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

Health Care Personnel Flu Vaccination Rates Published

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

CHA News Article

CDPH Issues Guidance for Hospitals on Submitting Plans of Correction

The California Department of Public Health (CDPH) has released the attached All Facilities Letter with new guidance for submitting plans of correction. Earlier this year, the Centers for Medicare & Medicaid Services (CMS) expanded the ways in which providers may submit plans. While previously required to submit plans of correction written on on the right side of CMS Form 2567, providers now have the option of instead including their plan as a separate attachment. CDPH has extended this practice to state-issued 2567 forms. More details are available in the attached letter.

CHA News Article

Wildfire-Affected Facilities May Apply for Program Waivers of Licensing Requirements

The California Department of Public Health has issued the attached All Facilities Letter stating that health facilities affected by recent California wildfires — including those in Butte, Lake, Napa, Orange, Mendocino, Nevada, Sonoma, Yuba and Solano counties — are eligible to apply for waivers of certain licensing requirements. The waivers are intended to expedite recovery efforts and ensure that hospitals and other health facilities remain open. Details on obtaining a waiver are included in the attached letter; requests should be submitted to executiveorderprogramwaivers@cdph.gov.

CHA News Article

First Flu-Related Death of the Season Reported in California
CDPH emphasizes importance of vaccination

Last week, the California Department of Public Health (CDPH) announced that it had received the first report of an influenza-related death in a person under the age of 65 for the 2017-18 flu season. Each year, influenza is estimated to cause millions of illnesses, tens of thousands of hospitalizations and thousands of deaths in California. To protect against the virus, CDPH recommends the annual flu vaccine, which can be obtained from health care providers, clinics or pharmacies. To find a nearby location, use CDPH’s flu vaccine finder.

CHA News Article

CHA Webinar to Address New Centralized Licensing Application Process
Will help hospitals avoid errors and complete the process with confidence

Hospitals planning ownership changes, service expansion or location changes to existing services should take advantage of an upcoming CHA webinar, to be held Dec. 12 from 10-11:30 a.m. (PT), that will address recent changes to California Department of Public Health (CDPH) application processes. In 2015, the CDPH Center for Health Care Quality announced that applications previously processed by district offices would instead be processed through a Centralized Application Unit. The change in process has caused confusion, resulting in some delays.

Overview

Community Benefit Programs
Hospitals give back to their communities

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

Tax-Exempt Status of Nonprofit Hospitals

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

CHA News Article For Members

CHA Releases Brochure Highlighting California’s Community Benefit History

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

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

Overview

Clinical Care

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

CHA News Article

CHA Webinar Will Clarify Laws Related to Law Enforcement Interactions
Register today to learn how to respond when officers or ICE come to the ED

CHA will hold a webinar Nov. 29 from 10 a.m. – noon (PT) to explore the state and federal laws that govern law enforcement access to patients and patient information. Case examples will illustrate common, but complex, situations that often trip up the best-intentioned hospital workers. Participants will gain valuable information to make confident decisions and take away tips to advance working relationships with law enforcement. For more information and to register, visit www.calhospital.org/law-enforcement-web.

Education event

Critical Decision Points: The Intersection of Law Enforcement and Patient Care Webinar
Gain the legal clarity you need to respond decisively

November 29, 2017
10:00 a.m. – 12:00 p.m., Pacific Time

The hospital environment is intense, but blood pressures can rise even higher when law enforcement is present. Sometimes staff are unsure how or if they should comply with law enforcement requests. This program provides valuable information so staff can make confident decisions and advance working relationships with law enforcement.

General Information

Emergency Department Toolkit
Behavioral health resources for the emergency department

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

CHA News Article

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

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

Recording

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

Webinar recorded live April 18, 2016

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

Overview

Construction / Renovation

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

CHA News Article

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

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

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

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

CHA News Article

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

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

CHA News Article

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

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

CHA News Article

OSHPD Moves to New Location in Sacramento

Last month, the Office of Statewide Health Planning and Development moved to a new location. Its headquarters are now at 2020 West El Camino Ave., Sacramento, CA 95833. Email addresses and phone numbers remain the same. Effective immediately, Hospital Building Safety Board (HBSB) meetings have also moved to the same location; details are available on the OSHPD website.

