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

New Law Requires Providers to Report Parkinson’s Cases Beginning July 1

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.

CHA News Article

Two CHA-Sponsored Bills Pass Assembly Health Committee
Bills on alternate destination, CDPH application processing move forward

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.

CHA News Article

Proposal Would Raise Hospital Licensing Fees 5 Percent for 2018-19
Los Angeles County hospitals subject to supplemental facility fee

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. 

CHA News Article

Providers Should Be Aware of Leuconostoc Bacteremia Associated With Total Parenteral Nutrition
Contact California Department of Public Health if cases are identified

The California Department of Public Health has alerted providers that two cases of Leuconostoc bacteremia, associated with total parenteral nutrition, are being investigated in children in Illinois. California health care providers that identify a case of Leuconostoc bacteremia associated with total parenteral nutrition should contact the department’s Healthcare-Associated Infection Program at HAI@cdph.ca.gov. Basic information to report includes pharmacy/total parenteral nutrition supplier, lot numbers, dates of use, places of purchase, dates of purchase and home health agency, if applicable.

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.

Overview

Community Benefit Programs
Hospitals give back to their communities

For more than 20 years, California’s not-for-profit hospitals have led the nation in ensuring that vulnerable populations have access to much needed health care services and health improvement programs. In 1994, not-for-profit hospitals’ missions were affirmed by a state law that constructed the framework for conducting a community health needs assessment and developing a community benefit plan. This framework served as a national model for similar provisions in the Affordable Care Act, enacted in 2010. Today, not-for-profit hospitals continue their tradition of commitment by investing an estimated $12 billion annually in their communities.

California’s not-for-profit hospitals are committed to improving the health and well-being of the communities they serve. This valuable work is inherent in not-for-profit hospitals’ mission and symbolizes a commitment to helping create healthy communities outside of the hospital walls — especially in high-need and vulnerable communities. Not-for-profit hospitals invest all resources in health care services or into their communities.

Tax-Exempt Status of Not-for-Profit Hospitals

The tax-exempt status of not-for-profit hospitals is continuously being reviewed by policymakers, regulators and public interest groups. Over the years, various proposals have been introduced that would impose burdensome and inflexible standards on not-for-profit hospitals. CHA supports the development of appropriate guidelines that are not unduly burdensome and that allow sufficient flexibility to ensure not-for-profit hospitals are able to carry out their mission. Guidelines must be based on broad measures of community benefit without establishing rigid formulaic thresholds.

CHA News Article

Senate Finance Committee Questions IRS on Hospital Not-for-Profit Status

Senate Finance Committee Chairman Orrin Hatch (R-UT) and committee member Chuck Grassley (R-IA) sent a letter to the acting Internal Revenue Services (IRS) Commissioner asking the agency about its oversight of not-for-profit hospitals.

In the letter, the senators question how the IRS reviews charitable giving information submitted by hospitals. The senators also inquire about the IRS’ guidance to hospitals related to the obligation to provide community benefits as a part of a hospital’s tax-exempt status. 

CHA News Article

Applications Available for National Award Recognizing Hospital Community Service

Applications are now open for the American Hospital Association’s Foster G. McGaw Prize, which honors health care organizations that have demonstrated exceptional commitment to community service. Applicants should showcase strong leadership within their community, a commitment to service and care, partnerships that help meet community needs, a breadth and depth of community service initiatives, and a high level of community involvement. The winner will receive a $100,000 prize, and the top three finalists will receive $10,000 each. For more information, visit www.aha.org/foster.

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.

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

CDPH Requests Notice of Specific Bacteria Clusters
Follows outbreak of Serratia marcescens bacteremia in Colorado

The California Department of Public Health has asked health care staff to report suspected Serratia marcescens bacteremia. Four cases are currently under investigation in patients at acute care hospitals in Colorado and suspected cases of this bacteria should be reported.

