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

CDPH Webinar Will Explain Reporting Data to California Parkinson’s Disease Registry

On Nov. 16 at noon, the California Department of Public Health (CDPH) will host a webinar that addresses reporting data to the California Parkinson’s Disease Registry. In addition to providing an overview of the registry, the webinar will teach attendees to submit data manually via secure web portal and through an automated electronic interface. Registration is available online. More information about the registry and related guidance is available on the CHA website.

CHA News Article

CDPH Releases Health Care-Associated Infection Report

The California Department of Public Health (CDPH) released the 2017 health care-associated infection (HAI) report this week. On average, California hospitals perform better than the national baseline on all four infections tracked — surgical site infections (SSI), central line-associated bloodstream infections (CLABSI), methicillin-resistant staphylococcus aureus bloodstream infections (MRSA BSI) and Clostridium difficile diarrheal infections (CDI). From 2016 to 2017, California hospitals made the most substantial progress in HAI prevention since reporting began in 2009. In 2017, hospitals reported 2,602 fewer HAI than in 2016.

CHA News Article

Hospital Feedback Encouraged to Help Improve CDPH Survey Process

After being surveyed by the California Department of Public Health, hospitals are encouraged to complete an online evaluation to help inform the survey process. The short, 16-question survey allows hospitals to rate survey staff on a scale of “Excellent” to “Poor” across seven areas, including whether an explanation of the survey process was provided when the survey began, whether areas of concern were presented clearly and concisely, and whether the survey was conducted in a professional manner. The evaluation also includes space for open-ended comments. Questions about the evaluation should be directed to hospitals’ local district offices.

CHA News Article

Influenza A Virus Advisory Issued
Cases confirmed in residents exposed to pig at Paso Robles fair

Yesterday, the California Department of Public Health issued the attached advisory related to two confirmed cases of influenza A. Both patients were exposed to a pig, in which the virus has also been detected, at the California Mid-State Fair in Paso Robles between July 17 and 29. Health care providers should ask patients presenting with influenza symptoms whether they attended a state or county fair within seven days of illness onset. Symptoms of influenza A are similar to those of seasonal influenza viruses and often include fever, cough, runny nose, body aches or sore throat. For more information, visit www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.

CHA News Article

CDPH Revises Parkinson’s Disease Reporting Guide

Today, the California Department of Public Health (CDPH) issued its revised Parkinson’s Disease Registry Implementation Guide (version 3.0). As previously reported in CHA News, a new state law requires health care providers diagnosing or treating Parkinson’s disease patients to report each case to CDPH as of July 1. When CDPH issued its first implementation guide in May, CHA worked with the department to clarify some of the elements. CHA successfully advocated to allow hospital medical staffs or medical groups to report as one entity, thus eliminating duplicate entities for the same information.

Although this reporting requirement began July 1, data from the first quarter of reporting is not due until March 2019. More information can be found on the CDPH website.   

Providers are reminded that — if they elected to submit case data using the manual data entry portal — they must submit the CalREDIE Authorization form. Providers who elected to report automatically do not need to take further action.

Questions should be directed to cpdrhelp@cdph.ca.gov.

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.

CHA News Article

CDPH Changes Name, Email Address of Centralized Applications Unit

The California Department of Public Health (CDPH) has reorganized its Center for Health Care Quality, Licensing & Certification Unit and Centralized Applications Unit. Now combined and renamed as the Centralized Applications Branch, the new structure consists of four distinct sections: Non-Long-Term Care, Long-Term Care, Report of Change, and Licensing-Certification and Policy. In the attached All Facilities Letter 18-44, CDPH notes that the change is intended to “provide additional resources and realign […] sections to better meet provider needs.” The new email address is CAB@cdph.ca.gov.

CHA News Article

CDPH Issues Guidance on Reducing Legionella Risk in Water Systems

The California Department of Public Health (CDPH) has issued the attached All Facilities Letter 18-39, which addresses Legionella risks in health care facility water systems. Hospitals, critical access hospitals and skilled-nursing facilities must develop and adhere to policies and procedures that inhibit microbial growth in building water systems, in order to reduce the growth and spread of Legionella and other pathogens in water. CDPH directs facilities to guidance issued by the Centers for Medicare & Medicaid Services, which clarifies expectations and notes that facilities must:

  • Conduct a facility risk assessment to identify where Legionella and other pathogens could grow and spread.
  • Develop and implement a water management program.
  • Specify testing protocols and document testing results.
  • Comply with other federal, state and local requirements.
CHA News Article

CMS Provides Updates for Post-Acute Care Quality Reporting

The Centers for Medicare & Medicaid Services (CMS) regularly provides important updates for post-acute care quality reporting programs, including training opportunities, public reporting details and reminders of data submission and review deadlines.  