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

Hospital Associations Raise $207,000 for Hospital Employees Affected by Wildfires

Last month, California experienced devastating wildfires that temporarily closed two northern California hospitals and displaced more than 250 hospital employees. Immediately following these events, the California Hospital Association, Hospital Council of Northern and Central California, Hospital Association of Southern California and Hospital Association of San Diego and Imperial Counties established the Hospital Workers’ Fire Relief Fund to provide financial support for hospital employees significantly affected by the fires. Through the generosity of over 70 individuals and organizations from across the nation, the fund has raised over $207,000. Hospitals in the affected areas will be contacted this week with information on the process to request a distribution from the fund. 

Post

CMS Presentation from the 2017 Annual Disaster Planning Conference
Information and Q&A

The CMS Emergency Preparedness Final Rule is now in effect. Review the CMS Power Point for information, Q&A, and CMS contact email.

CHA News Article

Discount Deadline Approaching for Behavioral Health Care Symposium, Emergency Services Forum
Register by Nov. 14 to save on tuition and accommodations

The discounted registration deadline for CHA’s upcoming Behavioral Health Care Symposium and Emergency Services Forum, to be held Dec. 4-6 in Riverside, is quickly approaching. Participants who register by the Nov. 14 deadline will save $100 on tuition. A limited number of rooms at the Historic Mission Inn in Riverside are still available, beginning at a discounted rate of $179.  

The event will begin Dec. 4 with a focus on behavioral health care policy issues and will continue Dec. 5 with a blended format for behavioral health care providers and emergency department professionals. The final day, Dec. 6, will focus solely on emergency medical care services issues and innovative practices to create future-focused emergency department care systems. 

Attendees will learn about the latest developments driving behavioral health care and emergency services, including how to:

CHA News Article

Report Offers Guidance on Protecting Research From Disasters

A new report from the National Academies of Science, Engineering, and Medicine outlines researchers’ role in protecting the academic biomedical research community from disasters. After a disaster, losses can include damage to research facilities and data, disruption to research outcomes, and significant financial and administrative burden. In addition to offering guidance on how researchers can protect their work from a disaster such as a fire, flood or cyberattack, the report suggests ways to create a culture of preparedness and resilience. Focusing on five areas for planning – including prevention, protection, mitigation, response and recovery – the report also highlights case studies from recent disasters, including Hurricane Sandy.

CHA News Article

Wildfire-Affected Facilities May Apply for Program Waivers of Licensing Requirements

The California Department of Public Health has issued the attached All Facilities Letter stating that health facilities affected by recent California wildfires — including those in Butte, Lake, Napa, Orange, Mendocino, Nevada, Sonoma, Yuba and Solano counties — are eligible to apply for waivers of certain licensing requirements. The waivers are intended to expedite recovery efforts and ensure that hospitals and other health facilities remain open. Details on obtaining a waiver are included in the attached letter; requests should be submitted to executiveorderprogramwaivers@cdph.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

New Guidance Available on PPE for First Responders Exposed to Opioids

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

CHA News Article

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

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

CHA News Article

CDC Highlights Hospital Patients’ Risk of Exposure to Legionella Bacteria

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

CHA News Article

CDPH Approves Medical Waste Treatment Facilities

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

CHA News Article

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

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

Overview

Finance

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

CHA News Article

House Passes Tax Reform Legislation
CHA continues to oppose elimination of tax exemption for private activity bonds

The U.S. House of Representatives today passed the Tax Cuts and Jobs Act (House Resolution 1) by a vote of 227-205. The legislation passed largely along party lines, with three members of the California Republican delegation — Reps. Darrell Issa, Tom McClintock and Dana Rohrabacher — voting no. The bill includes a provision that would eliminate the tax exemption for private activity bonds, including qualified 501(c)(3) hospital bonds, which will directly impact hospitals’ ability to access capital for mandated infrastructure projects. Currently, the Senate version of the legislation does not contain this provision. Formal legislative text is expected from the Senate next week. CHA will continue to advocate for the provision’s removal as the House and Senate work to reconcile their versions of the bill.