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

Seismic Safety Regulatory Updates Proposed for Building Code

The Hospital Building Safety Board Subcommittee on Structural and Non-Structural Regulations met on Jan. 31 to discuss proposed changes to the 2019 California Building Code, effective Jan. 1, 2020. The Office of Statewide Health Planning and Development (OSHPD) presented proposed revisions to the Non-Structural Performance Category (NPC) requirements effective in 2030, which would essentially adjust the NPC-4 requirements for 2030 to NPC-3. OSHPD also proposed revisiting the specific requirements for NPC-3. The CHA/OSHPD work group will meet Feb. 13 to review the changes. 

The subcommittee will meet again on Feb. 22 and March 6 before submitting the proposal to the board for adoption.

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.

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

One Week Left to Submit Presentations for Disaster Planning Conference

Hospital and health system representatives are invited to submit presentations and best practices posters for CHA’s 2018 Disaster Planning for California Hospitals conference, taking place Sept. 24–26 in Sacramento. The conference is a unique opportunity for members to share their emergency preparedness knowledge, innovative programs, tools and lessons learned with other member hospitals. Suggested topics include:

  • Lessons learned from the 2017 California wildfires
  • Patient movement
  • Business continuity/recovery planning
  • Disaster planning for small/rural hospitals
  • Radiological/nuclear contamination planning and response
  • Centers for Medicare & Medicaid Services emergency preparedness requirements — lessons learned from hospital surveys
  • Hurricane response (Harvey, Irma, Maria, etc.)
  • Health care lessons learned in response to mass shootings (e.g., Las Vegas)
  • Situation reporting and information sharing in a disaster
  • Patient reunification and repatriation
  • Lessons learned from supply and pharmaceutical shortages
  • Financial and operational lessons learned post-disaster
  • Critical incident stress management and staff recovery
CHA News Article

Preparedness Initiative to Be Launched on Anniversary of 1906 Earthquake

On April 18 — the anniversary of the Great San Francisco earthquake and fire of 1906 — the U.S. Geological Society will hold a press conference to announce its HayWired regional and statewide earthquake preparedness initiative. The hypothetical scenario seeks to determine what would happen if a magnitude 7.0 earthquake occurred on the Hayward fault under Oakland, CaliforniaBy bringing together experts from many disciplines, organizers hope to discover plausible hazards and impacts, such as ground shaking, fault rupture, landslides, liquefaction, damages to the built environment – including damage to water supply and the spread of fires – loss of community and economic impacts.

This hypothetical scenario will also explore information that will be needed and decisions that must be made before and after an earthquake. Overarching themes include improving the communication of earthquake hazard science and engineering for use in decision-making, helping to understand and inform actions to reduce earthquake risks and helping to build community capacity to respond to and recover from earthquakes.

CHA News Article

CHA Solicits Presentations for Disaster Planning Conference
Submission deadline is April 30

Hospital and health system representatives are invited to submit presentation and best practices poster applications for CHA’s 2018 Disaster Planning for California Hospitals Conference, taking place Sept. 24–26 in Sacramento. The conference is a unique opportunity for members to share their emergency preparedness knowledge, innovative programs, tools and lessons learned with other member hospitals. More than 700 hospital emergency preparedness coordinators, hospital administrators, chief nursing officers, emergency medical services personnel and public health officials are expected to attend. The conference committee will review presentation submissions consider them for pre-conference workshop, plenary and breakout sessions. The submission deadline is April 30. For more information and to submit an application, visit www.calhospital.org/disaster-planning.

CHA News Article

New Guidance Addresses Continuity of Operations After Emergency Disruption

The Federal Emergency Management Agency has released an updated Continuity Guidance Circular focused on efforts to ensure continuity of operations and government during an emergency that disrupts normal operations. The guidance describes federal and non-federal continuity efforts; outlines community roles, responsibilities and coordinating structures; and describes the process for building and maintaining capabilities to ensure the performance of essential functions and delivery of critical services.

Organizations are encouraged to refer to the guidance when creating or revising continuity plans, programs and processes. The Continuity Resource Toolkit contains additional tools, templates and resources.