Inpatient Rehabilitation Facilities 
Provider Preview Reports
Updated inpatient rehabilitation facility (IRF) provider preview reports are now available. Providers have until Oct. 8 to review their 2017 quality measure performance data prior to their posting to the IRF Compare website in December. Corrections to the underlying data will not be permitted during this time. However, providers can request CMS review if they believe the data scores displayed are inaccurate. 

Four new quality measures will be reported on IRF Compare: 

  • Assessment-based measures:
    • Application of Percent of Long-Term Care Hospital Patients With an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function (NQF #2631)
    • Application of Percent of Residents Experiencing One or More Falls with Major Injury (NQF #0674)
  • Claims-based measures: 
    • Medicare Spending Per Beneficiary
    • Discharge to Community
CHA News Article

Proposed Regulations Establish Best Practices for Stroke, STEMI Care Systems

The Emergency Medical Services Authority (EMSA) has released the attached proposed regulations that would establish standardized best practices for stroke and ST elevation myocardial infarction (STEMI) critical care systems. According to EMSA, the proposed regulations will protect public health and safety by establishing minimum requirements for the development and implementation of a STEMI or stroke critical care system plan, plan update requirements, the process for hospital designation and data collection. The regulations would also authorize EMSA to annually review and approve STEMI and stroke critical care system plans and plan updates submitted by local emergency medical services agencies.

CHA is currently reviewing the proposed regulations in anticipation of submitting comments, which are due July 25. For more information, including public comment forms, visit the EMSA website.

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.

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

OSHPD Seminar to Feature Hospital Case Studies
Will cover hospital building repurposing, 2019 building code changes

The Office of Statewide Health Planning and Development, in partnership with the Hospital Building Safety Board, will present a seminar on repurposing hospital buildings later this month. To be held Nov. 8 in Santa Ana and Nov. 14 in Santa Clara, the seminar will share strategies for transforming older structures and facilitating new uses for them, as well as explain how repurposed buildings can fit into master planning efforts.

CHA News Article

Hospital Building Reports Due to OSHPD Nov. 1
Applies to Structural Performance Category 1 buildings

Hospitals with one or more Structural Performance Category 1 (SPC 1) buildings must submit an SB 499 report to the Office of Statewide Health Planning and Development (OSHPD) on or before Nov. 1. Failure to do so will result in a fine of $10 per licensed acute care bed per day, not to exceed $1,000 per day, for each SPC 1 building, until the hospital complies with reporting requirements. More information about compliance is available on the OSHPD website. For questions or help completing the online report, contact Patrick Rodgers at (916) 440 8467 or by email at FDD-SB499@oshpd.ca.gov

CHA News Article

OSHPD to Host Seminars on Repurposing Hospital Buildings

A new seminar, to be held Nov. 8 in Santa Ana and Nov. 14 in Santa Clara, will provide an overview of construction issues specific to repurposing hospital buildings. The seminar — hosted by the Office of Statewide Health Planning and Development’s Facilities Development Division and the Hospital Building Safety Board — will feature discussion on removal of acute care services, 2019 building code changes and case studies. Attendance at the event is encouraged for those interested in the hospital construction industry. More information and a registration form are available in the attached flyer.

CHA News Article

Building Standards Commission Provides Notice of Proposed Code Changes
Comments due Oct. 29

The California Building Standards Commission has announced proposed code changes to Title 24, intended for the 2019 California Building Standards Code. The changes were developed by the Office of Statewide Health Planning and Development in collaboration with the Hospital Building Safety Board, industry representatives and other stakeholders. The changes are consistent with the draft terms reviewed during the pre-regulatory phase, detailed in the attached memo. CHA has been engaged throughout this process and is currently reviewing the proposed changes with a workgroup to determine whether it will submit comments. Comments are due Oct. 29.

CHA News Article For Members

CHA Submits Pre-Regulatory Comments on Title 22 Regulations

Today, CHA submitted comments to the California Department of Public Health (CDPH) regarding several areas of Title 22 regulations that CDPH plans to revise. CDPH issued seven All Facilities Letters (AFLs) earlier this month, requesting stakeholder input to inform its regulation development process. CHA commented on the following:

Comments are due to CDPH on Aug. 31. Questions should be submitted to CHCQRegulationsUnit@cdph.ca.gov.​

Overview

Coverage

Providing access to health coverage is essential to improving population health in California. A strategic and collaborative approach between hospitals, Covered California, the California Department of Health Care Services, counties and local communities is critical to the continued expansion of health coverage through the Covered California marketplace and the Medi-Cal program.

Over 5 million Californians have insurance as a result of the Affordable Care Act (ACA) — roughly a quarter of all Americans covered under the law. In California, 91 percent of individuals are now insured. The uninsured rate in California fell from 17 percent in 2013 to a historic low of 7.3 percent by the end of 2016. Since 2014, more than 3 million people have purchased health coverage through Covered California, and nearly 4 million have enrolled in the state’s Medi-Cal program — for a total of more than 13.5 million Californians now enrolled in Medi-Cal. Of Covered California’s 1.3 million enrolled consumers, nearly 90 percent receive some level of financial help.