CHA News Article

Tax Cuts and Jobs Act Would Impact Hospitals

House Republican leaders unveiled a tax plan today that would make sweeping changes in corporate and individual taxes, including provisions that would impact investor-owned and not-for-profit hospitals. The “Tax Cuts and Jobs Act” reduces the corporate tax rate to a flat 20 percent rate beginning in 2018. Personal services corporations would be subject to a flat 25 percent corporate tax rate. Changes to employee compensation include a repeal of the $1 million deduction limitation for commissions and performance-based compensation to “covered employees” in corporations. 

Additionally, the Act makes revisions to the definition of “covered employee” to align with current Securities and Exchange Commission disclosure rules, which include the chief executive officer, chief financial officer and the three other highest paid employees. Tax-exempt organizations would be subject to a 20 percent excise tax on compensation in excess of $1 million paid to any of their five highest paid employees for tax years beginning after 2017. Under current law, interest on governmental bonds and private activity bonds is tax exempt. The proposed plan would make taxable the interest on private activity bonds issued after 2017. One of the specific health care provisions calls for a repeal of tax credits for clinical testing expenses for certain drugs for rare diseases or conditions. Attached is a copy of the section-by-section summary issued by the House of Representatives Committee on Ways and Means. 

CHA News Article

FY 2018 IPPS and LTCH PPS Claims to be Held

Due to revised rates in the fiscal year (FY) 2018 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPSfinal rule correction notice, published on Sept. 29, the FY 2018 IPPS and LTCH PPS pricers will be installed into production on Oct. 23.

As a result, all IPPS and LTCH PPS claims with discharge dates on Oct. 1 through Oct. 23 will be held by Medicare administrative contractors (MACs) until the pricers are tested and installed. Since the required 14-day payment floor count begins the day a claim is received by the MAC, any clean claims held until Oct. 23 will not be subject to another payment floor. Providers should contact their MAC with any questions.

CHA News Article

Treasury Department Issues Recommendations for Reducing Regulatory Burden

The U.S. Department of the Treasury released a report on Oct. 4 recommending actions for eight previously identified regulations that “impose an undue financial burden,” “add undue complexity” or exceed the Internal Revenue Service’s statutory authority. The review of the regulations is part of President Trump’s Executive Order 13789, which further directs the Secretary to submit “specific actions to mitigate the burden imposed” by the identified regulations. The report recommends that two proposed regulations be withdrawn entirely, three temporary or final regulations be revoked in substantial part and the remaining three regulations be substantially revised. 

One of the regulations the report notes as needing substantial revision is under Section 337(d) on Certain Transfers of Property to Regulated Investment Companies and Real Estate Investment Trusts. Investor-owned hospitals and not-for-profit hospitals with taxable subsidiaries or interests should review the report to determine applicability. 

CHA News Article

Report Examines Volatility of California’s Personal Income Tax Structure

The Legislative Analyst’s Office has released a report discussing the volatility of California’s personal income tax. The personal income tax is state government’s most important revenue source, contributing over two-thirds of the state General Fund, which supports schools, universities, major health and social services programs, prisons and other state‑funded programs. 

The report found that about 40 percent of personal income tax volatility is due to choices about which types of income to tax. About another 40 percent is due to the rate structure, which taxes higher incomes at higher rates. This amplifies the volatility of taxes paid by high‑income taxpayers. Finally, about 20 percent of personal income tax volatility is due to deductions and credits, which mostly serve to reduce the tax liabilities of low‑income and middle‑income taxpayers.

The volatility of higher income taxes, by extension, will affect the revenues collected for Proposition 55. Proposition 55 extends by 12 years (through 2030) the temporary personal income tax increases enacted in 2012 on earnings over $250,000, with revenues targeted for K–12 schools, California community colleges and health care for low-income people.

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

CHA Provides Weekly Strategies for Hospitals During Open Enrollment

Hospitals are leaders in helping Californians enroll — and stay enrolled — in health coverage. Because ongoing debate at the federal level about the Affordable Care Act has left many Californians uncertain about the future of health insurance marketplaces, this year’s open enrollment period is more crucial than ever. Covered California’s open enrollment began Nov. 1 and will continue through Jan. 31, 2018, but consumers need to sign up by Dec. 15 to ensure coverage starting in January.

