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Overview

Coronavirus Response

The coronavirus is changing all of our lives, and we are relying on our health care system like never before. California’s hospitals are working around the clock to care for patients and prepare for a projected surge in patient volume. Many are taking unprecedented measures to expand their ability to care for current and anticipated COVID-19 cases, not to mention other urgent health care needs.

To support hospitals and health systems as they continue to care for patients potentially diagnosed with COVID-19 and significantly surge their capacity in the coming weeks, CHA has compiled the latest news, links to state and federal waivers and guidance, webinar recordings, and other resources for hospitals.

Important Updates for Hospitals

Cal/OSHA Allows for Surgical Masks When Respirator Supplies Are Insufficient During COVID-19 Crisis – See interim guidance.
CMS Issues Waivers for California Health Care Facilities — see waiver here.
Hospitals relieved of most regulatory requirements through June 30, 2020, with some exceptions — see CDPH statewide waiver
Health care workers who are asymptomatic and have been exposed to a COVID-19 positive patient can continue to work — see Governor’s Executive Order.

Resource Tracking Tool

CDPH has worked in partnership with the California Hospital Association (CHA) to develop a COVID-19 Tracking Tool to ensure collection of important patient and resource information during the COVID-19 pandemic. See CDPH’s All Facilities Letter for more information. While hospitals completing the CHA COVID-19 Tracking Tool are exempt from reporting COVID-19 cases to their CDPH district office, they must continue to report confirmed cases to their local public health officer.

Submit your daily report at this link daily tracking tool. Instructions for the tool are available here. If you have any questions, contact covidtracker@calhospital.org.

Relatedly, there is a federal request for data from the Centers for Medicare & Medicaid Services (CMS). CHA recommends providing data to both this federal request and the CHA COVID-19 Tracking Tool for the state. We understand that FEMA officials will base allocation decisions for resources from the Strategic National Stockpile on the data they have requested from hospitals.

FAQ: Augmenting Capacity

Would additional federal action be needed to open military sites for civilian patients to increase bed capacity regionally?

Yes. That requires federal action, which the Governor would need to request. (4/8)

FAQs: Persons Under Investigation

My hospital has a COVID-19-postive patient. Do we need to report this?

Yes. You must report COVID-19-positive patients to your local public health officer. Some local public health officers have a form they want the hospital to complete, while others take information over the phone and complete the paperwork themselves. Check with your local public health department to learn their process. You do not need to report suspected cases or persons under investigation (PUIs), unless your local public health officer has directed you to do so. However, if you have an unusual PUI case and believe it should be brought to the attention of your local public health officer, then do so.

The California Department of Public Health (CDPH) has allowed that hospitals that complete the CHA COVID-19 tracking tool on a daily basis do not need to separately report COVID-19 positive and suspected patients to CDPH. Instructions for the tool are available here.​ (4/9)

FAQs: Staffing

Are the nurse staffing ratios waived?

Yes. The nurse staffing ratios are waived, without any need for a hospital to submit a program flex request. The hospital must notify the California Department of Public Health (CDPH) only if there are substantial staffing shortages that jeopardize patient care or disrupt operations. Note this is a notification requirement, not a requirement to seek a flex or CDPH approval. CDPH laid this out in its statewide waiver released March 20. (4/9)​

Our hospital employs nursing assistants who have not yet completed their certification training. Can we utilize them as certified nursing assistants during this state of emergency​?

Per guidance from CDPH, a nursing assistant enrolled in an approved certification training program may continue to be employed as long as they provide services only at the competency level confirmed by the training program on a competency checklist to be shared with the facility. (4/9)

I’ve been a nursing student in a hospital and I have not been able to complete the required clinical hours for my degree because the hospital has deemed us non-essential personnel. How can I finish the requirements for my degree?

