many resources to advocate for fair government reimbursement. CHA DataSuite is an information-based toolset, available only to CHA members, that helps hospitals analyze government reimbursement changes, and the potential impact of regulatory and legislative actions on hospitals.

CHA News Article

Web Training to Focus on Outpatient Therapy Billing

Noridian, the Medicare administrative contractor for California-based hospitals, will host a web-based workshop on Jan. 25 from 11 a.m. to noon (PT), addressing coding and billing requirements for outpatient physical therapy, occupational therapy and speech language/pathology. This presentation will include information on therapy changes,  therapy caps and coding requirements. Registration is available online

CHA News Article

Changes Proposed to Risk Adjustment for Medicare Advantage Capitation Rates

The Centers for Medicare & Medicaid Services (CMS) has issued part one of its annual advance notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies in late December. The advance notice is being issued in two parts this year due to requirements of the 21st Century Cures Act, which mandated certain changes to the Part C risk adjustment model and a 60-day comment period for the changes.

For 2019, CMS proposes to include additional mental health, substance use disorder and chronic kidney disease conditions in the risk adjustment model for payment. The new risk adjustment model would be phased in using a blend of 25 percent of the proposed new risk adjustment model and 75 percent of the current risk adjustment model beginning in 2019. Comments on the advance notice are due by March 2.

CHA News Article

Mastering Medi-Cal Managed Care Webinar Set for Jan. 30

Over the past two years, the Medi-Cal program has grown significantly and now serves approximately one-third of Californians, with nearly 80 percent enrollment in managed care. This rapid expansion has meant a large transition for particularly vulnerable populations, including seniors, people with disabilities and low-income families. This shift has also affected hospitals as they attempt to coordinate benefits and ensure Medi-Cal patients are receiving the right care, at the right place and the right time, and that Medi-Cal managed care plans meet their obligations in managing care for millions of Californians.

To help members better understand Medi-Cal managed care, CHA will host a webinar Jan. 30 from 10 a.m. – noon (PT). Chief operating officers, chief financial officers, clinical operations executives, case management directors, legal counsel and finance staff should plan to participate in this webinar. The program will begin with a background of Medi-Cal managed care, followed by top tips for contracting and working with Medi-Cal managed care plans. For more information and to register, visit www.calhospital.org/medi-cal-managed-care-web.

CHA News Article

Study Finds Psychiatrists Receive Lower In-Network Reimbursement Than Other Medical Providers

A new study reports that psychiatrists receive lower in-network reimbursement than non-psychiatrist physicians for many of the same services — potentially contributing to psychiatrists’ lower participation in insurance networks than other providers. According to the study, the reimbursement disparity may also have implications for patient cost-sharing and access to psychiatrists.

Another recent report showed similar findings after examining whether insurers are abiding by the parity law when it comes to patient access to in-network providers and physician reimbursement rates.

CHA News Article

Update Issued on Drug Medi-Cal Organized Delivery System Waiver

The California Department of Health Care Services has provided an update on the Drug Medi-Cal Organized Delivery System (DMC-ODS) waiver, a voluntary pilot program that offers California counties the opportunity to expand access to care for Medi-Cal enrollees with substance use disorders. The program’s goal is to demonstrate that organized care for substance use disorders improves beneficiary health outcomes while decreasing system-wide health care costs. Counties that choose to participate in the DMC-ODS are required to provide access to a full continuum of benefits modeled after the American Society of Addiction Medicine criteria, in addition to other requirements.

The department notes that 40 counties from the first four implementation phases submitted implementation plans prior to the Sept. 1 deadline; of those, 26 have been approved.

Profile

Amber Ott
Vice President, Strategic Financing Initiatives

Amber Ott represents members’ financial interests related to Medicare, Medi-Cal, commercial payers and other government entities. She is responsible for providing advocacy and support on financial and reimbursement issues affecting California hospitals and health systems, and represents CHA with state agencies and other stakeholders where hospital finance and technical knowledge is needed. 

Amber is also involved with the development and implementation of the hospital fee and other financing programs.

1215 K Street, Suite 800
Sacramento, CA 95814
(916) 443-7401
(916) 552-7669 Direct
Overview

Workforce

California hospitals are concerned about the need for an adequate supply of highly skilled health professionals to meet the demands for health care services now and in the future. Numerous studies have validated the need to address critical health professional shortages in nursing and the allied health occupations. However, efforts to implement recommended strategies have been hindered by a lack of a coordinated statewide effort involving health employers and other necessary partners.

