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

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.

CHA News Article

Parkinson’s Disease Registry Implementation Guide in Final Stages

According to a recent communication from the California Department of Public Health (CDPH), its revised Parkinson’s Disease Registry Implementation Guide is nearly complete. 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. CDPH issued its first implementation guide in May; CHA continues to seek clarification on some of its elements. When the update is released, it will be shared in CHA News.

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 that elected to report automatically do not need to take further action.

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

CHA News Article

Hospitals Reminded of New Requirements for Sterile Compounding Pharmacy Clean Rooms

In January 2017, the California Board of Pharmacy (BoP) established new requirements for hospitals performing sterile compounding. In addition, the Office of Statewide Health Planning and Development’s Facilities Development Division and the California Department of Public Health (CDPH) Licensing and Certification Program must review physical plant and program changes that hospitals must make to comply with the new BoP requirements.

In May, CDPH released an All Facilities Letter clarifying requirements for new or remodeled pharmacy clean rooms and use of mobile sterile compounding units in general acute care hospitals. According to the letter, hospitals must obtain CDPH approval for all new or remodeled pharmacy clean rooms under the hospital’s license. Hospitals must also obtain CDPH approval — including program flexibility approval — to temporarily use mobile sterile compounding units. CDPH advises hospitals to submit applications to the Centralized Applications Unit 120 days prior to when they anticipate completion of the new or remodeled pharmacy, and to clearly mark that the application is for sterile compounding. In addition, CDPH advises hospitals to contact the CDPH Pharmacy Consultant Unit at LNCPharmCleanRoom@cdph.ca.gov 90 days prior to anticipated completion.

Additional resources to assist hospitals in complying with the new requirements were previously shared in CHA News.

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

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.

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.

Recording

Advanced Decision Making for EMTALA Webinar
EMTALA principles, case scenario learning, surveyor compliance tips

Webinar Recorded Live on November 14, 2014

Overview

Whether you are a sending or receiving hospital, many factors must be considered when dealing with a potential EMTALA situation. Knowing the right thing to do isn’t easy, especially in a stressful or busy emergency department.

Recording

Minors Health Care — The Basics of Consent, Privacy and More Webinar
Learn about the rules, exceptions to the rules, practical solutions to common problems

Webinar Recorded Live on October 29, 2014

Overview

This scenario plays out in hospitals every day: grandmother, teacher, neighbor or concerned friend brings a minor to the hospital. No parent in sight. Now what?

Can you treat the minor? Whose consent do you need? Who should you talk to about the minor’s treatment options? These are all too common questions that often challenge the most seasoned health care providers.

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 For Members

CDPH Requests Stakeholder Input on Pre-Regulatory Development
CHA to convene member workgroup

Earlier this week, the California Department of Public Health issued seven All Facilities Letters (AFLs) addressing upcoming changes to its regulations for general acute care hospitals. In each, the department seeks stakeholder input to inform its regulation development process. The letters are:

  • AFL 18-30, which applies to hospital administration regulations
  • AFL 18-31, which applies to hospital employee/personnel records requirements
  • AFL 18-32, which applies to hospital license, supplemental service approval and special permit regulations
  • AFL 18-33, which applies to hospital medical records regulations
  • AFL 18-34, which applies to hospital medical service regulations
  • AFL 18-35, which applies to hospital records and reporting regulations
  • AFL 18-36, which applies to small and rural hospital regulations

Instructions for submitting comments, which are due Aug. 31, are included in each letter. Questions should be submitted to CHCQRegulationsUnit@cdph.ca.gov.

CHA News Article

Proposed Building Code Changes Address Hospitals’ 2030 Seismic Compliance

The Hospital Building Safety Board (HBSB) met last month in a special session to consider changes to Title 24 of the building code, with the goal of decreasing hospitals’ cost and burden as they plan for and comply with seismic requirements that must be met by 2030. The revisions were established by the HBSB Structural and Non-structural Regulations Committee, with participation from a number of hospital representatives, CHA, a structural engineer contracted by CHA and experts from other disciplines. Attached are a high-level summary of the final draft requirements, and a table from the Office of Statewide Health Planning and Development (OSHPD) listing compliance deadlines.