The Department of Consumer Affairs has reduced the direct clinical patient care requirement for obstetrics, pediatrics, and mental health/psychiatric nursing from 75% to 50%. Special accommodations may be made for geriatric and medical/surgical hours too. See the department’s waiver and talk to your nursing school. (4/9)

Have physician credentialing and privileging requirements at hospitals been waived?

Yes, requirements for hospitals to credential and privilege physicians have been waived by the CDPH pursuant to All Facilities Letter 20-26.  In addition, the Centers for Medicare & Medicaid Services waived requirements under the Conditions of Participation to allow physicians whose privileges will expire to continue practicing, and for new physicians to be able to practice before full medical staff/governing body review and approval. (4/9)

What are the rules around when a possibly exposed but asymptomatic health care worker can continue to work and when a symptomatic health care worker can return to work?

Health care workers who are asymptomatic but have been exposed to a known or suspected COVID-19-positive patient can continue to work during this period of emergency, subject to infection control precautions, according to the Governor’s Executive Order of March 15, 2020. The CDC has issued guidance based on the exposure risk. With respect to health care workers who have COVID-19 symptoms, whether they have been tested or not, CDC guidance provides two methods for determining when they can return to work. (4/9)

How can I get approval for out-of-state doctors, nurses, and other health care practitioners to work in California?

The state Emergency Medical Services Authority (EMSA) has a simple application form and instructions for facilities to complete to allow -out-of-state licensed health care professionals to work in California. It is located at https://emsa.ca.gov/covid19/  under “Authorization of Out-of-State Medical Personnel.”  (4/9)

Are hospitals able to provide compensation or loans for physicians who are suffering from loss of income?

Under normal circumstances, a complex legal analysis must be undertaken to determine if, and how much, compensation can be provided by a hospital to a physician. During the pandemic, the Secretary of the U.S. Department of Health and Human Services has issued 18 blanket waivers of the federal physician self-referral law, making this issue somewhat less complicated. However, hospitals should be aware that certain comparable provisions in state law have not been waived at this time. Under California’s similar statute, there is a broad exception for referrals to hospitals and other health facilities if the recipient of the referral does not compensate the physician for the referral. An equipment lease arrangement between the licensee and the referral recipient must meet certain requirements.  (see Business and Professions Code section 650 et seq.) CHA is advocating for a full waiver of state law, but in the meantime, hospitals should seek competent legal counsel before entering into an arrangement that involves compensating a physician.

To help financially struggling health care providers, the president signed the Coronavirus Aid, Relief, and Economic Security Act on March 27. This legislation includes $100 billion of federal funding to reimburse eligible health care providers for health care-related expenses or lost revenues not otherwise reimbursed that are directly attributable to COVID-19. Eligible providers include Medicare- or Medicaid-enrolled providers. In addition, physicians can sign up to work during the pandemic – with pay – at the California Health Corps website. (4/9)

Can a hospital provide telehealth services using out-of-state physicians who are not licensed in California?

Yes, during the COVID-19 emergency the state EMSA has set up a quick process for hospitals to be able to use health care practitioners and telehealth licensed providers from other states. For details, go to https://emsa.ca.gov/covid19/. (4/9)

Some of my nurses’ certificates evidencing training in Basic Life Support, Advanced Life Support, Cardiopulmonary Resuscitation, Pediatric Advanced Life Support, Electronic Fetal Monitoring, Neonatal Resuscitation, and similar skills are expiring. What do we do?

Neither CDPH nor CMS requires certificates from specific organizations. Instead, they require “documented competency.” Many hospitals choose to require some of the certificates listed above to fulfill this requirement, but other ways to document competency are acceptable. In addition, a practitioner doesn’t lose competency simply because their certificate expired the week before. The American Heart Association and the American Academy of Pediatrics have recommended that regulatory bodies consider extending recognition of these certifications beyond their renewal dates for at least 60 days and perhaps longer depending on the pandemic. The Joint Commission (TJC) has agreed to do this. On April 2, the AHA announced that its certificates remain valid for 120 days beyond their recommended expiration date. In addition, CMS, TJC and other survey agencies have almost completely ceased survey activity and will focus only on serious complaints involving immediate patient jeopardy. CDPH has waived almost all hospital licensing requirements, including staff competency validation and documentation. CHA believes that a hospital can utilize staff whose certificates may have expired recently without fear of penalties or sanctions. (4/9)​

Some doctors and nurses at my hospital have licenses that are about to lapse. However, they can’t renew them because they can’t take their needed continuing education class as a result of the pandemic. Can they continue to work?