Despite these coverage gains, about 3 million Californians will remain uninsured in 2017. The majority of those projected to remain uninsured in California are not eligible for Medi-Cal or Covered California due to their immigration status. Just under 25 percent of the remaining uninsured are eligible for either Medi-Cal or subsidized coverage through Covered California, while 18 percent are eligible through Covered California but would not receive subsidies.

CHA News Article

DHCS Whole Child Model Implementation Delayed for CalOptima

Implementation of the Whole Child Model for CalOptima has been delayed from Jan. 1 to July 1, 2019, according to a recent update from the Department of Health Care Services (DHCS).

CHA News Article

Covered California Provides 2019 Plan, Rate Snapshots

Following the release of its 2019 rate book, Covered California has released snapshots of plan offerings and sample rates, by county, for 2019. The snapshots are intended to help consumers better understand their enrollment options. They show premium rates for 25-year-old and 40-year-old single individuals and identify the lowest priced plan for each metal tier, as well as the second lowest priced silver plan. Consumers may also use Covered California’s “Shop and Compare” tool to see specific premium rates.

CHA News Article

DHCS Posts Stakeholder Update

The Department of Health Care Services (DHCS) has released its bimonthly stakeholder update, including information on upcoming meetings as well as ongoing DHCS activities. The October edition includes updates on the assisted living waiver renewal, the Dental Transformation Initiative, the Drug Medi-Cal Organized Delivery System, the Health Homes Program, the Medicaid State Plan and State Plan Amendments, medication assisted treatment and much more. Additional details are available online.

CHA News Article

DHCS Issues Update on Drug Medi-Cal Organized Delivery System Waiver

According to a recent update from the Department of Health Care Services, 19 counties — representing nearly 75 percent of the Medi-Cal population — are currently approved to deliver Drug Medi-Cal Organized Delivery System (DMC-ODS) services. The DMC-ODS waiver is a voluntary pilot program that offers California counties the opportunity to expand access to care for Medi-Cal enrollees with substance use disorders.

CHA News Article

CMS Approves DHCS’ Proposed Medi-Cal Managed Care Access Assessment Design

On Sept. 19, the Department of Health Care Services (DHCS) received Centers for Medicare & Medicaid Services’ approval of its proposed Access Assessment Design. California’s section 1115(a) demonstration waiver (titled “California’s Medi-Cal 2020 Demonstration”) requires that DHCS, working with its external quality review organization, conduct a one-time assessment evaluating primary, core specialty and facility access to care for managed care members.

The evaluation will be based on current health plan network adequacy requirements, as set forth in the state’s Knox-Keene Health Care Service Plan Act of 1975 and Medicaid managed care contracts. It will consider the state’s fair hearing and independent medical review decisions as well as grievances and appeals/complaints data, and will report on the number of providers accepting new beneficiaries. The report will also describe the state’s current compliance with the access and network adequacy standards outlined in the Medicaid managed care final rule.

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

As Wildfires Continue, CHA Encourages Members to Assist Those Impacted

Hospitals and health care facilities across the state continue to respond to, and be affected by, the devastation caused by the Camp Fire in Northern California and the Woolsey and Hill fires in Southern California.

CHA News Article

Wildfires Threaten, Damage Hospitals in Different Parts of the State

Wildfires in both Northern and Southern California have threatened hospital patients and structures this week. The Camp Fire in Butte County has seriously damaged part of Feather River Hospital in the town of Paradise, including some inpatient units and multiple hospital outbuildings. At this time, the hospital is inoperable. Fortunately, all patients and employees were safely evacuated. 

CHA News Article

Statewide Medical and Health Exercise Helps Meet Emergency Preparedness Requirements

Hospitals are encouraged to register for this year’s Statewide Medical and Health Exercise, to be held Nov. 15. This year’s scenario asks providers to respond to an infectious disease — with a high mortality rate — spreading from South and Central America. By participating, providers will meet certain emergency preparedness requirements from The Joint Commission and the Centers for Medicare & Medicaid Services.

CHA News Article

Updated Resource Offers Tips for Caring for Staff After a Disaster

A new resource from the Office of the Assistant Secretary for Preparedness and Response details steps health care providers can take to care for staff following a disaster. The attached tip sheet includes ways to meet employees’ immediate needs for shelter, transportation, and food and water, as well as considerations for short-term needs such as clothing and laundry services, behavioral health care, and pay and vacation practices. The tips were developed to help health care facility executives support their staff and ensure the continuity of a safe, healthy workforce. CHA encourages members to review the resource in conjunction with their emergency preparedness activities.

CHA News Article

Hospitals May Experience Power Outages as Fire Precautions
Utilities begin public safety power shut off programs

The Pacific Gas & Electric (PG&E) and Southern California Edison have begun public safety power shut off programs in various California counties as part of their Community Wildfire Safety programs. San Diego Gas and Electric currently runs a similar program. The utilities plan to temporarily disable power during extreme weather conditions, where warranted, based on the California Public Utility Commission’s Fire Threat Map.  