CHA News Article

Webinar on Emergency Preparedness Final Rule to Be Held April 24

The Centers for Medicare & Medicaid Services (CMS) and the International Association of Emergency Managers will host a webinar April 24 from 10-11 a.m. (PT) on the emergency preparedness final rule, which required hospital compliance by Nov. 15, 2017. During the webinar, a representative from CMS’ Quality, Safety & Oversight Group will provide an overview of the final rule, as well as discuss key areas where CMS is seeing an increased number of deficiencies related to the rule. The program will also allow time for a question-and-answer session; questions should be submitted to iaem.health@gmail.com by April 16. Registration is available online.

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

HQI Accepting Applications for 2018 C. Duane Dauner Quality Award

Applications are now being accepted for the Hospital Quality Institute’s (HQI) 2018 C. Duane Dauner Quality Award, which recognizes outstanding achievement in patient safety, quality improvement and patient experience. The award was established in 2016 to further the vision that California hospitals will lead the nation in patient safety and quality performance.

All member hospitals are invited to apply. Strong submissions will demonstrate successful implementation of strategies that have improved performance while also addressing sustainability and spread. Applications are due June 20; awardees will be notified at the end of August. The award winner and finalists will receive statewide recognition at the 2018 HQI Annual Conference, Oct. 28-30 in Huntington Beach.

Details about the award and application process — including last year’s winner and finalist applications — are available on the HQI website. For additional information, call HQI at (916) 552-7600 or email info@hqinstitute.org.

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.

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 For Members

CHA Leads Opposition to Rate-Setting Legislation in First Policy Committee

Yesterday, CHA President & CEO Carmela Coyle was the lead witness in opposition to AB 3087 (Kalra, D–San Jose), legislation that would devastate hospitals’ financial viability, during the bill’s first hearing in the Assembly Health Committee. Along with the California Medical Association, the California Chamber of Commerce and hundreds of other organizations that oppose the bill, CHA spoke out strongly against its harmful implications. AB 3087 would establish a new state commission to set payment rates for hospitals, doctors, dentists and others based on a multiplier of what Medicare pays, without understanding the underlying drivers of health care costs.

During the course of a three-hour debate, assemblymembers on the committee were openly critical and raised significant concerns about the bill. Ultimately, it passed out of the committee along party lines as a courtesy to continue the broader conversation around health care costs. The coalition of groups opposed to the bill — including CHA — released a press release after the committee meeting.

CHA News Article

Registration Open for Hospital Finance and Reimbursement Seminar

Registration is now open for CHA’s annual Hospital Finance and Reimbursement Seminar, to be held June 13 in Sacramento, June 20 in Costa Mesa and June 21 in Glendale. This year’s seminar will provide a clear understanding of state and federal legislative and regulatory changes impacting hospitals’ financial futures.

Topics include:

  • Important court cases with implications for Medi-Cal reimbursement
  • What lies ahead with Medicare Payment Advisory Commission recommendations
  • Tax reform impact on bonds, corporate debt and more
  • Navigating reporting for the Internal Revenue Service Form 990 Schedule H and S-10 Worksheet
  • State budget proposal for 340B Drug Discount Program

For more information and to register, visit www.calhospital.org/hospital-finance-and-reimbursement-seminar.

CHA News Article For Members

CHA Works to Defeat Rate-Setting Legislation

CHA has launched an all-out legislative and public advocacy campaign to ensure state lawmakers understand the harmful impacts that would result from a proposed rate-setting bill to be heard tomorrow in the Assembly Health Committee. Assembly Bill 3087 (Kalra, D-San Jose) would establish a new state commission to set payment rates for hospitals, doctors, dentists and others based on a multiplier of what Medicare pays. The bill would simply cap payment rates for services covered by commercial health insurance, but it would not address the chronic payment shortfalls that plague the Medicare and Medi-Cal programs.

CHA President & CEO Carmela Coyle will testify on behalf of hospitals at tomorrow’s legislative hearing. Additionally, Coyle and other CHA staff have conducted numerous media interviews about the devastating impact the bill would have on California’s health care delivery system. On Sunday, KNBC Channel 4 in Los Angeles aired a television interview with Coyle, who underscored the problems associated with AB 3087.

Today, the Sacramento Bee published an opinion editorial authored by Coyle that forcefully explains the difference between AB 3087 and the rate-setting process in Maryland.

