Hospital Topics


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

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

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

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 90 days prior to anticipated completion.

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


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.


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

Webinar Recorded Live on November 14, 2014


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.


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


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.


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

CHA Submits Pre-Regulatory Comments on Title 22 Regulations

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

Comments are due to CDPH on Aug. 31. Questions should be submitted to​

CHA News Article

OSHPD to Hold Seminars on SPC-1 and SPC-2 Buildings, New Code Standards

The Office of Statewide Health Planning and Development Facilities Development Division and the Hospital Building Safety Board will hold an in-person educational seminar in November about repurposing SPC-1 and SPC-2 buildings to align with the proposed 2019 California Building Standards Code. The program will be held in Southern California on Nov. 8 and in Northern California on Nov. 14; the same information will be covered in each seminar. Both seminars will include case studies to help hospitals and their design teams as they plan ahead. CHA recommends that members attend and will share more details in CHA News as they become available.

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.



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

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

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

CHA News Article

Covered California Announces 2019 Rates, Plans for Small Businesses

Last week, Covered California released the 2019 health plan choices and rates for small businesses and their employees. On average, premiums in 2019 will increase 4.6 percent over 2018, the smallest year-over-year increase since the marketplace’s inception in 2014. Plan offerings for 2019 include two preferred provider organization plans from Blue Shield of California and Health Net; two health maintenance organization plans (Kaiser Permanente and Blue Shield); Chinese Community Health Plan in San Francisco; and Sharp Health Plan in San Diego. Health Net will launch new offerings in the final quarter of 2018.

Currently, more than 47,000 individuals have insurance through Covered California for Small Business. Since last year, membership has grown 33 percent — by approximately 12,000 individuals. As a result of this growth, it is one of the largest small business health options programs in the nation.

CHA News Article

U.S. Census Data Show Drop in California’s Uninsured Rate
2017 income, poverty and health insurance coverage data released

This week, the U.S. Census Bureau released reports on Income and Poverty in the United States: 2017Health Insurance Coverage in the United States: 2017 and The Supplemental Poverty Measure: 2017. The data show California’s uninsured rate dropped from 17.2 percent in 2013 to 7.2 percent in 2017, a nearly 60 percent drop in the number of uninsured Californians since 2013. California’s reduction in the uninsured rate represents the largest in the nation, with more than 3.7 million Californians obtaining health insurance coverage through Covered California and Medi-Cal since the Affordable Care Act launched in 2014. Overall, the national uninsured rate remained statistically unchanged at 8.8 percent. 

To provide additional information and perspective on the new health insurance coverage data, Covered California released the attached press release.

The U.S. Census Bureau also announced that, nationally, real median household income increased by 1.8 percent between 2016 and 2017, while the official poverty rate decreased for the third consecutive year to 0.4 percent. The nation’s official poverty rate in 2017 was 12.3 percent, with 39.7 million people in poverty — statistically unchanged from 2016. Since 2014, the poverty rate has fallen 2.5 percentage points, from 14.8 percent to 12.3 percent. California’s 2017 overall poverty rate (13.3 percent) and child poverty rate (18.1 percent) are both down from 2016 (14.3 percent and 19.9 percent, respectively), yet still above their pre-recession levels. 

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

Covered California to Host Plan Management and Delivery Systems Reform Advisory Group Webinar

Covered California will host a Plan Management and Delivery Systems Reform Advisory Group webinar Sept. 6 from 10 a.m. – noon (PT). The health plan advisory group provides input to the Covered California board and staff on qualified health plan contracting strategies, ongoing benefit design issues and strategies to promote health care value and drive delivery system reform. 

The Sept. 6 meeting is scheduled to include discussions about the Covered California Quality Rating System for 2019 open enrollment, plan selection decision support tools and future capabilities, benefit design for the 2020 plan year, a subcommittee update on Assembly Bill 1810 (Chapter 34, Statutes of 2018) affordability reporting requirements and stakeholder survey results, and next steps. For more information, participants can register and find meeting materials in advance of the webinar online. A meeting agenda is attached.