CHA has met with representatives from PG&E to discuss the program’s implications for patient care and hospital operations — as well as the potential impact on the overall health care delivery system. CHA requested that hospitals be exempt from or bypassed by these power outages, but was informed that the complexities of the circuits make that impossible. PG&E will notify its hospital customers of planned outages in advance. While it is difficult to determine the exact length of an outage because weather is a key factor, providers should note that outages may last as long as five to seven days.

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

Hospitals Reminded to Post Updated Prop. 65 Signs
New signage requirements took effect Aug. 30

CHA reminds members that the Safe Drinking Water and Toxic Enforcement Act of 1986 (Proposition 65) requires hospitals and other businesses to post warning signs about potential exposure to certain chemicals. Beginning Aug. 30, the required content of the signs changed. Previously, the signs were not required to list any specific chemicals but now must inform consumers and employees of at least one specific chemical to which they may be exposed in the area.

Each sign must also include a symbol consisting of a black exclamation point in a yellow equilateral triangle with a bold black outline; if no color is used in printing, then black and white is acceptable. Many commercial vendors sell these signs.

CHA News Article

CDPH Issues Guidance on Reducing Legionella Risk in Water Systems

The California Department of Public Health (CDPH) has issued the attached All Facilities Letter 18-39, which addresses Legionella risks in health care facility water systems. Hospitals, critical access hospitals and skilled-nursing facilities must develop and adhere to policies and procedures that inhibit microbial growth in building water systems, in order to reduce the growth and spread of Legionella and other pathogens in water. CDPH directs facilities to guidance issued by the Centers for Medicare & Medicaid Services, which clarifies expectations and notes that facilities must:

  • Conduct a facility risk assessment to identify where Legionella and other pathogens could grow and spread.
  • Develop and implement a water management program.
  • Specify testing protocols and document testing results.
  • Comply with other federal, state and local requirements.
CHA News Article

Hospitals Reminded That Prop. 65 Warning Regulations Take Effect Aug. 30
New requirements apply to content and types of warnings

CHA reminds hospitals that new regulations related to Proposition 65 and warnings that must be publicly posted take effect Aug. 30. Failure to comply could subject hospitals to potential penalties of up to $2,500 per day, per violation. The new regulations specify separate safe harbor warnings based on the types of listed chemicals, the number of listed chemicals and the methods of transmission. They also significantly revise the required content, including adding these elements:

  • The name of at least one listed chemical that prompted the warning
  • The Internet address for the Office of Environmental Health Hazard Assessment’s (OEHHA) new Proposition 65 warnings website, www.P65Warnings.ca.gov, which includes additional information on the health effects of listed chemicals and ways to reduce or eliminate exposure to them
  • A triangular yellow warning symbol on most warnings
CHA News Article

Workshops Will Detail Proposed Regulations for Toxic Emissions Reporting

A new series of workshops presented by the California Air Resources Board (CARB) will share draft language and concepts for proposed regulations related to toxic emissions reporting. The regulations, required by Assembly Bill 617 (Chapter 136, Statutes of 2017), are intended to support certain CARB programs — including the Community Air Protection Program, established by AB 617, and the Air Toxics Hot Spots Program — as well as state implementation plans, air toxic control measures and monitoring studies. Workshops will be held in July and August throughout the state. A full list of dates and locations, as well as registration information, is available online.

CHA News Article

Hospitals Notified of Digital TV Channel Frequency Change
Potentially affects telemetry systems

The Federal Communications Commission requires television stations to notify health care facilities within their service area when they change the frequency on which they transmit, because such changes can affect hospitals’ wireless monitoring equipment. CHA has received the attached notice from Widelity ­— a company retained by KRNS-CD television station in Reno, NV — to make the required notifications that the frequency on which it transmits will change. Widelity is one of a few organizations along with select television stations that will notify health care facilities in their coverage of similar changes over the next three years.

While many hospitals no longer use television channels for wireless monitoring or equipment, those that do will need to move and retune equipment. Hospitals should work with the manufacturer of their telemetry systems to determine which channels and frequencies to use. Attached are a presentation that includes a list of facilities in the Widelity region and an overview of the process, as well as a list of California stations that are or will be changing frequencies.

Overview

Finance & Reimbursement

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 is committed to providing hospital financial executives with the resources needed to address these challenges, and believes that hospitals should be reimbursed adequately to cover the cost of care.

Through state and federal advocacy efforts, CHA dedicates many resources to fair government reimbursement and strives to improve hospitals’ financial outlook through legislative and regulatory channels. CHA’s statewide committees and workgroups help provide direction on how to best represent the diverse issues that affect hospitals’ financial performance. In addition, 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

CMS Proposes Changes to Medicaid Managed Care and CHIP
Comments due Jan. 14

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that revises Medicaid Managed Care and Children’s Health Insurance Program (CHIP) regulations.