CHA News Article

Remittance Advice Details, Medi-Cal Financial Summaries Now Available Online

Providers can now use their secure Medi-Cal login to view and download PDF versions of remittance advice details (RADs) and Medi-Cal financial summaries on www.medi-cal.ca.gov. RADs, along with their embedded financial summary information, are available online sooner than in paper versions. The site offers up to six calendar weeks of current RADs  for immediate download. Currently, historical RADs in PDF, dating back to April 2017, are available on the Medi-Cal website; a larger database will be built over time. When complete, three years of historical RADs will be available within one business day of a request.

Providers may submit printed versions of the online RADs as supporting documentation with claims inquiry and appeal forms. More information is available in the attached flyer. 

Education event

Hospital Finance and Reimbursement Seminar
Medi-Cal and Medicare updates, tax reform, S-10 vs. Form 990 reporting, 340B drug discount program

June 13, Sacramento
June 20, Costa Mesa
June 21, Glendale

Trying to gain a clear understanding of state and federal legislative and regulatory changes impacting your hospital’s financial future, is like trying to hit a moving target. Right when you think you understand, it changes.

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

New Data Compare States’ Funding for Public Health

State Health Compare, an online tool that explores state-level data on a wide range of topics related to health care, has released its latest estimates of public health funding by state. Using data collected by Trust for America’s Health, a new issue brief reports a wide variation in public health funding among states, with 2015 funding ranging from $4 per capita in Nevada to $221 per capita in West Virginia. According to State Health Compare, per capita public health funding in California is $56.

The brief cautions, however, that comparisons of public health funding are complicated because each state allocates and reports its budget in different ways. In addition, according to the report, each state’s tax base as it relates to its population must also be considered. For example, Hawaii had the second highest FY 2015 per capita state public health funding, collected $6.54 billion in taxes and had a population of about 1.4 million. Nevada reported the lowest per capita state public health funding in FY 2015, but also collected less tax revenue than Hawaii and had a population more than twice as large as Hawaii’s.

More information on this and other indicator categories — including health insurance coverage, cost of care, access to and utilization of care, care quality, health behaviors, health outcomes and social determinants of health —is available at http://statehealthcompare.shadac.org.

Education event

Hospital Finance and Reimbursement Seminar
Medi-Cal and Medicare updates, tax reform, S-10 vs. Form 990 reporting, 340B drug discount program

June 13, Sacramento
June 20, Costa Mesa
June 21, Glendale

Trying to gain a clear understanding of state and federal legislative and regulatory changes impacting your hospital’s financial future, is like trying to hit a moving target. Right when you think you understand, it changes.

CHA News Article

Quarterly Cal MediConnect Performance Dashboard Available

The Department of Health Care Services has released its quarterly update of the Cal MediConnect performance dashboard. The program, which seeks to better coordinate care for patients who are eligible for both Medicare and Medicaid services, is operated in partnership with the Centers for Medicare & Medicaid Services and health plans. Cal MediConnect health plans combine and coordinate Medicare and Medi-Cal benefits for eligible members, including medical, behavioral health, long-term institutional and home- and community-based services. Seven counties participate in the program: Los Angeles, Orange, San Diego, San Mateo, Riverside, San Bernardino and Santa Clara.

The dashboard highlights performance trends for program monitoring, quality improvement and data transparency, and shows information and data measures on the program’s key aspects, including enrollment and demographics, care coordination, grievances and appeals, behavioral health services and long-term services and supports.

CHA News Article

DHCS Modifies Access to Hospital Presumptive Eligibility Computer-Based Training, Application Portal

Yesterday, the California Department of Health Care Services (DHCS) announced that it has made changes to providers’ ability to access the Hospital Presumptive Eligibility (HPE) Provider/Employee Computer Based Training (CBT) and HPE Application Portal through the Medi-Cal Learning Portal. Only HPE providers who have registered properly as either a “healthcare provider” or provider staff” and submitted a valid National Provider Identifier will continue to have access to the HPE Provider/Employee CBT and the HPE Application Portal. However, HPE providers/employees who have registered but did not submit the required information must register properly and take the HPE Provider/Employee CBT. Failure to do so will result in HPE providers/employees no longer having access to the HPE Application Portal, and not being able to use it to make HPE determinations.