CHA News Article

DHCS Releases Medi-Cal Monthly Enrollment Fast Facts

DHCS has released a Fast Facts report about Medi-Cal’s certified eligible population by basic demographic and administrative characteristics, such as age group, race/ethnicity, eligibility pathway and delivery system participation. The report was designed to provide stakeholders with the most current reportable eligibility information, making use of visual displays to convey information.  According to the most recent report:

  • Enrollment peaked at 13.6 million in April 2018.
  • Managed care enrollment comprises 82 percent of the total, while fee-for-service enrollment makes up 18 percent.
  • Enrollment by aide category includes: parent/caretaker relative & child (39 percent), Affordable Care Act expansion adults ages 19 to 64 (29 percent), seniors and persons with disabilities (15 percent), Children’s Health Insurance Program (10 percent), undocumented (5 percent), adoption/foster care (1 percent), other (1 percent), and long-term care (less than 1 percent).
  • Enrollment is 54 percent female, 46 percent male.
  • Fifty percent of enrollees are 21-64 years old, 42 percent are 0-20 years old, and 9 percent are 65 years or older.
  • Race/ethnicity breakdown for this population is Hispanic (50 percent), White (19 percent), not reported (13 percent), Asian/Pacific Islander (10 percent), African-American (8 percent), American Indian/Alaskan Native (less than 1 percent)
  • Dually eligible individuals represent 11 percent of enrollment.

To view Fast Facts and other research produced by DHCS, visit the DHCS website.


Emergency Preparedness
Is your hospital prepared?

Visit CHA’s Emergency Preparedness website at


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

CHA News Article

CMS Proposes Changes to Emergency Preparedness and Other CoPs

The Centers for Medicare & Medicaid Services (CMS) has released the attached proposed rule intended to reduce regulatory burden for hospitals, critical access hospitals (CAHs) and other providers. CMS proposes changes to its conditions of participation (CoPs) — including its emergency preparedness CoPs — and conditions for coverage.

With respect to its emergency preparedness policies, CMS proposes to:

  • Give facilities the flexibility to review their emergency program every two years rather than annually, or more often at their discretion.
  • Eliminate a duplicative requirement that the emergency plan include documentation of efforts to contact local, tribal, regional, state and federal emergency preparedness officials, as well as participation in collaborative and cooperative planning efforts.
  • Give facilities greater flexibility in revising training requirements to allow training to occur annually, or more often at their discretion.
  • Increase flexibility for the inpatient provider testing requirement so that one of the two testing exercises required annually may be an exercise of the facility’s choice. 
  • Reduce the number of testing exercises outpatient providers are required to conduct annually from two to one.
CHA News Article

September Is National Preparedness Month
CHA's Disaster Planning for California Hospitals conference is Sept. 24-26

National Preparedness Month highlights the importance of planning for disasters and emergencies that can occur at any time. This year’s theme — “Disasters Happen. Prepare Now. Learn How.” — emphasizes lifesaving skills and practical steps that can be used in disaster situations. A toolkit from with graphics, videos and social media content designed to promote awareness is available online.

CHA’s annual Disaster Planning for California Hospitals conference, set for Sept. 24-26 in Sacramento, will dive into the lessons learned during recent disasters across the nation. Sessions will address a wide range of emergency preparedness topics, including responses to the hurricane in Puerto Rico, the shooting in Las Vegas and cyberattacks. For more information and to register, visit

CHA News Article

HHS Issues Protocols for Emergency Response to Nerve Agent Exposure

Responding to requests from the emergency response community for advice on how to prepare for a chemical nerve agent attack, the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response, in conjunction with other federal agencies, has issued guidance titled “Nerve Agent Information for Emergency Medical Services and Hospitals.”

The document explains the difference between “high volatility” and “low volatility” chemicals that could be used as toxic warfare agents. It also includes information on the signs and symptoms of exposure, detection, personal protective equipment, patient decontamination, treatment, pediatric considerations and additional resources.

CHA News Article For Members

CHA Submits Pre-Regulatory Comments on Title 22 Regulations

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

Comments are due to CDPH on Aug. 31. Questions should be submitted to​

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.


Environmental Health & Safety

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

CHA News Article

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

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

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

Workshops Will Detail Proposed Regulations for Toxic Emissions Reporting

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

CHA News Article

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

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

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

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. 


CDC releases toolkit to reduce risk of Legionella

The Centers for Disease Control and Prevention (CDC) released a new toolkit to prevent Legionnaires’ disease outbreaks. The toolkit builds off of ASHRAE 188: Legionellosis: Risk Management for Building Water Systems.

The toolkit provides an easy-to-understand interpretation of ASHRAE Standard 188, as well as worksheets, checklists and scenarios of common water-quality problems. It also contains special sections and considerations for health care facilities.


Finance & Reimbursement

Hospital finance is complicated, and California hospitals operate in a challenging environment. Hospital executives are faced with the task of developing financial strategies that contain costs yet allow for the provision of health care to the state’s large uninsured population. CHA is committed to providing hospital financial executives with the resources needed to address these challenges, and believes that hospitals should be reimbursed adequately to cover the cost of care.