To facilitate hospitals’ efforts this year, CHA is launching a weekly series of strategies for helping patients obtain coverage through the Covered California marketplace and the Medi-Cal program. The attached summary explains how the strategies have been developed and how hospitals can apply them, and includes updates on health insurance coverage in California. Tomorrow’s CHA News will include the first of seven strategies, with weekly installments to follow. The complete strategy series, as it is published, will also be available at CHA’s dedicated web page.

CHA News Article

Report Poses Key Questions for Considering Single-Payer System in California

A new report from the California Health Care Foundation identifies key questions and issues related to establishing a single-payer health care system in California. The report does not address specific legislation or proposals, but instead seeks to establish a baseline understanding of a single-payer system. The report first sets forth a common definition of “single payer” as a centralized, publicly organized means to collect, pool and distribute money to pay for the delivery of health care services for all members of a defined population. Then, the report addresses key questions about how such a system would impact the state, including:

  • What problems is a single-payer system being designed to solve?
  • What money is available to support a single-payer system in California?
  • How would a single-payer entity arrange to purchase health care services?
  • How would payments to providers of health care services be set and structured?
  • What would be the conditions of provider participation?
  • Who would be eligible to use the system?
  • What would be the covered benefits and services?
  • How would the system’s governance and administrative structure be designed?
CHA News Article

Covered California 2018 Open Enrollment Period Begins

Consumers can renew or change existing coverage, or purchase new coverage, on California’s state-based health care exchange through Jan. 31, 2018.

CHA News Article

Covered California Offers Open Enrollment Toolkit for Hospitals
Open enrollment begins Nov. 1 and lasts through Jan. 31, 2018

CHA and Covered California are joining together to ask for hospitals’ continued assistance in ensuring that all patients understand the health coverage options available to them through the Covered California marketplace. In addition, Covered California has developed a toolkit for hospitals, offering ready-to-use information to share with patients. The attached letter contains links to a variety of toolkit resources, including an open enrollment fact sheet, as well as flyers on the financial assistance available through the Covered California marketplace and steps patients can take to apply for coverage.  Covered California urges hospitals to consider other ways to promote open enrollment in their communities, such as through social media, by including information in community newsletters, participating in local press events or partnering to promote enrollment events.  

California hospitals have played a vital role in communicating with patients about their Covered California health coverage options and will continue to lead the way in assisting patients with eligibility and information during the open enrollment period from Nov. 1 through Jan. 31. 

CHA News Article

President Issues Executive Order Related to Health Insurance

Today, President Trump issued an Executive Order directing the Secretary of Labor to consider expanding access to association health plans through a broader interpretation of the Employee Retirement Income Security Act, which could allow small businesses anywhere in the country to join together across state lines to offer health care coverage to their employees. Additionally, the order directs the Departments of the Treasury, Labor and Health and Human Services to consider 1) expanding coverage through short-term limited duration insurance plans that would not be subject to Affordable Care Act (ACA) consumer protections and benefit rules, and 2) expanding flexibility and use of health reimbursement arrangements. While the Trump Administration views the Executive Order as taking action to increase health care choices for millions of Americans, the action is viewed by some as a potential threat to the viability of ACA marketplaces. CHA will monitor this action’s impact on the Covered California marketplace and on the broader health care delivery system.

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

Governor Signs Bills Amending Medical Records, Privacy Laws

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

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

CHA News Article

Electronic Clinical Quality Measures Transitioning to Clinical Quality Language in 2019

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

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

CHA News Article

CMS Issues Draft eCQM Specifications Using Clinical Quality Language

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

CHA News Article

Updated eCQM Specifications Available for Calendar Year 2018

The Centers for Medicare & Medicaid Services (CMS) has posted the 2017 annual update for electronic clinical quality measures (eCQMs) for calendar year 2018 reporting for eligible hospitals and critical access hospitals (CAHs), as well as eligible professionals and clinicians. The updated eCQMs may be included in the future in any of the following programs:

  • Hospital Inpatient Quality Reporting Program
  • Medicare Electronic Health Record (EHR) Incentive Program for eligible hospitals and CAHs
  • Medicaid EHR Incentive Program for eligible professionals, hospitals and CAHs
  • Quality Payment Program: The Merit-based Incentive Payment System (MIPS) for MIPS-eligible clinicians and alternative payment models
CHA News Article