HPE providers who are unsure of the user type associated with their account or who need to change their user type must contact DHCS. A DHCS staff member will verify whether information is correct and, if necessary, submit a request to update the user profile. User profiles should be updated automatically within 48 hours. Once a profile is updated, the HPE provider/employee must successfully complete the HPE Provider/Employee CBT to be granted access to the HPE Application Portal.

For more information, visit the DHCS website.

CHA News Article

Discount Deadline Near for California Congressional Action Program
Plan now to join peers and health leaders in Washington, DC

CHA encourages member hospital executives to register before April 4 to take advantage of discounted hotel room and registration fees for the annual California Congressional Action Program.

The federal advocacy program is an opportunity to advocate on behalf of California hospitals with federal lawmakers and to help shape the future of health care. Scheduled for May 6-9 in Washington, DC, the program will be held in conjunction with the American Hospital Association’s Annual Membership Meeting.

For more information and to register, visit www.calhospital.org/CCAP. To facilitate the scheduling of appointments, please register by April 4. Separate registration is required for the AHA meeting; for more information, visit www.aha.org.  

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

CMS to Update 2019 Electronic Clinical Quality Measure Reporting, Performance

The Centers for Medicare & Medicaid Services (CMS) has issued its pre-publication of the annual update to electronic clinical quality measures. The document describes changes in the standards and terminology in updated measures for potential use in CMS quality reporting programs for the 2019 reporting and performance period.

The pre-release is designed to help health information technology and electronic health record developers, eligible professionals, clinicians and hospitals prepare for 2019 reporting. The annual update is expected to be available in spring 2018.

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. 20 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.

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

CHA Develops Tools to Help Hospitals Activate Emergency Operations Plans

To help hospitals ensure they are ready in the event of an emergency, CHA’s Hospital Preparedness Program has developed a checklist to help hospitals activate their emergency operations plans.

CHA News Article

New Law Increases Fines for Retaliation Against Whistleblowers
Does not apply to long-term health care facilities

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.

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.

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

Court Grants CHA’s Request to Publish Opinion
Decision addresses peer review issues

The California Court of Appeal for the fourth appellate district yesterday granted CHA’s request to publish its opinion in Powell v. Bear Valley Community Hospital. The Court of Appeal affirmed a trial court’s decision that the hospital was not required to give Dr. Powell a hearing prior to the expiration of his provisional privileges or to extend those privileges until a hearing could be held, because the physician refused to submit requested documentation. The court also clarified two other important issues in the peer review process: what it means for a hospital’s governing board to give “great weight” to the recommendation of the Medical Executive Committee, and when and how the board may exercise its independent judgment in making a final peer review decision.

The appellate court decision, attached, was unpublished when released, but CHA (among others) filed a letter requesting that the court publish it because it addressed and clarified these recurring issues in peer review. The appellate court agreed to publish the decision; attorneys in future cases may now rely on it.

CHA News Article

2018 California Hospital Compliance Manual Now Available

CHA has released the ninth edition of the Hospital Compliance Manual, written specifically to help California’s hospital compliance officers, chief financial officers, legal counsel and risk managers stay abreast of pertinent state and federal laws. The manual focuses on high-risk compliance issues and addresses the key components of an effective compliance plan.

Written by lead author Lloyd Bookman, Esq., CHA’s Lois Richardson, Esq., and a team of legal experts from Hooper, Lundy & Bookman, PC, the 2018 manual encompasses more than 700 pages and has been updated to reflect:

  • The federal Tax Cuts and Jobs Act of 2017, which imposes an excise tax on certain executive compensation and changes the computation of unrelated business taxable income
  • The California Department of Public Health’s new Centralized Applications Unit and how to know when something has to go to this new unit
  • The Office of Inspector General’s revised Stark Self-Referral Disclosure Protocol, new mandatory forms, required financial analysis and reports, and more
Education event

Consent Law Seminar
Discrimination, patients with mental health issues, privacy updates and hot spots, new laws and more

Location:                
April 24, Fresno
May 9, San Diego
May 10, Ontario
May 15, Costa Mesa
May 30, Sacramento
May 31, San Ramon
June 5, Pasadena        

Consent for treatment decisions often must be made quickly and may carry significant ramifications for patients, their families and your hospital. Ever-changing regulations further complicate matters.