Through state and federal advocacy efforts, CHA dedicates many resources to fair government reimbursement and strives to improve hospitals’ financial outlook through legislative and regulatory channels. CHA’s statewide committees and workgroups help provide direction on how to best represent the diverse issues that affect hospitals’ financial performance. In addition, CHA DataSuite is an information-based toolset, available only to CHA members, that helps hospitals analyze government reimbursement changes, and the potential impact of regulatory and legislative actions on hospitals.  

CHA News Article

AHA Announces Initiative to Strengthen 340B Program

CHA encourages hospitals to participate in a new American Hospital Association initiative that encourages good stewardship of the 340B Drug Pricing Program. The initiative, announced earlier today, aims to strengthen the 340B program by increasing transparency while helping 340B hospitals better communicate the program’s immense value for vulnerable patients and communities. Under the initiative, hospitals are encouraged to:

  • Communicate the program’s value by publishing an annual narrative that describes how the hospital uses program savings to benefit the community.
  • Publicly disclose the hospital’s estimated savings under the program.
  • Continue rigorous internal oversight to ensure the hospital’s program meets Health Resources and Services Administration rules and guidance.

For more information on the 340B program, visit

CHA News Article

IRS Requests Comments on Unrelated Business Income Calculation
Provides guidance for exempt organizations

Last month, the Internal Revenue Service (IRS) issued Notice 2018-67, which requests public feedback on the calculation of unrelated business taxable income. The notice also provides interim guidance and transition rules related to IRS Code Section 512(a)(6) for exempt organizations with more than one unrelated trade or business. Finally, the notice addresses treatment of Global Intangible Low-Taxed Income Inclusions (GILTI) for purposes of unrelated business income (UBI).

Exempt organizations may rely on the notice for tax years beginning after Dec. 31, 2017, until proposed regulations are published. Organizations may rely on reasonable, good-faith interpretations of the unrelated business income rules, taking into account all the facts and circumstances.

 Comments are due Dec. 3.

CHA News Article

Hospital Groups’ Lawsuit Seeks 340B Program Price Transparency

In an effort to promote drug pricing transparency, hospital groups yesterday sued the Department of Health and Human Services (HHS) in an attempt to force the agency to make effective a final rule that requires drug companies to disclose the ceiling price for drugs acquired under the 340B Drug Pricing Program. The plaintiffs — the American Hospital Association, Association of American Medical Colleges, America’s Essential Hospitals, 340B Health and three hospital systems — allege that, in delaying the effective date of the final rule five times, HHS violated the Administrative Procedure Act.

In 2010, Congress required the HHS Secretary to develop a final rule that addressed ceiling prices, among other topics. The final rule includes provisions that address the method of calculating ceiling prices and allow the federal government to penalize drug companies that intentionally overcharge 340B providers. More information about the lawsuit is available on the American Hospital Association website. CHA will continue to monitor the situation and will share developments with members as it unfolds.

CHA News Article

Hospital Groups Refile Lawsuit to Reverse 340B Payment Cuts

Earlier this week, hospital representatives — including the American Hospital Association, the Association of American Medical Colleges, America’s Essential Hospitals and three hospital plaintiffs — refiled a lawsuit seeking relief from Medicare payment cuts to hospitals participating in the 340B Drug Pricing Program. The cuts reduced Medicare payments by nearly 30 percent, or $1.6 billion, to certain hospitals for outpatient drugs purchased under the 340B program.

Late last year, a federal district court granted the government’s motion to dismiss an earlier lawsuit that sought to prevent these payment cuts, which consequently became effective Jan. 1, 2018. At the time, the judge who ruled on the case did not address the case’s merits, instead holding that plaintiffs must first present a concrete claim for reimbursement to the Department of Health and Human Services. In July, an appeals court further delayed ruling on the case because no claims had been filed when the lawsuit to prevent the cuts was initially filed. 

CHA News Article For Members

CHA Member Forum on CY 2019 OPPS Proposed Rule Rescheduled
New date is Sept. 14

The CHA member forum to discuss the Centers for Medicare & Medicaid Services’ (CMS) outpatient prospective payment system (OPPS) proposed rule for calendar year (CY) 2019 has been rescheduled for Sept. 14 at 10 a.m. (PT). The proposed rule also includes payment updates for ambulatory surgical centers.

Members who have already registered will automatically receive meeting materials and the dial-in number the morning of the call.

During the forum, CHA will provide an overview of the proposed rule and seek member input for its comments, which are due to the agency Sept. 24.