CHA News Article

CMS Extends Timeline for Publishing Discharge Planning Requirements

The Centers for Medicare & Medicaid Services (CMS) has extended until Nov. 9, 2019, its timeline for revising discharge planning requirements for hospitals, critical access hospitals and home health agencies. 

On Nov. 3, 2015, CMS proposed updates to discharge planning requirements that included provisions required by the Improving Medicare Post-Acute Care Transitions (IMPACT) Act of 2014. At that time, CHA submitted a comment letter on members’ behalf. Based on the numerous comments and information it received, CMS has determined that significant policy issues must be resolved and it needs additional time to coordinate with other government agencies. More information is available in the attached notice. 

CHA News Article

CMS Issues Annual Report to Congress

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its fiscal year 2017 report to Congress addressing Medicare oversight of accrediting organizations and the Clinical Laboratory Improvement Amendments of 1988 (CLIA) Validation Program. Accrediting organizations are required to comply with the Medicare conditions of participation, while CLIA requires laboratories that perform testing on human specimens to meet requirements established by the Department of Health and Human Services. The report details the review, validation and oversight of these programs, and is required under the Social Security and Public Health Service acts. The report also outlines current pilot studies intended to streamline the assessment process.   

CHA News Article

FAQs Address Requirement to Publish Internet List of Standard Charges
Hospitals must comply by Jan. 1

Responding to a request for additional clarification from many hospitals around the country, the Centers for Medicare & Medicaid Services (CMS) posted frequently asked questions (FAQs) about the requirement that hospitals make public a list of their standard charges (e.g., a hospital chargemaster). As outlined in the federal fiscal year 2019 inpatient prospective payment system final rule, hospitals must publish that information via the internet in a machine-readable format. 

CHA News Article

IRS Releases Draft Form 990-T for Nonprofit Organizations
Offers insight into 2019 tax changes

The Internal Revenue Service has released a draft version of Form 990-T for 2018, offering new insight into how certain portions of the Tax Cuts and Jobs Act of 2017 that impact organizations with 501(c)(3) exempt status will be implemented.

As of Jan. 1, section 512(a)(7) now treats certain employee fringe benefit expenses — including expenses related to transportation benefits — as taxable income for tax-exempt employers.

Hospitals should seek additional direction and guidance from their tax department or consultants.

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

Updated Record and Data Retention Schedule Now Available
Available in print and electronic formats

CHA is pleased to announce the new release of its Record and Data Retention Schedule, the first update of this publication in seven years. The guidebook provides an overview of practical considerations in record retention policies and helps hospitals determine which records need to be kept and for how long.

The guide can help reduce storage costs and avoid legal pitfalls by making clear when it is safe to dispose of certain records.

CHA News Article

CHA Attends Site Visit With ONC Deputy National Coordinator

CHA last week joined the American Hospital Association in a site visit with Office of the National Coordinator for Health Information Technology (ONC) Deputy National Coordinator Jon White, MD. Dr. White visited Scripps Memorial Hospital La Jolla to understand the successes and challenges of meaningful use programs and to discuss how to improve interoperability in the exchange of health information.

From left: Megan Howard, senior policy analyst, CHA; Shane Thielman, AVP information services, Scripps Health; Joseph Stein, MD, Scripps Health; Jon White, MD, deputy national coordinator for health information technology, U.S. Department of Health and Human Services; David Wetherhold, MD, Scripps Health; Andy Crowder, corporate senior VP & CIO, Scripps Health; Chantal Worzala, VP health information & policy operations, American Hospital Association; Diane Jones, director IT health policy, American Hospital Association; Amber Ter-Vrugt, senior director government relations, Scripps Health
CHA News Article

Researchers Use Electronic Health Records to Study Mental Illnesses

A new method of scanning electronic health records has been found to identify associations between broad dimensions of behavioral function and genes relevant to mental disorders. The study, published in Biological Psychiatry earlier this year, analyzes use of a natural language processing method to help identify characteristics that might lead to a common genetic variation that is relevant to psychopathology. According to its authors, the technique allows researchers to access an enormous source of data that will assist in a dimensional approach to the study of mental illnesses, rather than using traditional diagnostic categories.

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).

Overview

Hospital Fee Program

The hospital fee program is crucial to the preservation of California’s entire safety net, which is why California’s safety-net hospitals initiated provider fee legislation and why all California hospitals support it. The program uses fees assessed by the state on hospitals to draw down federal matching funds, which are then issued as supplemental payments to hospitals. It is an integral element to improving access to health care for some of California’s most vulnerable residents.

The hospital fee program and all of its statutory provisions and protections were made permanent through the passage of CHA’s ballot initiative, the Medi-Cal Funding and Accountability Act (Proposition 52), in the November 2016 General Election. By removing the sunset date of Jan. 1, 2018, in the existing statute (SB 239, 2013), the Act becomes the framework for all future hospital fee programs. Among other statutory provisions, Proposition 52 makes permanent the limit on the amount the state can take out of the program for the General Fund; the construct of the fee program (both the fee side and the payment mechanisms); and the source of data and information used to develop the program. The next program period covers Jan. 1, 2017, through June 30, 2019.