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

No Private Lawsuit Allowed Under Involuntary Mental Health Evaluation Laws

Last week the California Court of Appeals ruled in Julian v. Mission Community Hospital, finding that California’s involuntary mental health evaluation and treatment laws do not confer a private cause of action. This means that a patient cannot sue a hospital or physician for involuntarily detaining, evaluating or treating him or her. The court held that only administrative agencies — such as the California Department of Public Health or the Medical Board of California — can enforce these laws against a hospital or physicians. The court also held that the hospital and physicians were not state actors under civil rights laws and, therefore, could not be liable for violating the plaintiff’s rights under the federal and California constitutions. 

The case was certified for publication, which means that it may be cited as precedent in future lawsuits. It is unknown at this time whether the plaintiff will ask the California Supreme Court to review the case. The court’s decision is attached.

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.

Education event

Consent Law Seminar
Discrimination, patients with mental health issues, privacy updates and hot spots, new laws and more

Location:                
April 24, Fresno
May 9, San Diego
May 10, Ontario
May 15, Costa Mesa
May 30, Sacramento
May 31, San Ramon
June 5, Pasadena        

Consent for treatment decisions often must be made quickly and may carry significant ramifications for patients, their families and your hospital. Ever-changing regulations further complicate matters.

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

2018 Consent Manual
The 2018 Consent Manual to Ship Late-April

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

Promoting Healthy Communities
Hospitals Address Social Determinants of Health

CHA has compiled examples of programs and activities that California member hospitals have developed and support to address social determinants of health in their local communities. There is increasing awareness that social determinants of health – the conditions in the places where people live, learn, work and play – affect a wide range of health risks and outcomes. The examples are intended as a resource for both CHA member hospitals and the public to learn about effective programs in their community.

To participate, members may submit their hospital’s program or initiative to CHA.

General Information

Economic Stability

Recognizing the connection between people’s finances (income, cost of living and socioeconomic status) and their health, California’s hospitals have developed innovative community-based programs and activities that address key issues such as poverty, food insecurity, housing instability and homelessness, vocational training, and employment and income.

 

POVERTY

General Information

Education

Recognizing the connection between education and health and well-being, California’s hospitals have developed innovative community-based programs and activities that support early childhood education and development, language and literacy, high school graduation and enrollment in higher education.

 

 

EARLY CHILDHOOD EDUCATION & DEVELOPMENT/LANGUAGE & LITERACY

General Information

Health and Health Care

Recognizing the connection between people’s access to and understanding of health services and their own health, California’s hospitals have developed innovative community-based programs that promote access to maternal, child and teen health services; primary and specialty health care services; mental health and substance use disorder treatment; oral health services; tobacco cessation programs; health literacy and education; and care transition programs.

MATERNAL, CHILD AND TEEN HEALTH 

General Information

Neighborhood and Built Environment

Recognizing the connection between people’s health and well-being, and where they live — including their housing, neighborhood and environment — California’s hospitals have developed innovative community-based programs that promote access to healthy foods for healthy eating patterns; transportation access and mobility; injury prevention and safety; and parks, playgrounds and walkability.

ACCESS TO HEALTHY FOODS FOR HEALTHY EATING PATTERNS

General Information

Social and Community Context

Recognizing the connection between people’s health and well-being and the contexts within which they live, learn, work and play, California’s hospitals have developed innovative programs and activities that promote community cohesion, support systems and civic participation — and others that address abuse, trauma and/or violence, grieving, human trafficking and incarceration.