Important Changes Announced for Medi-Cal EHR Incentive Program

The Department of Health Care Services (DHCS) has changed an eligibility rule for hospitals applying to the program year 2016 Medi-Cal Electronic Health Record Incentive Program for the first time. Previously, DHCS required hospitals to submit cost report data for a continuous 12-month period ending before the start of the federal fiscal year (Oct. 1-Sept. 30) that serves as the program year for the Medi-Cal EHR Incentive Program. Under the recent change, hospitals will be able to submit data for the 12-month period before the fiscal year ends. In addition, hospitals with a new CCN must reapply to the program.

Hospitals are reminded that program year 2016 marks the last opportunity to start the program; applications from hospitals that have not successfully participated in the 2016 program will not be accepted for 2017 and subsequent years. Applications are due May 2. For more information, visit http://medi-cal.ehr.ca.gov/ or call (916) 552-9181.

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

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

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

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

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

CHA News Article

CDPH Seeks Comment on Criminal Record Clearance Regulations

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

CHA News Article

New Criminal Background Regulations Approved
Rules will take effect July 1

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

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

CHA News Article

RNs With Incomplete Records Must Submit Fingerprints
BRN to notify affected RNs, provide instructions

The Board of Registered Nursing (BRN) has determined that certain registered nurses do not have both Department of Justice (DOJ) and Federal Bureau of Investigation (FBI) fingerprint results on file with the BRN. LiveScan testing incorporates both DOJ and FBI requirements; however, if the LiveScan technology did not produce clear results or an outdated method of fingerprinting was used, the RN may not have acceptable fingerprints on file. 

The BRN is working to contact all affected RNs via mail and/or email with instructions. To avoid potential delays in license renewal or other action, RNs should read the information carefully and respond accordingly. In most cases, RNs will be required to submit fingerprints within 60 days of notification or risk citation, fines or referral to the Attorney General’s office for possible disciplinary action.

Detailed information is available at www.rn.ca.gov.

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 Webinar Will Clarify Laws Related to Law Enforcement Interactions
Register today to learn how to respond when officers or ICE come to the ED

CHA will hold a webinar Nov. 29 from 10 a.m. – noon (PT) to explore the state and federal laws that govern law enforcement access to patients and patient information. Case examples will illustrate common, but complex, situations that often trip up the best-intentioned hospital workers. Participants will gain valuable information to make confident decisions and take away tips to advance working relationships with law enforcement. For more information and to register, visit www.calhospital.org/law-enforcement-web.

Education event

Critical Decision Points: The Intersection of Law Enforcement and Patient Care Webinar
Gain the legal clarity you need to respond decisively

November 29, 2017
10:00 a.m. – 12:00 p.m., Pacific Time

The hospital environment is intense, but blood pressures can rise even higher when law enforcement is present. Sometimes staff are unsure how or if they should comply with law enforcement requests. This program provides valuable information so staff can make confident decisions and advance working relationships with law enforcement.

CHA News Article

No Private Lawsuit Allowed Under Involuntary Mental Health Evaluation Laws

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

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

CHA News Article

2017 Consent Manual Released
CHA mails each member organization a free manual

CHA is pleased to announce the 2017 Consent Manual is now available. Updated to reflect changes to state and federal consent law through January 2017, the Consent Manual explains the law and what hospitals need to do to comply. As a service to members, one complimentary copy of this acclaimed publication is being sent to each member hospital and system CEO this week.

The Consent Manual is the most comprehensive resource available on consent for medical treatment, covering situations involving minors, mental health, end-of-life issues and advance health care directives, patients’ rights, privacy basics, reporting requirements and related health care law. It is designed to help keep hospital executives abreast of the law and provide answers to difficult questions faced by staff every day.

Recording

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

Webinar recorded live April 18, 2016

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

Overview

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

CHA Webinar Will Clarify Laws Related to Law Enforcement Interactions
Register today to learn how to respond when officers or ICE come to the ED

CHA will hold a webinar Nov. 29 from 10 a.m. – noon (PT) to explore the state and federal laws that govern law enforcement access to patients and patient information. Case examples will illustrate common, but complex, situations that often trip up the best-intentioned hospital workers. Participants will gain valuable information to make confident decisions and take away tips to advance working relationships with law enforcement. For more information and to register, visit www.calhospital.org/law-enforcement-web.