CHA News Article

DHCS to Host Webinar on Hospital Fee Program

As previously reported in CHA News, the Department of Health Care Services (DHCS) recently published the attached guidance related to the definition of a “network provider” under the 2017–19 Hospital Fee Program and the designated public hospital Enhanced Payment Program. Next week, DHCS will host a technical assistance webinar to further explain the definition and answer hospitals’ questions related to the attachment. Registration is required for the webinar, which will be held Oct. 31 at 10 a.m. (PT).   

CHA News Article

Deadline Extended for Hospitals to Report Information for Statewide Directory
Due by July 13

The Department of Health Care Services’ (DHCS) has extended the deadline for private hospitals to submit contact information for the new statewide hospital and health plan directory. The directory, which will be publicly available online, will identify primary points of contact for each organization that other plans or hospitals may use for inquiries related to the Hospital Fee Program. Providers are encouraged to complete DHCS’ online form to identify points of contact for general inquiries, encounter data inquiries and contracting inquiries. Information should be submitted by July 13. If a hospital does not provide the requested contacts by the deadline, DHCS will list the primary contact provided in the National Provider Identifier spreadsheet as the contact for all general, encounter data and contracting questions in the statewide directory.   

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

California’s Minimum Wage, Other Pay Rates Increase Jan. 1, 2019

The California Labor Code requires an increase to the state minimum wage each year. Effective Jan. 1, 2019, the statewide minimum wage will increase from $11 to $12 per hour. This also impacts other wage and hour obligations, such as the minimum salary requirement for exempt employees, which will increase to $49,920.

CHA News Article

Updated Resource Offers Tips for Caring for Staff After a Disaster

A new resource from the Office of the Assistant Secretary for Preparedness and Response details steps health care providers can take to care for staff following a disaster. The attached tip sheet includes ways to meet employees’ immediate needs for shelter, transportation, and food and water, as well as considerations for short-term needs such as clothing and laundry services, behavioral health care, and pay and vacation practices. The tips were developed to help health care facility executives support their staff and ensure the continuity of a safe, healthy workforce. CHA encourages members to review the resource in conjunction with their emergency preparedness activities.

CHA News Article For Members

CHA Submits Pre-Regulatory Comments on Title 22 Regulations

Today, CHA submitted comments to the California Department of Public Health (CDPH) regarding several areas of Title 22 regulations that CDPH plans to revise. CDPH issued seven All Facilities Letters (AFLs) earlier this month, requesting stakeholder input to inform its regulation development process. CHA commented on the following:

Comments are due to CDPH on Aug. 31. Questions should be submitted to CHCQRegulationsUnit@cdph.ca.gov.​

CHA News Article

California Supreme Court Reconciles State Background Check Notice Laws
Employers must comply with both ICRAA and CCRAA

Earlier this month, the California Supreme Court provided direction to employers that conduct background checks. In Connor v. First Student, Inc. the court held that the employer violated the Investigative Consumer Reporting Agencies Act (ICRAA) by failing to provide the specific notice required by the statute, as well as failing to obtain written authorization for the background check. This case illustrates that employers must be diligent in compliance and cannot necessarily delegate responsibility to a background check vendor. 

In Connor, the employer requested that its consumer reporting agency conduct background checks on its employees on three separate occasions in 2007, 2009 and 2010 to confirm that the employees were “properly qualified to safely perform their job duties.” The background reports included criminal records, sex offender registries, address history, driving records and employment history. 

Before conducting the background checks, the employer sent employees a booklet that contained a notice authorizing the background check vendor to prepare a consumer report or investigative consumer report. The notice provided that employees could view the file, receive a summary of that file by telephone or obtain a copy of it.

CHA News Article

Federal Contractors Can Expect Changes in Compliance Assistance
OFCCP signals shift to compliance assistance

Last week, the Office of Federal Contract Compliance (OFCCP) issued the attached update emphasizing the agency’s role in compliance assistance. Titled “What Federal Contractors Can Expect,” the document explains that contractors “seeking OFCCP’s assistance with satisfying their nondiscrimination and equal employment opportunity obligations can expect clear, accurate, and professional interactions with OFCCP’s staff. OFCCP provides compliance assistance on a range of issues including technical help with understanding the requirements for developing an Affirmative Action Program.” 

The release of this document came at approximately the same time as an announcement that OFCCP Director Ondray Harris was stepping down after eight months. Deputy Director Craig E. Leen will serve as OFCCP’s interim director until a permanent director is named, at which time the agency’s direction could shift.

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

Homeless Patient Discharge Planning Guidebook Now Available for Free Download
Print copies also available

CHA’s latest guidebook, Discharge Planning for Homeless Patients, explains California’s new homeless patient discharge planning law and offers insights to help hospitals prepare to return homeless patients to the community. 