Of note, CMS proposes to reduce the payment rate for hospital outpatient clinic visits provided at all off-campus hospital outpatient provider-based departments (HOPDs) to 40 percent of the OPPS rate. This includes excepted and non-excepted off-campus provider-based HOPDs. CMS also proposes to modify its policy related to excepted off-campus provider-based HOPDs that expand the families of services they offer. 


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 or (866) 288-8912.


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.   


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

2018 CHA Labor and Employment Seminar Registration Now Open

Registration is now open for CHA’s 2018 Labor and Employment seminar, to be held Oct. 22 in Sacramento and Oct. 25 in Costa Mesa. CHA members working in human resources, legal counsel or risk management departments are invited to attend. During the seminar, employment attorneys Jeff Berman and Christian Rowley will explore the use of arbitration agreements in hospital settings. A panel presentation by California Department of Fair Employment and Housing staff counsel Martha Gomez and Jeanette Hawn, with employment attorney Muira Mishra, will share hospitals’ experiences implementing recent transgender identity expression regulations and discuss case developments related to LGBTQ issues in the hospital environment. Gail Blanchard-Saiger, CHA’s vice president and in-house counsel, will conclude the seminar with a legislative and regulatory update for 2018-19.

For the full agenda and to register, go to

CHA News Article

Labor and Employment Law Seminar Features Important Case Law Developments
Oct. 22 in Sacramento, Oct. 25 in Costa Mesa

To help members stay abreast of California’s constantly changing employment environment, CHA’s upcoming Labor and Employment Law Seminar will feature legal analysis of recent developments. Attorney Richard Simmons, partner at Sheppard Mullin Richter & Hampton, LLP, will​ provide up-to-date information on recent case law developments including what the JANUS decision means in California, how lump sum bonuses impact the overtime rate and what the new independent contractor test means for health care. Later in the seminar, Ingrid Cobb, assistant general counsel for Torrance Medical Center, will use real case examples to provide practical tips for avoiding employment litigation.

For the full agenda and to register, visit

CHA News Article For Members

CHA Submits Pre-Regulatory Comments on Title 22 Regulations

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

Comments are due to CDPH on Aug. 31. Questions should be submitted to​

CHA News Article

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

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

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

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

CHA News Article

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

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

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



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

Hospitals Required to Offer Declaration of Paternity Forms

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

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

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

CHA News Article For Members

CHA Submits Pre-Regulatory Comments on Title 22 Regulations

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

Comments are due to CDPH on Aug. 31. Questions should be submitted to​

CHA News Article

TJC, Hospital Staff to Provide Compliance Guidance for Ligature, Self-Harm Risks
Webinar will cover CMS recommendations, including facilities that must comply

CHA will hold a webinar Oct. 2 from 10 – 11:30 a.m. (PT) to explain guidance from the Centers for Medicare & Medicaid Services (CMS) related to ligature and other self-harm risks.

Featured faculty include representatives from The Joint Commission, including Kathryn Petrovic, field director, surveyor management and development, behavioral health care and psychiatric hospital programs; Herman McKenzie, engineer, standards interpretation group; and Emily Wells, project director, surveyor management and development, accreditation and certification operations. They will discuss the recommendations made by The Joint Commission’s multi-stakeholder suicide panel, including which patients must be assessed for suicide risk; best practices for training staff to identify risk levels; requirements for designated ligature-free patient rooms; managing high-risk emergency room patients; observing patients at risk; and more.

CHA News Article

CHA Webinar to Detail CMS, TJC Recommendations to Reduce Self-Harm Risk
Will include regulatory update, compliance expectations for hospitals

CHA will hold a webinar on Oct. 2 from 10-11:30 a.m. (PT) to explain recent changes to the Medicare Conditions of Participation (CoPs) related to ligature and other self-harm risk. The Centers for Medicare & Medicaid Services (CMS) recently expanded the types of health care facilities and hospital areas that must comply with these regulations and is in the process of developing interpretive guidelines for compliance. However, as previously reported in CHA News, the agency clarified its intentions for CoP compliance in a recently released memo that directs surveyors and health care providers to follow recommendations developed by The Joint Commission’s (TJC) multi-stakeholder Suicide Panel. CMS participated on the panel and plans to incorporate the recommendations into the next release of its interpretive guidelines. 

CHA’s upcoming webinar will explain the panel’s findings and recommendations and provide practical guidance on steps hospitals can take to maintain compliance with Medicare CoPs. Faculty from TJC include Kathryn Petrovic, field director, surveyor management and development, behavioral health care and psychiatric hospital programs; Herman McKenzie, engineer, standards interpretation group; and Emily Wells, project director, surveyor management and development, accreditation and certification operations. Hospital representatives will also participate.

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 New this year, some publications are available in an electronic format.  