CHA will continue to work with RAND Corporation to conduct an updated study on evaluating the requirements and the projected cost to meet them.

Other proposed 2019 building code amendments are specific to intensive care units, outpatient observation units, OSHPD 3/clinics and hospital outpatient clinical services. A new delineation of hospital buildings under OSHPD jurisdiction will be OSHPD 5, assigned to acute psychiatric hospitals. If adopted by the California Building Standards Commission, these proposed requirements will take effect Jan. 1, 2020.

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/.

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

Disaster Planning Conference Speakers Will Share Major Event Experiences
Keynotes to focus on Puerto Rico, Las Vegas and cyberattack events

This year’s Disaster Planning for California Hospitals Conference — to be held Sept. 24-26 in Sacramento —  features presentations from those who lived through some of last year’s devastating events, including hurricanes in Puerto Rico, cyberattacks and the shooting in Las Vegas. Focusing on the theme “Voices of Experience, Lessons for the Future,” speakers will describe their experiences and the lessons they learned.

Brandon Bond, administrative director, Office of Emergency Management at Stanford Health Care, will open the conference with a discussion of his experience as safety officer for Disaster Medical Assistance Team CA-6, which deployed to Puerto Rico and the U.S. Virgin Islands following hurricanes Irma and Maria. Bond will discuss patient movement and how the team assisted a vulnerable population in a disaster.

Following that keynote, Craig Felty, vice president, patient care services at Hancock Health/Hancock Regional Hospital, will recount the day his hospital was struck by a sophisticated cyberattack. He will share leadership’s reaction to the crisis, staff’s role in ensuring continuity of patient care and the Federal Bureau of Investigation’s involvement in the resolution.

CHA News Article For Members

CDPH Requests Stakeholder Input on Pre-Regulatory Development
CHA to convene member workgroup

Earlier this week, the California Department of Public Health issued seven All Facilities Letters (AFLs) addressing upcoming changes to its regulations for general acute care hospitals. In each, the department seeks stakeholder input to inform its regulation development process. The letters are:

  • AFL 18-30, which applies to hospital administration regulations
  • AFL 18-31, which applies to hospital employee/personnel records requirements
  • AFL 18-32, which applies to hospital license, supplemental service approval and special permit regulations
  • AFL 18-33, which applies to hospital medical records regulations
  • AFL 18-34, which applies to hospital medical service regulations
  • AFL 18-35, which applies to hospital records and reporting regulations
  • AFL 18-36, which applies to small and rural hospital regulations

Instructions for submitting comments, which are due Aug. 31, are included in each letter. Questions should be submitted to CHCQRegulationsUnit@cdph.ca.gov.

CHA News Article

Hospitals Near Major Wildfires Face Evacuations, Power Outages

As multiple wildfires continue to burn throughout the state, hospitals and other health care facilities near two fires in Northern California were severely affected over the weekend. The Carr fire, near Redding, is now 20 percent contained and has burned more than 98,000 acres, destroyed 723 residences and caused the evacuation of Patients’ Hospital of Redding. Further west, the Mendocino Complex fire – comprised of the River and Ranch fires – prompted the evacuation of Sutter Lakeside Hospital in Lakeport. The Mendocino Complex fire has burned nearly 58,000 acres, destroyed six residences and is just 5 percent contained.

In both the Redding and Mendocino areas, health care facilities have requested emergency supplies of air scrubbers and masks to mitigate the effects of contaminating smoke. In addition, some hospitals experienced intermittent power outages but were able to operate on generator power, and some hospital employees have had to evacuate their homes. So far, the hospitals have not requested additional health care workers. However, additional nurses have been requested for some of the community evacuation shelters. Requests for supplies and volunteers are being filled by the state.

CHA will continue to provide updates on these and other wildfires as information becomes available. Hospitals can also track all fires statewide at www.fire.ca.gov/current_incidents.

CHA News Article

Health Care Facilities Impacted by Northern California Fire

Several health care facilities in and around Redding are treating injured firefighters and civilians, as well as evacuating highly vulnerable patients, as a result of the Carr Fire. So far, the facilities remain open but prepared for evacuations if necessary.