SOCIAL COHESION

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

CDPH Examines Outbreak of Burkholderia cepacia Infections
Associated with use of Medline Remedy Essentials No-Rinse Foam

The California Department of Public Health (CDPH) continues to investigate an outbreak of Burkholderia cepacia infections, previously reported in CHA News. According to CDPH, infections are linked to Medline Remedy® Essentials No-Rinse Foam, a product used for skin and perineal care. Medline has issued a voluntary recall of lots beginning with batch numbers M05703, M06691 and M07247. Health care facilities should follow the instructions for the recalled lots and consider avoiding other lots of the product while the investigation is being conducted. Facilities that use Medline Remedy® Essentials No-Rinse Foam and have at least one case of Burkholderia cepacia since Feb. 1, or that identify two or more cases of Burkholderia cepacia in non-cystic fibrosis patients since Feb. 1, should notify their local public health department and the CDPH Healthcare-Associated Infections Program at HAIprogram@cdph.ca.gov. More information is available in the attached update from CDPH.

CHA News Article

HQI to Host Virtual ‘Think Tank’ on Patient, Family Engagement April 24

As part of its programming for Health Services Advisory Group’s Hospital Improvement Innovation Network, the Hospital Quality Institute (HQI) invites member hospitals to attend a Patient and Family Engagement (PFE) Think Tank on April 24 from noon – 1 p.m. (PT). The networking and learning event will discuss how hospitals have partnered with patients and families to help improve quality and patient safety. Leaders and champions of patient and family engagement are invited to attend, share and learn. 

PFE Think Tanks are monthly virtual meetings designed to help move the bar on patient and family engagement as a strategy for improving quality and patient safety. Each session features peer-to-peer learning and expert coaching relevant to the Centers for Medicare & Medicaid Services’ PFE metrics. There is no cost to attend, and the events are open to all hospitals participating in the Hospital Improvement Innovation Network. Registration is available online.

Questions about the PFE Think Tank should be directed to Boris Kalanj, HQI director of cultural care and patient experience, at bkalanj@hqinstitute.org or (916) 552-7694.

CHA News Article

FDA Advises Providers Not to Use Certain Multi-Patient Endoscope Connectors

The Food and Drug Administration has announced that providers should not use multi-patient endoscope connectors that do not require reprocessing between patients, as testing has not demonstrated that they can be used without a risk of cross-contamination. Instead, providers should use single-use or reusable connectors with backflow prevention features, and should reprocess reusable connectors according to instructions before each procedure. Providers should report adverse events or side effects related to 24-hour multi-patient use connectors, currently made only by Erbe USA Inc., to the MedWatch program.

CHA News Article

HQI Releases Video on Providing the Best Care to Californians
Highlights one patient’s journey to illustrate joy, meaning in providing care

The Hospital Quality Institute (HQI) has released a video (trailer below) of a stage production demonstrating the power of the caring, interdependent connections that define health care. Featuring a real patient and his family, the production walks viewers through the facets of health care and the numerous ways in which one life can be touched by the actions of others.

CHA News Article

Drug Enforcement Administration Addresses IV Opioid Shortage

Responding to hospitals’ requests for action on the intravenous opioid shortage, the Drug Enforcement Administration has granted additional quota for raw materials to certain manufacturers so that they can produce needed medications.

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

Registration Open for Hospital Finance and Reimbursement Seminar

Registration is now open for CHA’s annual Hospital Finance and Reimbursement Seminar, to be held June 13 in Sacramento, June 20 in Costa Mesa and June 21 in Glendale. This year’s seminar will provide a clear understanding of state and federal legislative and regulatory changes impacting hospitals’ financial futures.

Topics include:

  • Important court cases with implications for Medi-Cal reimbursement
  • What lies ahead with Medicare Payment Advisory Commission recommendations
  • Tax reform impact on bonds, corporate debt and more
  • Navigating reporting for the Internal Revenue Service Form 990 Schedule H and S-10 Worksheet
  • State budget proposal for 340B Drug Discount Program

For more information and to register, visit www.calhospital.org/hospital-finance-and-reimbursement-seminar.

CHA News Article

CMS Issues FFY 2019 Inpatient Prospective Payment System Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rule updating the inpatient prospective payment system for federal fiscal year 2019. CMS proposes a market basket update of 2.8 percent, reduced by a negative 0.8 percent productivity adjustment. The update also reflects a 0.5 percent adjustment required by the Medicare Access and CHIP Reauthorization Act and a negative 0.75 percent adjustment required by the Affordable Care Act. Overall, CMS estimates the payment and policy updates proposed — including updates to operating, uncompensated care, capital and low-volume payments — will increase payments to hospitals by approximately 3.4 percent, or $4 billion, for federal fiscal year 2019 compared to 2018.