In response to the need for focus on this issue and the need for statewide solutions, CHA established the CHA Workforce Committee in 2007. Members of the committee include a broad cross-section of California’s hospitals, both urban and rural, and also represent the state’s various geographic regions. The committee has been focused primarily on allied health professional shortages, but in 2013 broadened its mission to include supporting various statewide nursing and physician shortage initiatives. The committee recognizes that current challenges in the area of health workforce will be exacerbated by an aging population and implementation of the Affordable Care Act, and is dedicated to working as a group and with other stakeholders to develop and implement solutions that will address the numerous barriers that constrict the supply of health care professionals in California.

CHA News Article

CMS Seeks Comments on Clinical Laboratory Personnel Requirements
Agency also addresses testing standards and industry fee structures

The Centers for Medicare & Medicaid Services (CMS) has issued the attached request for information on updating personnel requirements, testing standards and industry fee structures under the clinical laboratory improvement amendments. Among the personnel requirements listed, CMS seeks comment on whether it should codify in regulations the current guidance that a bachelor’s degree in nursing is considered equivalent to a bachelor’s degree in biological sciences for the purposes of educational requirements for moderate and high-complexity testing personnel under the clinical laboratory improvement amendments.

CMS notes that these regulations have not been meaningfully updated since 1992. The topics listed in the request for information are areas that the Centers for Disease Control and Prevention, state agency surveyors and other stakeholders have identified as needing to be updated to better reflect current knowledge and advancements in laboratory testing. CMS intends to consider public responses to the request for information when it drafts proposals to update the existing regulations. Comments are due March 12.

CHA News Article

State Proposes to Cut Funding for Residencies

CHA learned late yesterday that the 2018-19 budget released by Gov. Brown contains an additional issue of great concern to many hospitals — a $40 million decrease in the University of California’s core budget. Under Proposition 56 — the Healthcare, Research and Prevention Tobacco Tax Act of 2016 — the University of California system was allocated $40 million specifically to fund graduate medical education; this reduction erases the additional funding.

Proposition 56 increased taxes on tobacco products, directing $40 million of new revenue annually to the University of California system to develop and implement a program to increase the number of primary care and emergency physicians trained in the state. All accredited residency programs in California that meet the guidelines set forth in Proposition 56 are eligible to receive funding. However, in last year’s state budget, this source of funding for graduate medical education was characterized as revenue for the University of California. As a result, the state budget reduced the University of California’s budget by the same amount. This year’s budget once again cuts the University of California budget by $40 million, compromising Proposition 56’s intent and provisions that the system serve as the public entity responsible for administering this new program. To achieve the public benefit intended by Proposition 56, it is critical that funding for the University of California be restored in this year’s budget. CHA is strongly opposed to this budget action and will work vigorously to oppose the reduction.

CHA News Article

New Law Increases Fines for Retaliation Against Whistleblowers

The California Department of Public Health has released All Facilities Letter 17-28 notifying health facilities that a new law increases the maximum penalty to $75,000 for health facilities that are found to have discriminated or retaliated against patients, employees, medical staff or other health care workers for presenting a complaint against the facility or cooperating in an investigation of a facility. The law became effective Jan. 1. Questions should be directed to hospitals’ local Licensing and Certification district offices.

CHA News Article

UCSF Releases Forecasts of the Registered Nurse Workforce in California

A report developed by the University of California, San Francisco and released earlier this year finds that supply and demand for registered nurses will be well balanced over the next 10 years, if current enrollment and state-to-state migration patterns remain stable. The forecasts of RN supply consider the aging of the RN workforce, new graduates (including those from out-of-state and international nursing programs), interstate flows of RNs and changes in license status. 

Using data from the 2016 California Board of Registered Nursing Survey of Registered Nurses, license records, and other state and national data sources, the forecasts project high and low supply scenarios. The demand forecasts are based on national numbers of RNs per 100,000 population. An alternate forecast of demand was developed that estimates future hospital utilization in California and current data on RN employment in hospitals. The report compares the forecasts with other published forecasts, including those from the U.S. Bureau of Health Workforce and California Employment Development Department. Together, the demand estimates provide a range of possible scenarios for the future.

CHA News Article

Map Shows Primary Care and Specialist Physicians by County

The California Health Care Foundation has developed interactive maps displaying the number of primary care physicians and specialists practicing at least 20 hours per week in counties across California. Based on licensure data from the Medical Board of California as well population information from the U.S. Census Bureau, the maps indicate that San Benito County had the fewest primary care physicians per 100,000 population in 2015, while Napa County had the most. San Francisco and Napa counties recorded the highest concentration of specialists, while Sierra County had none. 

Commands