The fire has prompted mandatory evacuations in Redding and the nearby cities of Summit and Shasta Lake, burning more than 44,000 acres and destroying 65 buildings. With thousands of firefighters battling the blaze — which is only 3 percent contained — triple-digit temperatures and high winds are expected to exacerbate conditions through the weekend. 

As with any active fire or disaster, circumstances can change rapidly. CHA will continue to provide updates about this and other fires as they become available, and will notify members if there are opportunities to help affected hospitals and hospital staff.

In response to the wildfires, the California Department of Public Health (CDPH) and Emergency Medical Services Authority (EMSA) have activated the Medical and Health Coordination Center (MHCC) at Level 3. The MHCC will be open today until 7 p.m. and July 28 from 7 a.m. to 7 p.m. 

CHA News Article

Northern California Facilities Reminded to Take Heat-Related Precautions

The California Department of Public Health (CDPH) has released the attached All Facilities Letter 18-25 reminding facilities to take precautionary measures during extremely hot weather. According to the National Weather Service, temperatures across Northern California will peak today, with excessive temperatures continuing through Thursday. CDPH reminds facilities to have contingency plans in place to deal with the loss of air conditioning. If air conditioning is not available, facilities must take measures to ensure patients and residents are protected from heat conditions that may cause health complications. Facilities must report extreme heat conditions that compromise patient health and safety or require patient evacuation, transfer or discharge. For more information about area-specific weather advisories, visit www.weather.gov/.

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

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

New Regulations for Prop. 65 Warnings Take Effect Aug. 30
Resources available for businesses

The California Office of Environmental Health Hazard Assessment has released new resources for businesses to help them comply with Proposition 65 warning regulations that take effect Aug. 30.

Businesses can also contact the Proposition 65 Implementation Program office at (916) 445-6900 or by email at P65.Questions@oehha.ca.gov

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.

CHA News Article

Governor Brown Signs Legislation Establishing Water Efficiency Goals

Last week, Gov. Brown signed legislation — Senate Bill 606 (Chapter 14, Statutes of 2018) and Assembly Bill 1668 (Chapter 15, Statutes of 2018) — establishing statewide water efficiency standards that must be in place by 2022. According to the administration, the legislative action builds on efforts to make water conservation a way of life in California.

Intended to help the state better prepare for droughts and climate change, the bills’ provisions:

  • Establish an indoor, per person water use goal of 55 gallons per day until 2025, 52.5 gallons from 2025 to 2030 and 50 gallons beginning in 2030.
  • Create incentives for water suppliers to recycle water.
  • Require both urban and agricultural water suppliers to set annual water budgets and prepare for drought.

The legislation also includes a framework for the implementation and oversight of the new standards.

“In preparation for the next drought and our changing environment, we must use our precious resources wisely. We have efficiency goals for energy and cars – and now we have them for water,” said Gov. Brown. 

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.

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.

California hospitals operate in one of the nation’s most competitive environments, while managing some of the most difficult pressures, including labor costs, technology advancements and building upgrades to meet mandated seismic standards.

CHA is committed to providing hospital financial executives with the resources needed to address these challenges. Through state and federal advocacy efforts, CHA strives to improve the financial outlook for member hospitals through legislative and regulatory channels. Through statewide committees and workgroups, CHA strives to stay connected with hospital financial executives so they can provide CHA with direction on how to best represent the diverse issues that affect hospitals’ financial performance.

CHA News Article

Providers Encouraged to Download Remittance Advice Details, Medi-Cal Financial Summaries Online

Providers are reminded that they 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. 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. 

CHA News Article

Updated Medicare Hearings and Appeals Case Processing Manual Available

Six new or revised chapters of the Office of Medicare Hearings and Appeals (OMHA) Case Processing Manual have been published.

The manual standardizes the day-to-day procedures for carrying out adjudicative functions, in accordance with applicable statutes, regulations and OMHA directives. It also gives OMHA staff direction for processing appeals.

New or revised chapters that have been issued since May 10 are available online.