Yes. The Department of Consumer Affairs, which oversees most health care professional licensing boards, has waived continuing education and exam requirements for certain professionals whose license expires between March 31 and June 30, 2020. This waiver applies to  physicians, nurses, pharmacists, mental health professionals, physician assistants, respiratory therapists, clinical lab scientists/bioanalysts, optometrists, dietitians, physical therapists, occupational therapists, speech-language pathologists, perfusionists, and other professionals licensed under Division 2 of the Business and Professions Code. However, it does not apply to certified nursing assistants, paramedics, or emergency medical technicians they are licensed/certified by other state agencies. Licensees must still submit their required renewal form on time, and satisfy waived exam or continuing education requirements by October 1, unless an additional extension is issued. The health care professional licensing boards continue to process license renewals, although there are processing delays. (4/9)

Are there any accommodations for pharmacy staffing during the COVID-19 emergency?

The Board of Pharmacy has authorized a waiver of the ratio of pharmacists to pharmacy technicians to allow for one additional pharmacy technician for each supervising pharmacist under certain conditions:

  • The pharmacy documents the need for the ratio modification due to the COVID-19 public health emergency. Examples of documentation may include, but are not limited to, an increased prescription volume or limitation on staff availability because of quarantine.
  • The supervising pharmacist, exercising their professional judgment, may refuse to supervise the additional pharmacy technician and tell the pharmacist-in-charge of this determination. When making such a determination, the supervising pharmacist must specify the circumstances of concern with respect to the pharmacy and patient care implications. (4/9)

I’ve heard that licensed health care professionals, medical retirees, and medical and nursing students are being encouraged to join a new Health Corps in California. How can I sign on this for this and contribute through my professional experience?

Interested medical and health care professionals are encouraged to visit healthcorps.ca.gov for more information and to register for the California Health Corps. Medical doctors, nurses, respiratory therapists, behavioral health scientists, pharmacists, emergency medical technicians, medical and administrative assistants, and certified nursing assistants are encouraged to help California respond to the outbreak. (4/9)

FAQs: Telehealth

Can a hospital provide telehealth services using out-of-state physicians who are not licensed in California?

Yes, during the COVID-19 emergency the state Emergency Medical Services Authority has set up a quick process for hospitals to be able to use health care practitioners licensed in other states. For details, go to https://emsa.ca.gov/covid19/ . (4/10)

Is there any federal guidance on how we can utilize telehealth services during this emergency?

Yes, the Centers for Medicare & Medicaid Services (CMS) has issued a fact sheet and frequently asked questions that provide guidance on how hospitals can use telehealth services under the Medicare program as a result of recently enacted legislation. In addition, CMS has prepared an FAQ on the use of telehealth by private health insurance plans. (4/10)

Where can I find information about telehealth services covered by health plans and insurers?

Both the Department of Managed Health Care and the Department of Insurance have issued guidance directing health plans and insurers to provide increased access to telehealth services during the COVID-19 emergency. (4/10)

Can hospitals use popular applications – such as FaceTime, Skype, or Google Hangouts – to provide telehealth services?

Yes, the federal Health and Human Services Office of Civil Rights has issued a notice of enforcement discretion announcing it will not impose penalties for noncompliance with HIPAA rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. However, public facing platforms — such as Facebook Live, Twitch, TikTok, and similar video communication applications — should not be used in the provision of telehealth by covered health care providers. (4/10)

Can providers from other states provide telehealth services to patients in California?