Education event

Critical Decision Points: The Intersection of Law Enforcement and Patient Care Webinar
Gain the legal clarity you need to respond decisively

November 29, 2017
10:00 a.m. – 12:00 p.m., Pacific Time

The hospital environment is intense, but blood pressures can rise even higher when law enforcement is present. Sometimes staff are unsure how or if they should comply with law enforcement requests. This program provides valuable information so staff can make confident decisions and advance working relationships with law enforcement.

CHA News Article

Hospitals Should Review Child Abuse Reporting Policies

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

Publication

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

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

Publication

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

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

General Information

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

Overview

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

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

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

Podcasts

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

Webinar Recordings

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

Quality & Patient Safety

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

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

CHA News Article

OSHPD Issues Report on Ischemic Stroke Care Quality
Data cover care from 2014-15

The Office of Statewide Health Planning and Development (OSHPD) has released its report on the quality of ischemic stroke care at California acute care hospitals between 2014 and 2015, providing performance ratings for 267 hospitals on two risk-adjusted outcome measures: 30-day mortality and 30-day hospital readmission. In cases of ischemic stroke, timely interventions are critical to reverse the damage; reduce mortality, morbidity and disability; and improve quality of life.

30-day Ischemic Stroke Mortality Findings
Statewide, the percentage of patients who died within 30 days of hospital discharge was 9.8 percent, down slightly from 10 percent in the 2013-14 report. The average risk-adjusted mortality rate for the 14 hospitals rated “Worse” (18.8 percent) than the state average was more than three times higher than the average rate for the 11 hospitals rated “Better” (5.5 percent). Seven hospitals rated “Better” in the 2013-14 report were again rated “Better” in 2014-15. Eight hospitals rated “Worse” in the 2013-14 report were again rated “Worse” in 2014-15.

CHA News Article For Members

CHA Urges FDA to Resolve Shortage of Small-Volume Intravenous Solutions

CHA continues to monitor the ongoing shortage of intravenous fluid mini-bags resulting from Hurricane Maria in Puerto Rico. Last week, CHA sent the attached letter to the Food and Drug Administration, urging the agency to take “any and all steps possible” to expedite the shortage’s resolution.

CHA News Article

HQI Announces 2017 Annual Quality Award Winner, Finalists
Renames award to honor C. Duane Dauner

The Hospital Quality Institute (HQI) last week announced Santa Clara Valley Medical Center as the winner of the 2017 C. Duane Dauner Quality Award (formerly known as the Vanguard Award) for its Specialty Care Access Improvement Initiative, an innovative approach to improving patient experience and timely access to quality specialty referrals. 

The HQI Board of Directors renamed the organization’s Vanguard Award to the C. Duane Dauner Quality Award. Dauner recently retired after a 32-year tenure as CHA’s President/CEO and played an instrumental role in creating HQI, which seeks to discover new and better ways to improve care in California hospitals and communities. In renaming the award, HQI honors Dauner and carries forward his legacy of excellence for generations to come.

HQI also announced the following 2017 award finalists:

CHA News Article

Electronic Clinical Quality Measures Transitioning to Clinical Quality Language in 2019

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

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

CHA News Article

CHA Continues to Monitor IV Solution Shortage

As previously reported in CHA News, CHA and the American Hospital Association (AHA) are actively working to address a growing intravenous (IV) fluid mini-bag shortage resulting from Hurricane Maria in Puerto Rico. CHA has contacted the California Board of Pharmacy and surveyed the CHA Medication Safety Committee for information on specific shortages and the strategies hospitals are pursuing. AHA has communicated to Food and Drug Administration staff the seriousness of the situation and requested that the agency take all steps possible to expedite its resolution. AHA continues to track the Food and Drug Administration’s progress in responding to the shortage.

AHA is also communicating with U.S. Department of Health and Human Services staff working on Puerto Rico recovery efforts, as Baxter ­— a leading medical supply company ­— has several plants in Puerto Rico that are currently unable to manufacture small-volume parenteral IV solutions. In addition, AHA has released a Quality Advisory Alert outlining strategies for conservation during the shortage.