CHA is currently reviewing the proposed rule, which includes additional provisions related to the continued implementation of Medicare S-10 Worksheet data for distributing Medicare disproportionate share hospital payments, changes to the Medicare and Medicaid Electronic Health Record Incentive Program and the removal and de-duplication of a number of quality measures across programs. Additional information will be provided in CHA News tomorrow, and a detailed summary will follow in the coming weeks. A CMS fact sheet is attached.

Education event

Hospital Finance and Reimbursement Seminar
Medi-Cal and Medicare updates, tax reform, S-10 vs. Form 990 reporting, 340B drug discount program

June 13, Sacramento
June 20, Costa Mesa
June 21, Glendale

Trying to gain a clear understanding of state and federal legislative and regulatory changes impacting your hospital’s financial future, is like trying to hit a moving target. Right when you think you understand, it changes.

CHA News Article

CMS Provides Update on Outpatient Therapy Caps

The Centers for Medicare & Medicaid Services (CMS) has issued the attached MLN Connects Special Edition on legislative provisions that were recently extended in the Bipartisan Budget Act of 2018, including provisions related to Medicare payment for outpatient (Part B) physical therapy, occupational therapy and speech language pathology services. 

The law repeals application of the Medicare outpatient therapy caps, but retains the caps as a threshold above which claims must include the “KX” modifier as a confirmation that services are medically necessary. Additionally, the law retains the targeted medical review process, but at a lower threshold of $3,000. CMS will begin releasing claims that were held briefly after the expiration of the therapy caps exception process. 

CHA News Article

DHCS to Reverse Disproportionate Share Hospital Reductions

On Feb. 9, the House of Representatives passed a bill delaying the Medicaid disproportionate share hospital (DSH) payment reduction until Oct. 1, 2020. Previously, the Department of Health Care Services (DHCS) had implemented the DSH reductions on Oct. 1, 2017, to comply with current law.

As a result of the delay, DHCS will now reverse the reductions that have taken place since Oct. 1, 2017, and has updated the program payments to add the previous reductions into the next payment, according to hospital group, as follows:

  • Private hospitals will see the increase in their December-January DSH replacement payment, scheduled for March 1.
  • Non-designated public hospitals will see the increase during the February-March 2018 DSH payment, scheduled for April 26.
  • University of California hospitals will see the increase in the round 3 DSH payments, scheduled for April 5 for certified public expenditures, and April 19 for intergovernmental transfers.
  • Global Payment Program hospitals will see the increase in their prior year 3, quarter 3 payments, scheduled for April 15.
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

CHA Co-Hosts Workforce Excellence Symposium

On April 12, the California Department of Industrial Relations and the Department of Apprenticeship Standards, in partnership with CHA, convened a Workforce Excellence Symposium in Sacramento. The event brought together health workforce leaders – as well as representatives from state agencies and education and labor organizations — to develop strategies for creating pathways to recruit, train and sustain a skilled, talented and diverse workforce. Hospitals in attendance provided crucial feedback on occupational needs and potential opportunities for creating recognized apprenticeship models in California. This effort will continue through 2020 with the goal of reducing barriers to creating health care apprenticeship training models. For more information, visit www.dca.ca.gov/consumers/earn_and_learn.shtml.

CHA News Article

California to Face Critical Shortage of Behavioral Health Workers

A research report released Feb. 12 by the University of California, San Francisco’s Healthforce Center forecasts dire shortages of behavioral health professionals in California by 2028. The report warns that current 10-year projections show a significantly inadequate supply of behavioral health professionals and an imbalance in the geographic and racial distribution of these workers.

California’s aging behavioral health workforce is a primary cause of the impending shortages. While all behavioral health occupations will face major deficiencies, shortages of psychiatrists and psychologists are of critical concern, as one in four will reach retirement age over the next decade.

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.

Commands