CHA News Article

CMS Issues FFY 2019 IPPS Final Rule
Additional information will be in CHA News tomorrow

The Centers for Medicare & Medicaid Services (CMS) has issued the attached final rule updating the inpatient prospective payment system for federal fiscal year 2019. CHA is currently reviewing the final rule, which includes 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 programs, now the Promoting Interoperability programs; 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. More information is available in a CMS fact sheet.

CHA News Article For Members

CHA Guide Helps Hospitals Plan for Financial Impact of Disasters

When disasters occur, treating patients is a hospital’s first priority. CHA’s guide outlines considerations for developing a financial preparedness and response plan.

CHA News Article

CHA Submits Letter to HHS on 340B Program

CHA has submitted the attached letter to the Department of Health and Human Services in response to the 340B section of its Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs.

In the letter, CHA argues that the administration’s focus on the 340B drug discount program as part of a plan to lower drug prices is misplaced. CHA describes the importance of the 340B program in providing essential medications and access to health care for California’s most vulnerable populations.

To highlight the program’s importance, CHA offers specific examples of how California’s hospitals have used the savings from the program to fund vital patient care services — including mobile health clinics, chemotherapy infusion centers, Hepatitis C treatment and inner-city primary care centers.

CHA encourages members to use the letter as a template to submit their own comments. Comments are due Monday, July 16 by 2 p.m. (PT) and may be submitted online.

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

Federal Administration Issues Short-Term, Limited Duration Health Plan Final Rule

Today, the U.S. Departments of Treasury, Labor, and Health and Human Services issued the short-term, limited duration insurance final rule, which finalizes many of the changes in the proposed rule and modifies proposals in other areas. While the three departments finalized the less than 12-month length of the policy as proposed, they changed the total length of the policy to no longer than 36 months in total, taking into account renewals or extensions, based on comments received.

The final rule also retains the requirement that issuers of short-term, limited-duration insurance display prominently in consumer materials one of two versions of a consumer notice explaining the policy that they are purchasing. The departments also strengthened the language required in the notice and included language deferring to state authority. Finally, the departments revised the estimates of the impact of short-term, limited-duration coverage on the individual health insurance market. The final rule is effective and applicable 60 days after publication in the Federal Register. In California, legislation has been introduced — Senate Bill 910  (Hernandez, D-West Covina) — that would prohibit short-term, limited duration health plans from being sold in California.  

CHA News Article

CHA Offers Tools for Understanding California’s Health Insurance Marketplace

CHA has developed a web page to help hospitals and their staff understand California’s health insurance marketplace. Resources include publications and other educational tools for hospitals, such as a summary of Covered California’s 2018 individual health insurance plans, fact sheets on Covered California and Medi-Cal expansion, and enrollment strategies for assisting patients who wish to obtain coverage in the Covered California marketplace. The page also provides links to regulations that govern the state-based exchange, as well as previously recorded CHA webinars that address delivery system reform, assisting individuals in obtaining coverage, employer benefits under the Affordable Care Act and the California Health Benefit Exchange.

CHA News Article

House Ways and Means Committee Holds Hearing on Modernizing Stark Law

Yesterday, the House Ways and Means Committee, Subcommittee on Health held a hearing on the Stark Law. The hearing examined the need to modernize the physician self-referral law, as well as possible solutions that would facilitate the Medicare program’s successful transition to value-based care. Witnesses urged Congress to amend the existing law to reflect modern care practices.

Last month, the Centers for Medicare & Medicaid Services (CMS) issued a request for information on how the Stark Law impedes care coordination and recommendations on how to address its burdens. CHA is soliciting input from members about the request for information; comments are due to CMS by 2 p.m. (PT) on Aug. 24. 

CHA News Article

DHCS Provides Update on Proposition 56 Supplemental Provider Payments

New information from the Department of Health Care Services (DHCS) highlights how a portion of Proposition 56 revenue will be distributed in the 2018-19 state fiscal year. Proposition 56 — also known as the California Healthcare, Research and Prevention Tobacco Tax Act — allocates a portion of the revenue it generates to support health care services across the state. Over the next fiscal year, DHCS proposes to use those funds to:

  • Expand supplemental physician payments to include new and established patient office/outpatient visits, psychiatric diagnostic evaluations, psychiatric diagnostic evaluations with medical services and psychiatric pharmacological management services, as well as various initial and periodic comprehensive, age-appropriate evaluation and management services.
  • Add payments for the top 26 utilized dental services, including general aesthesia, periodontal and orthodontia.
  • Continue supplemental reimbursement to providers under the Family Planning, Access, Care, and Treatment Program.
  • Provide increased reimbursement for state plan home health agency services and certain pediatric day health center services.