CHA News Article

Updated Record and Data Retention Schedule Now Available
Available in print and electronic formats

CHA is pleased to announce the new release of its Record and Data Retention Schedule, the first update of this publication in seven years. The guidebook provides an overview of practical considerations in record retention policies and helps hospitals determine which records need to be kept and for how long.

The guide can help reduce storage costs and avoid legal pitfalls by making clear when it is safe to dispose of certain records.

CHA News Article

CMS Proposes Changes to Medicare Claims Appeals Process

The Centers for Medicare & Medicaid Services (CMS) has issued the attached proposed rule that would revise certain requirements for Medicare Parts A, B and D claims appeals. The proposed rule is intended to reduce regulatory burden and improve clarity and consistency in the appeals process. Among the provisions, CMS proposes to eliminate the requirement that appellants sign appeal requests, and change the time frame for vacating dismissals from six months (which can vary from 181 to 184 days) to 180 calendar days.

CHA News Article

Hospitals Required to Offer Declaration of Paternity Forms

State law requires birthing hospitals to offer fathers — if available — the opportunity to complete a Declaration of Paternity form when the mother is unmarried.

Hospitals must attempt to have the parents complete all required data elements on the Declaration of Paternity form (CS 909) prior to submission to the California Department of Child Support Services (DCSS). DCSS has asked CHA to remind hospitals that the Social Security number (SSN) field must be completed. Individuals who do not have a SSN should check the box on the form that states, “By checking this box, I declare under penalty of perjury under the laws of the State of California that I do not have a Social Security number.” If a parent declines to provide a SSN or select the check box, the Declaration of Paternity form may not be used to establish paternity. Incomplete forms should not be sent to DCSS.

Additional details about the Declaration of Paternity form and process are included in CHA’s Consent Manual – A Reference for Consent and Related Healthcare Law. Questions about the Declaration of Paternity form should be directed to the California Paternity Opportunity Program at askpop@dcss.ca.gov or (916) 464-1982.

CHA News Article For Members

CHA Submits Pre-Regulatory Comments on Title 22 Regulations

Today, CHA submitted comments to the California Department of Public Health (CDPH) regarding several areas of Title 22 regulations that CDPH plans to revise. CDPH issued seven All Facilities Letters (AFLs) earlier this month, requesting stakeholder input to inform its regulation development process. CHA commented on the following:

Comments are due to CDPH on Aug. 31. Questions should be submitted to CHCQRegulationsUnit@cdph.ca.gov.​

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

Homeless Patient Discharge Planning Guidebook Now Available for Free Download
Print copies also available

CHA’s latest guidebook, Discharge Planning for Homeless Patients, explains California’s new homeless patient discharge planning law and offers insights to help hospitals prepare to return homeless patients to the community. 

CHA News Article

Court of Appeal Grants CHA Request for Published Opinion
Court ruled in favor of hospital, physicians in wrongful death suit

The California Court of Appeal last week granted CHA’s request to publish its opinion in Alexander v. Scripps Memorial Hospital La Jolla et al. CHA requested that the court publish the decision because of the important legal issues it addresses, and because having it published allows attorneys in future cases to rely on it.

In the case, a patient with incurable stage four pancreatic cancer was transferred to a hospital from a skilled-nursing facility (SNF) for evaluation. The transferring physician did not believe she would return to the SNF, as he believed her death was imminent. The patient had completed an advance directive and a Physician Orders for Life Sustaining Treatment (POLST) form electing to have all measures taken to prolong her life, including full resuscitation if necessary. All physicians caring for the patient agreed that cardiac compression would be futile and cause harm and suffering. The family said they understood her condition was terminal, but still wanted full resuscitation.

CHA News Article

CHA Requests Published Opinion From California Court of Appeal
Court ruled in favor of hospital, physicians in wrongful death suit

CHA filed a request yesterday with the California Court of Appeal to publish its opinion in Alexander v. Scripps Memorial Hospital La Jolla et al. In that case, a patient with incurable stage four pancreatic cancer was transferred to a hospital from a skilled-nursing facility (SNF) for evaluation. The transferring physician did not believe she would return to the SNF, as he believed her death was imminent. The patient had completed an advance directive and a Physician Orders for Life Sustaining Treatment form electing to have all measures taken to prolong her life, including full resuscitation if necessary. All physicians caring for the patient agreed that cardiac compression would be futile and cause harm and suffering. The family said they understood her condition was terminal, but still wanted full resuscitation.

The physicians consulted the hospital’s Appropriate Care Committee, which met at the patient’s bedside, reviewed her medical records and spoke with her physicians. The committee explained to the family that doctors could not embark on ineffective care. The patient died three days after admission, having received palliative care and pain control, but without receiving cardiac compression. She died about an hour before she was scheduled to be transferred to another facility that the family believed would comply with its directions. The family sued, alleging 16 different causes of action, including malpractice, wrongful death, elder abuse, misrepresentation, infliction of emotional distress and violations of state law regarding advance directives.