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.


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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

Upcoming Webinar Will Examine Findings From California Maternal Care Survey
To be held Sept. 20 from noon to 1 p.m. (PT)

The California HealthCare Foundation, a partner of the Hospital Quality Institute, will host a webinar Sept. 20 from noon to 1 p.m. (PT) to discuss key findings from a new survey on maternal care in California. In 2017, a team led by the National Partnership for Women & Families surveyed more than 2,500 women in California about their views and experiences with childbirth. The results, compiled into a report called Listening to Mothers in California, reveal what is and is not working with maternity care in the Golden State.

Webinar presenters include survey team leaders Carol Sakala, PhD, director of childbirth connection programs at the National Partnership for Women & Families, and Eugene R. Declercq, PhD, professor of community health at Boston University. 

The webinar is designed for media, state and national policymakers, researchers, advocates, and anyone interested in the health and health care of childbearing women and infants. Registration is available online.

CHA News Article

HQI Resources Support Hospital Efforts to Improve Sepsis Detection

Hospital Quality Institute (HQI) and CHPSO — in partnership with hospitals across the state — are highlighting resources and tools to drive improvement in sepsis detection as part of Sepsis Awareness Month.

CHA News Article

HQI Webinar to Highlight Care Equity for Limited English Proficient Populations

The Hospital Quality Institute (HQI) invites member hospitals to attend a webinar on Sept. 18 from 10 – 11 a.m. (PT) to learn about ensuring quality and patient safety for limited English proficient (LEP) populations. The event is part of the Disparities Webinar Series developed for the Health Services Advisory Group’s Hospital Improvement Innovation Network.

Language barriers can have adverse effects on safety and quality of hospital care, a critical consideration for California’s multilingual and multicultural environment. Webinar attendees will deepen their understanding of the links between communication barriers and patient safety outcomes, as well as the strategies and tools hospitals can use to advance equitable care for LEP populations. Presenter Joe Betancourt, MD, MPH, founder and director of The Disparities Solutions Center at Massachusetts General Hospital, is a foremost national expert on the topic. 

The webinar is free and open to all hospitals participating in the Hospital Improvement Innovation Network. Registration is available online. Questions should be directed to Boris Kalanj, HQI director of cultural care and patient experience, at or (916) 552-7694.

CHA News Article

Health Advisory Issued About Leptospirosis

The Centers for Disease Control and Prevention has released a health alert notifying clinicians that three patients in the U.S. have been diagnosed with leptospirosis after travel to Israel. Leptospirosis is a bacterial disease that can be spread through contact with infected animals or contaminated water sources. Early symptoms include fever, headache, chills, muscle aches, vomiting, diarrhea, cough, jaundice or rash. Clinicians should consider this diagnosis for patients presenting with those symptoms who have traveled to northern Israel since July 1.

CHA News Article

FDA Reminds Providers About Safety With Tubing Connectors

The U.S. Food and Drug Administration (FDA) has issued a guidance letter in response to continued reports of misconnections with enteral devices. The FDA recommends that hospitals and clinicians use enteral devices with connectors that meet the International Organization for Standardization (ISO) 80369-1 or ISO 80369-3 standard, or that are otherwise designed to reduce the risk of misconnections. (The FDA also notes that some currently marketed enteral connectors that meet the 80369-3 standards use the tradename ENFit).

The letter also recommends that health care professionals:

  • Check the labeling or check with the distributor or manufacturer to determine whether connectors meet the ISO standards.
  • Organize a plan to implement the use of these new devices.
  • Do not modify or adapt devices, because that may defeat their safety system.
  • Minimize the use of transition adapters.
  • Do not use cross-application connectors.
  • Trace all lines back to their origin when reconnecting devices.
  • Route tubes and catheters that have different purposes in unique and standardized directions to avoid accidental misconnections.

A California law prohibits hospitals and skilled-nursing facilities from using epidural, intravenous or enteral feeding connectors that can fit into connection ports other than the type for which they were intended. Hospitals and skilled-nursing facilities are now required to use reengineered tubing connectors, which work to prevent misconnections, eliminate human error and facilitate patient safety.



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

Education event For Members

Labor & Employment Law Seminar
Best practices to avoid litigation, evaluating the use of arbitration agreements, implementing transgender regulations, legislative updates

October 22, Sacramento
October 25, Costa Mesa

CHA’s 2018 Labor and Employment Law Seminar covers a broad array of topics designed to help you understand the changing landscape and assist you in developing a compliance strategy. The information will be presented by experts, including health care labor and employment attorneys, Department of Fair Employment and Housing legal staff and in-house counsel.

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

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.