DHCS’ proposal is subject to federal approval. Details can be found on the DHCS website.

CHA News Article

CMS Requests Information About Stark Law’s Impact on Care Coordination

The Centers for Medicare & Medicaid Services (CMS) has issued the attached request for information (RFI) seeking recommendations on how to address the burdens of the physician self-referral law – also known as the Stark Law – as well as feedback on how the law impedes care coordination. CMS notes it is particularly interested in information about the structure of arrangements between parties that participate in alternative payment models or other novel financial arrangements; the need for revisions or additions to exceptions to the physician self-referral law; and definitions of terminology related to alternative payment models and the physician self-referral law.

Responses to the RFI are due by Aug. 24. Additional information is available on CMS’ website.

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

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).

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.

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

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

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.

CHA News Article For Members

CDPH Requests Stakeholder Input on Pre-Regulatory Development
CHA to convene member workgroup

Earlier this week, the California Department of Public Health issued seven All Facilities Letters (AFLs) addressing upcoming changes to its regulations for general acute care hospitals. In each, the department seeks stakeholder input to inform its regulation development process. The letters are:

  • AFL 18-30, which applies to hospital administration regulations
  • AFL 18-31, which applies to hospital employee/personnel records requirements
  • AFL 18-32, which applies to hospital license, supplemental service approval and special permit regulations
  • AFL 18-33, which applies to hospital medical records regulations
  • AFL 18-34, which applies to hospital medical service regulations
  • AFL 18-35, which applies to hospital records and reporting regulations
  • AFL 18-36, which applies to small and rural hospital regulations

Instructions for submitting comments, which are due Aug. 31, are included in each letter. Questions should be submitted to CHCQRegulationsUnit@cdph.ca.gov.

General Information For Members

Legalized Recreational Cannabis
A CHA Communications Toolkit

In 2018, the recreational use of cannabis became legal in California. Considering the law’s significant impact on health and wellness and major media interest, CHA has created this communications toolkit to assist hospital communications and government relations professionals as they address the issue within their own organizations and communities. The toolkit provides general information about cannabis and answers basic questions about the law and its impact on hospital protocols.

CHA News Article For Members

California Health System Wins Timekeeping Rounding Decision
Employers must remain vigilant with respect to wage and hour compliance

In AHMC Healthcare Inc. v. Superior Court, the 2nd District Court of Appeal dismissed the portion of a plaintiff’s lawsuit challenging the employer’s timekeeping system’s rounding practice. The issue in the case was whether an employer’s use of a timekeeping system that automatically rounds employee time up or down to the nearest quarter hour, and thus provides a less than exact measure of employee work time, violates California law. The court found that, based on the facts in that case, the system did not violate California law.

AHMC Healthcare’s timekeeping system rounds employees’ time clock swipes up or down to the nearest quarter hour. For example, if an employee clocks in between 6:53 and 7:07, he or she is paid as if he or she had clocked in at 7:00; if an employee clocks in from 7:23 to 7:37, he or she is paid as if he or she had clocked in at 7:30. In addition, meal breaks that last between 23 and 37 minutes are rounded to 30 minutes. This practice is consistent with a federal regulation so long as the rounding system “is used in such a manner that it will not result, over a period of time, in failure to compensate the employees properly for all the time they have actually worked.” While there is no state law or regulation on the issue of rounding, plaintiffs did not dispute that the federal regulation is applicable to claims made under state law. The court also noted that the California Division of Labor Standards Enforcement adopted the federal regulation in its Enforcement Policies and Interpretations Manual.