The federal government has waived requirements that physicians or other health care professionals hold licenses in the state in which they provide services for Medicare payment purposes, including for telehealth services; however, state law on licensure still applies. California’s Emergency Medical Services Authority has established a quick process for telehealth agencies and other entities, including hospitals, to obtain approval to use out-of-state personnel. (4/10)

Can Medicare telehealth services only be provided to patients that have been seen within the past three years?

No, the Coronavirus Aid, Relief, and Economic Security (CARES) Act removed the restriction that telehealth services only be provided to established patients who have been seen by the clinician within the past three years. CMS had previously announced it would not enforce this requirement. (4/10)

Can providers in rural health clinics (RHCs) and federally qualified health clinics (FQHCs) provide Medicare telehealth services to patients outside of their clinics during this emergency?

Yes, the CARES Act removed “distant site” restrictions, allowing RHCs and FQHCs to receive Medicare payment for telehealth services delivered by a provider in their clinics to a patient outside of their clinic, including in their home. (4/10)

Can providers use telehealth to meet “face-to-face” encounter requirements?

For Medicare beneficiaries with end-stage renal disease who receive home dialysis, telehealth can be used for the monthly clinical assessment without first receiving the initial face-to-face clinical assessment and ongoing face-to-face assessments that would typically be required. In addition, telehealth visits with a physician or nurse practitioner can be used to satisfy face-to-face encounter requirements to recertify hospice care eligibility. (4/10)

FAQs: Facility Licensing & Certification

I see that the California Department of Public Health (CDPH) issued All Facilities Letter (AFL) 20-26, which notifies hospitals of a temporary waiver of licensing requirements from March 20 through June 30, 2020. Exactly which “licensing requirements” are waived? 

All of the requirements in Title 22 and in Health and Safety Code sections 1250-1339.59 are waived, except for the requirement to report adverse events and unusual occurrences (including any substantial staffing/supply shortages that jeopardize patient care or disrupt operations). In addition, hospitals must follow their disaster response plan and infection control guidelines from the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) related to COVID-19.  Read more (4/9)

Has CMS  issued any waivers for California health care facilities?

Yes. CMS has issued many waivers, including waivers for hospitals related to EMTALA, verbal orders, reporting requirements, patient rights, sterile compounding, discharge planning, medical staff, medical records, and physical environment. Additional waivers have also been issued for skilled-nursing facilities, home health, and hospice. In addition, many federal agencies have issued flexes or enforcement discretion.

CMS has also announced a three-week suspension of all survey activity except to investigate complaints and facility-reported events that appear to be “immediate jeopardy” violations (“immediate jeopardy” as interpreted by the federal government, not the state – which is a high threshold). The agency may also conduct targeted infection control surveys of providers identified through collaboration with the Centers for Disease Control and Prevention and the U.S. Health and Human Services Assistant Secretary for Preparedness and Response. (They will use a streamlined checklist to minimize the impact on providers.) Hospitals are, therefore, able to prioritize infection control and responding to the COVID-19 pandemic over less important regulatory requirements. (4/9)

What is the status of Medicaid 1135 waivers?

The Department of Health Care Services (DHCS) has submitted two 1135 Waiver requests to CMS, seeking temporary relief of existing federal requirements — service authorization and utilization controls, program eligibility, telehealth, administrative activities, targeted payment rates, and request for flexibility with IMD exclusion. The first request was submitted on March 16. The second request was submitted on March 19.

On March 23, DHCS received the approval from CMS in response to its 1135 Waiver requests submitted the week before. The approval consists of flexibilities for the Medi-Cal program, seeking temporary relief of existing administrative requirements to rapidly increase access to medical services. (4/9)

Can patients be moved from an acute care bed to a swing bed without the 72-hour hospitalization requirement? 