Publication

2018 Consent Manual
The trusted resource for consent and related health care law

Member Rate  
Printed Manual
$265
Buy Now
Electronic Manual (PDF)
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

Opioid Safe Prescribing Guidelines Updated for Emergency Departments

The California section of the American College of Emergency Physicians has updated its opioid safe prescribing guidelines to reflect expanded use of medication-assisted treatment in emergency departments. Notably, the guidelines no longer prohibit treating addiction in the emergency department.

CHA News Article

As Wildfires Continue, CHA Encourages Members to Assist Those Impacted

Hospitals and health care facilities across the state continue to respond to, and be affected by, the devastation caused by the Camp Fire in Northern California and the Woolsey and Hill fires in Southern California.

CHA News Article

Wildfires Threaten, Damage Hospitals in Different Parts of the State

Wildfires in both Northern and Southern California have threatened hospital patients and structures this week. The Camp Fire in Butte County has seriously damaged part of Feather River Hospital in the town of Paradise, including some inpatient units and multiple hospital outbuildings. At this time, the hospital is inoperable. Fortunately, all patients and employees were safely evacuated. 

CHA News Article

Statewide Medical and Health Exercise Helps Meet Emergency Preparedness Requirements

Hospitals are encouraged to register for this year’s Statewide Medical and Health Exercise, to be held Nov. 15. This year’s scenario asks providers to respond to an infectious disease — with a high mortality rate — spreading from South and Central America. By participating, providers will meet certain emergency preparedness requirements from The Joint Commission and the Centers for Medicare & Medicaid Services.

CHA News Article

Changes Proposed to Medicare Advantage Telehealth Services, Star Ratings System

The Centers for Medicare & Medicaid Services (CMS) issued the attached proposed rule updating the Medicare Advantage (MA) and the Medicare prescription drug benefit (Part D) programs for contract year 2020. Specifically, CMS proposes changes to implement certain provisions of the Bipartisan Budget Act of 2018 that expand telehealth services for MA beneficiaries beyond what is available under traditional Medicare. The rule also proposes updates to the MA and Part D Quality Star Rating System, as well as to certain program integrity provisions. Additional information is available in a CMS fact sheet. Comments on the proposed rule are due Dec. 31.

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

Hospitals Encouraged to Support HealthImpact

CHA encourages member hospitals to support HealthImpact, an organization committed to ensuring California has a dynamic, highly skilled nursing workforce. As a 501(c)(3) organization, HealthImpact does not receive public funds, so it depends on contributions from financial partners — primarily hospitals and health systems. CHA and its members have supported the organization since it was started 17 years ago.

In the video below, HealthImpact CEO Judee Berg provides some highlights of the organization’s important work and its effectiveness throughout the state. Berg also explains how to make a financial contribution that will allow the organization to continue helping nurses who work in hospitals.

CHA News Article

Loan Repayment Available for Allied Health Professionals
Application deadline Oct. 16

The County Medical Services Program and the Office of Statewide Health Planning and Development have partnered to provide educational loan repayments of up to $16,000 annually to allied health professionals. To be eligible, professionals must complete one year of service at a provider site contracted with the County Medical Services Program. The application deadline has been extended to Oct. 16; details are available online.

CHA News Article

CMS Issues Guidance on Operating Multiple Laboratories at Same Location

The Centers for Medicare & Medicaid Services (CMS) has issued a memo clarifying existing policies on the operation of multiple laboratories at the same location under the Clinical Laboratory Improvement Amendments of 1988.

The memo reinforces existing guidance on multiple laboratories at the same location. Laboratories operating at the same physical location must operate as separate and distinct entities, and should not be referred to as “shared laboratories.”

Laboratories operating at the same physical location and using the same testing personnel and equipment must keep records separate to show that each is operating independently. Each laboratory must specify its hours of operation; times of testing cannot overlap or be simultaneous.  

Questions about the memo should be directed to LabExcellence@cms.hhs.gov.

CHA News Article

Medi-Cal Supplemental Payments for Selected Physician Services to Increase Under Budget Package
Funding also allocated for new Physicians and Dentists Loan Repayment Program

The fiscal year 2018-19 state budget allocates more than $1 billion of Medi-Cal’s share of Proposition 56 funding for 1) payment increases for doctors, dentists, and other Medi-Cal providers ($821.3 million) and 2) a new loan assistance program for recent medical and dental school graduates who serve Medi-Cal members ($220 million). Approved by California voters in 2016, Proposition 56 increases the excise tax rate on cigarettes and tobacco products. A specified portion of the Proposition 56 tobacco tax revenue is allocated to the California Department of Health Care Services (DHCS) for the non-federal share of health care expenditures in accordance with the annual state budget process. 

The funds will be matched with federal dollars, resulting in over $2 billion in increased funding to physicians who treat Medi-Cal members. 

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.

Commands