CHA News Article

Moratorium Extended on Affirmative Action Obligation for TRICARE Subcontractors
Extension effective until May 7, 2021

The Office of Federal Contract Compliance Programs (OFCCP) has extended the moratorium on enforcing the affirmative obligations required of TRICARE subcontractors through May 7, 2021. 

In 2014, OFCCP ordered a five–year suspension of affirmative obligations — a requirement to take affirmative steps to ensure equal employment opportunity in employment processes — for TRICARE subcontractors. OFCCP committed to using the five-year period to provide guidance on policy and procedures, as affiliated entities and the Department of Labor had conflicting interpretations of the law. The moratorium was set to expire on May 7, 2019.

OFCCP will use the extended moratorium time frame to collect additional stakeholder feedback, as well as to plan for legislative changes that could be enacted by Congress in the near future.

The moratorium does not apply to health care providers holding separate, independent, non-health care-related federal contracts or subcontracts. In addition, the moratorium does not affect Medicaid and Medicare providers, which are not considered contractors or subcontractors subject to OFCCP’s jurisdiction.

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

CHA Publications Help Hospitals Comply with Complicated Laws

CHA’s publications include numerous legal manuals, forms and other documents to help California hospitals understand and comply with the law — and save time and money.

 “CHA brings together state and federal statutes and regulations in one place to make hospitals’ job easier,” said Lois Richardson, Esq., CHA vice president and legal counsel. “The manuals don’t just repeat the law; they explain complex legal requirements in clear and concise language to tell you exactly what you need to do to comply.”

Publications cover a variety of health care topics, including health information privacy, consent law, mental health law, hospital compliance, charity care and discount policies, minors, patient “anti-dumping” laws, records retention and other key issues.

All legal manuals are regularly reviewed and updated as needed to ensure legal accuracy. Recent updates include the standard-setting Consent Manual, revised to cover legal changes through January 2018, and the 2018 EMTALA Manual. For the latest editions, visit www.calhospital.org/Publications. New this year, some publications are available in an electronic format.  

CHA News Article For Members

CDPH Requests Stakeholder Input on Pre-Regulatory Development
CHA to convene member workgroup

Earlier this week, the California Department of Public Health issued seven All Facilities Letters (AFLs) addressing upcoming changes to its regulations for general acute care hospitals. In each, the department seeks stakeholder input to inform its regulation development process. The letters are:

  • AFL 18-30, which applies to hospital administration regulations
  • AFL 18-31, which applies to hospital employee/personnel records requirements
  • AFL 18-32, which applies to hospital license, supplemental service approval and special permit regulations
  • AFL 18-33, which applies to hospital medical records regulations
  • AFL 18-34, which applies to hospital medical service regulations
  • AFL 18-35, which applies to hospital records and reporting regulations
  • AFL 18-36, which applies to small and rural hospital regulations

Instructions for submitting comments, which are due Aug. 31, are included in each letter. Questions should be submitted to CHCQRegulationsUnit@cdph.ca.gov.

CHA News Article

CDPH Issues Report on End of Life Option Act

The California Department of Public Health (CDPH) released the 2017 End of Life Option Act Annual Report on Friday. The act, which became effective in June 2016, allows terminally ill individuals to obtain a prescription for a drug for the purpose of ending their lives if certain requirements are met. It also requires CDPH to publish aggregated annual reports on the act’s usage. According to the 2017 report, during that calendar year 577 individuals received aid-in-dying drugs under the act, 374 individuals died following ingestion of the prescribed drugs (11 of whom had obtained the drugs in 2016) and 86 individuals died without having ingested them; the outcome of the remaining individuals is currently undetermined.

The median age of those who died as a result of ingesting aid-in-dying drugs was 74 years. Almost 90 percent of those patients were white, nearly 73 percent had at least some level of college education and more than 83 percent were receiving hospice or palliative care.

CHA News Article

State Appeals Court Reinstates Physician-Assisted Death Law

A California appeals court has reinstated the state’s End of Life Option Act, which allows terminally ill individuals to obtain a prescription for a drug for the purpose of ending their lives if certain requirements are met. Last month, a Riverside County Superior Court judge declared the act unconstitutional because it was passed during a special legislative session called by Gov. Brown specifically to address certain budget shortfalls in health care services. The attorney general and patients and providers appealed this ruling; on Friday, the appeals court granted their requests for an immediate stay of that ruling. The act will now remain in effect — with patients and providers able to participate in physician-assisted death in accordance with its terms — pending further action by the appeals court.