AHA is co-sponsoring a drug shortage summit, to be held Nov. 6, that will convene several government committees to address drug shortages and solutions. CHA will continue to communicate information on the shortage via CHA News

Overview

Reimbursement

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

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

CHA News Article

Tax Cuts and Jobs Act Would Impact Hospitals

House Republican leaders unveiled a tax plan today that would make sweeping changes in corporate and individual taxes, including provisions that would impact investor-owned and not-for-profit hospitals. The “Tax Cuts and Jobs Act” reduces the corporate tax rate to a flat 20 percent rate beginning in 2018. Personal services corporations would be subject to a flat 25 percent corporate tax rate. Changes to employee compensation include a repeal of the $1 million deduction limitation for commissions and performance-based compensation to “covered employees” in corporations. 

Additionally, the Act makes revisions to the definition of “covered employee” to align with current Securities and Exchange Commission disclosure rules, which include the chief executive officer, chief financial officer and the three other highest paid employees. Tax-exempt organizations would be subject to a 20 percent excise tax on compensation in excess of $1 million paid to any of their five highest paid employees for tax years beginning after 2017. Under current law, interest on governmental bonds and private activity bonds is tax exempt. The proposed plan would make taxable the interest on private activity bonds issued after 2017. One of the specific health care provisions calls for a repeal of tax credits for clinical testing expenses for certain drugs for rare diseases or conditions. Attached is a copy of the section-by-section summary issued by the House of Representatives Committee on Ways and Means. 

CHA News Article

CMS Issues Revised Instructions for S-10 Worksheet
Also extends deadline to submit amended FFY 2014 and 2015 cost reports to Oct. 31

The Centers for Medicare & Medicaid Services (CMS) has updated its instructions for Worksheet S-10. The update, attached, clarifies definitions and instructions for uncompensated care, non-Medicare bad debt, non-reimbursed Medicare bad debt and charity care to include uninsured discounts. It also modifies the calculation relative to uncompensated care costs. The changes are effective for cost reporting years from Oct. 1, 2013, onward. CHA is currently reviewing the revisions and will provide members with more detail in the coming weeks.

In addition, CMS has extended the deadline for hospitals to revise and submit amended cost reports for federal fiscal years (FFY) 2014 and 2015 from Sept. 30 to Oct. 31. CHA urges members to review Worksheet S-10 of their FFY 2014 and 2015 cost reports and submit amendments to their respective Medicare administrative contractors before the Oct. 31 deadline. More information is available in the attached MLN Matters article. 

CHA News Article

CMS Releases Newly Redesigned Medicare Cards

The Centers for Medicare & Medicaid Services (CMS) last week released the newly redesigned Medicare card, which contains a unique, randomly-assigned number that replaces the current Social Security-based number. To meet its statutory deadline for replacing all existing Medicare cards by April 2019, CMS will begin mailing the new cards to individuals with Medicare benefits in April 2018 .

CMS has assigned everyone with Medicare benefits a new, unique Medicare number, which contains a combination of numbers and uppercase letters. Issuance of the new number will not change recipients’ Medicare benefits.  

Health care providers and Medicare beneficiaries will be able to use secure look-up tools that will allow quick access to the new Medicare numbers when needed. To ease the transition, CMS will provide a 21-month transition period during which doctors, providers and suppliers will be able to use either the current or new Medicare number.

This initiative takes important steps toward protecting the identities of Medicare beneficiaries. CMS is also working with health care providers to answer their questions and ensure they have the information they need to make a successful transition to the new Medicare number. More information is available at www.cms.gov/newcard.

CHA News Article

Hospitals Reminded to Submit Revised Worksheet S-10 Data to CMS
Revision deadline is Oct. 31

The Centers for Medicare & Medicaid Services’ (CMS’) federal fiscal year (FFY) 2018 inpatient prospective payment system final rule establishes changes to fund distribution for Medicare disproportionate share hospital (DSH) uncompensated care (UCC) payments. CMS determined that it will phase-in payments based on information collected from Line 30 on the S-10 Worksheet of the Medicare cost report to determine the UCC payment factor, starting with FFY 2014 cost reports for DSH UCC payments in FFY 2018.