CHA News Article

Physician-Assisted Death Law Ruled Unconstitutional

A Riverside County Superior Court ruled in May that California’s End of Life Option Act violated the state constitution because it was passed during a special legislative session called to work on other issues. The act, which went into effect in 2016, allows terminally ill individuals to obtain a prescription for a drug to end their life if they meet specified requirements.

The judge’s ruling was limited to this procedural issue; he did not rule on the legality of physician-assisted death. The California attorney general appealed the ruling and requested the appellate court to allow the act to be effective while the appeal is pending. The appellate court responded by ordering the parties to submit briefs on the legal issues involved. In addition, the attorney general filed a motion to vacate the trial court judgment, and a hearing on that motion will be held June 29.

In the meantime, the superior court’s ruling declaring the act void and enjoining the state from recognizing it remains in effect throughout the state. CHA will update its members on the status of the case after the hearing later this month.

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

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

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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

CMS to Provide Hospital-Specific Reports for Preview
Preview period Aug. 24-Sept. 24

The Centers for Medicare & Medicaid Services (CMS) will provide confidential, hospital-specific reports on two disparity methods that assess hospital performance for patients with social risk factors in the Hospital 30-day, All-Cause, Risk-Standardized Readmission Rate Following Pneumonia Hospitalization (NQF #0506) measure.

The reports will be available by Aug. 24 and available for preview through Sept. 24.  

CMS will host a national provider call on Sept. 12 from 1-2 p.m. (PT) to review the disparity methods and answer questions. Once available, registration details will be provided in CHA News.

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

CMS Guidance to Include The Joint Commission Standards for Ligature Risk

The Centers for Medicare & Medicaid Services (CMS) announced in the attached memo that its interpretive guidance for helping to reduce suicide and self-harm in health care facilities will include The Joint Commission’s ligature risk recommendations. CMS states in the memo that, until it releases its guidance, state survey agencies and accrediting organizations “may use their judgment as to the identification of ligature and other safety risk deficiencies, the level of citation for those deficiencies, as well as the approval of the facility’s corrective action and mitigation plans to minimize risk to patient safety and remedy the identified deficiencies.”

The American Society for Health Care Engineering, a professional membership group of the American Hospital Association, has created several tools and resources to help hospitals address ligature risk and patient safety.

Education event

Ligature Risks — Regulatory Update and Compliance Expectations for all Hospitals Webinar
Learn about CMS, TJC recommendations, ways to comply

October 2, 2018
10:00 – 11:30 a.m., Pacific Time

Suicide is on the rise and the leading cause of death in the nation. While CMSInterpretive Guidelines regarding ligature compliance are still in development, they have made their intentions for compliance clear in a recently released memo. Surveyors and health care providers are to follow recommendations developed by a Joint Commission multi-stakeholder Suicide Panel. Learn the steps to maintain compliance with Medicare CoPs for ligature/self harm.

CHA News Article

HQI Features ‘Stellar’ Panel at 2018 Annual Conference
Physician astronauts Yvonne Cagle and Jim Bagian to keynote

In its fifth year, the Hospital Quality Institute (HQI) Annual Conference will spotlight physician leaders from NASA as well as the U.S. Navy and Air Force. Featuring themes of respect, reliability and resilience, the conference will be held Oct. 28–30 in Huntington Beach. A panel discussion moderated by Neil Romanoff, MD, will feature Jim Bagian, MD, PE, physician engineer and former NASA astronaut; U.S. Air Force Colonel Yvonne Cagle, physician and former NASA astronaut; and naval Commander Zac Alexander, MD. 

HQI invites hospital quality improvement, risk, and patient safety leaders to learn strategies and tools for leading reliability, transforming care and delivering value to each person, each time and in each community. Details and registration information are available at www.hqinstitute.org/hqi2018.

Overview

Workforce

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

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

CHA News Article

CMS 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.

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.

Commands