As previously reported in CHA News, hospitals may submit revisions to Worksheet S-10 of their Medicare cost report for FFYs 2014 and 2015. CHA urges members to review Worksheet S-10 of their FFY 2014 and 2015 cost reports and submit amendments to their respective Medicare administrative contractors before the Oct. 31 deadline.

CHA News Article

Providers Required to Use Two Updated CMS Forms
Revised EFT, Advance Beneficiary Notice of Noncoverage forms available

The Centers for Medicare & Medicaid Services (CMS) has released two new forms for providers’ use. The first form relates to electronic funds transfers, and is required to be completed by all Medicare Part A providers who are enrolling or revalidating, or who have changes to their employer identification number, pay-to address or legal business same. The second form released by CMS is an updated Advance Beneficiary Notice of Noncoverage; providers were required to begin using this form June 21. Any new notices submitted on the old form after June 21 will be considered invalid, and will result in provider liability if Medicare denies the claim.

Profile

Amber Ott
Vice President, Strategic Financing Initiatives

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

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

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

Workforce

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

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

CHA News Article

Map Shows Primary Care and Specialist Physicians by County

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

CHA News Article

Report Describes Physician Market in California

A recent report from the California Health Care Foundation examines the landscape of physician services in California, including supply, physician demographics, education and compensation. According to the report, nearly half of licensed physicians provide 40 or more hours of care per week, while 21 percent provide fewer than 20 hours. Active patient care physicians overwhelmingly identified as white or Asian/Pacific Islander – 60 percent combined – while Latino and African American physicians represented only a combined 8 percent. Roughly one-quarter of physicians represented in the report attended medical school in California. The report also found that physician supply varied by region — the greater Bay Area was the only region that met the recommended supply of primary care physicians, while Inland Empire, San Joaquin Valley, and northern and Sierra counties all fell short of the recommended supply of specialists.

CHA News Article

Support Requested for HealthImpact

Many CHA members financially support HealthImpact, and the progress that has been made through their commitment to ensuring a well prepared nursing workforce demonstrates it has been a sound investment. The program’s name change to HealthImpact two years ago reflects a focus on optimizing health through nursing. The organization remains committed to improving the health of Californians by promoting a dynamic, highly skilled nursing workforce. As a 501(c)(3) organization, HealthImpact does not receive public funds, so its infrastructure funding is dependent on contributions from financial partners, primarily hospitals and health systems. Soon, CHA members will receive a letter from HealthImpact requesting a financial contribution. Please join CHA in providing financial support as a community benefit contribution.

Post

New Study Analyzes Medical Lab Technician Scope of Practice
UCSF Healthforce Center, CHA Healthcare Laboratory Workforce Initiative collaborated on study

With support from CHA’s Healthcare Laboratory Workforce Initiative, the University of San Francisco Healthforce Center has released the attached comprehensive study comparing scope of practice nationwide for medical laboratory technicians (MLTs).

California, along with the rest of the nation, faces a critical laboratory workforce shortage. Clinical lab scientists (CLS) — bachelor degree trained individuals licensed to perform highly complex tests in a federally approved clinical lab — are in high demand and considered among the most difficult positions to fill in a hospital. To mitigate the impact of this shortage, in 2007 California licensed MLTs, after a long period of developing both a training program and regulations. MLTs are associate degree level professionals allowed to perform moderately complex tasks under federal law.

CHA News Article

Report Shows 1.4 Million Californians Employed in Health Care in 2015

The California Health Care Foundation has released a new report on the health care workforce in California. According to the report, 1.4 million Californians were employed in health care in 2015; of that number, 55 percent were employed in ambulatory settings, 25 percent in hospitals, and 20 percent in nursing or residential care facilities. Between 2012 and 2015, the number of pharmacists and physician assistants grew by 17 percent and 37 percent, respectively. Additionally, the supply of occupational and physical therapists increased over that period, as did the number of medical/clinical lab technicians. However, California’s supply of clinical laboratory scientists remained stable, and the state’s number of speech-language pathologists decreased slightly. The report notes that an aging population, population growth and federal health reform will likely contribute to increased workforce demand.

Commands