CMS issued a Section 1135 waiver to allow critical access hospitals (CAHs) and rural (non-CAH) swing-bed hospitals to move patients from their acute care beds to swing beds for extended care services without a 72-hour prior hospitalization. This clarification will help utilization review processes in rural hospitals to better maximize use of patient care beds. The waiver does not allow non-rural (urban) prospective payment system hospitals to transfer patients to a swing bed without a 72-hour qualifying stay. (4/9)

 

FAQs: Human Resources

CHA has compiled a comprehensive list of FAQs related to general employment, labor relations, and furlough and layoff issues; the American Hospital Association has prepared a summary of federal legislation employers should know about. Other commonly asked questions are below.

The federal government recently passed the Families First Coronavirus Response Act, which contains two leave provisions. Does this law apply in California since we have our own leave laws and, if so, what am I required to provide?  

Yes, the act applies to California employers with fewer than 500 employees and all public employers. It went into effect on April 1. However, the law contains an optional exemption for health care providers. On April 1, the Department of Labor issued emergency regulations, adopting a broad definition of health care provider to include anyone working in a hospital, doctor’s office, long-term care facility, and other health care-related workplaces. Read more (4/9)

Has there been any change to the California meal and rest period rules?

Not specifically. However, with the waiver of the nurse-to-patient ratios in CDPH AFL 20-26, the ratios, including the “at all times” requirement is no longer in place, so hospitals have a bit more flexibility with regard meal and rest period coverage. Hospitals with represented employees, however, should review their collective bargaining agreements to determine if they address this issue. (4/9)

Many counties have been issuing shelter-in-place orders over the past few weeks and on March 19, the Governor issued an Executive Order that required most people in California to shelter in place. Does this apply to hospital and other health care workers? Can I require them to come to work?

The Governor’s Executive Order allowed individuals needed to maintain continuity of operations of critical infrastructure to be able to travel to work. Health care is a critical infrastructure, but the Executive Order did not address whether some individuals were deemed essential to support health care while others may be non-essential. The following day, the Governor issued a list of “essential critical infrastructure workers.” In the health care sector, the definition of “essential” workers is broad. We understand that some hospital staff are being stopped by law enforcement on their way to work and that their hospital badge may not be sufficient to demonstrate that they are critical infrastructure staff.  CHA is working with the CalChamber to find a solution that will allow all essential critical infrastructure employees to travel easily to work.  (4/9)  

I understand some cities and counties are developing expanded sick leave ordinances. Do they apply to hospitals and health systems?

There are a number of proposals across the state, and each has its own provisions related to health care workers. Current local ordinances include the city of Los AngelesSan Jose, San Francisco (awaiting mayor’s signature), and Emeryville. Both Los Angeles County and the city of Oakland are considering a local ordinance. (4/12)

Complying with all aspects of California Labor law is challenging during the best of times. Am I expected to comply right now as my hospital is faced with preparing and responding to the COVID-19 pandemic?

To date, the Governor’s Executive Orders have not relaxed any provisions of California Labor Code or the wage orders. CHA, along with CalChamber, appreciates the operational realities of complying with the hundreds of California’s employment laws and are strategizing on ways to limit liability. We will keep hospitals posted about any developments. (4/9)

Our staff need help with childcare. What resources are available?

The Department of Social Services issued a waiver for hospital sponsored  childcare licensing. (4/9)

I may have to lay off staff. Does California’s Worker Adjustment and Retraining Notification (WARN) Act still apply?

Only parts of the California WARN Act apply.  On March 17, the Governor issued an Executive Order suspending many aspects of the California WARN Act. The executive order suspends, starting March 4, 2020, Labor Code Sections 1402(a), 1402, and 1403 for an employer that orders a mass layoff, relocation, or termination at a covered establishment. Certain conditions apply: Read more (4/9)

FAQs: Employee Safety

What are the rules around when a possibly exposed but asymptomatic health care worker can continue to work and when a symptomatic health care worker can return to work?

Health care workers who are asymptomatic but have been exposed to a known or suspected COVID-19 positive patient can continue to work during this period of emergency, subject to infection control precautions, according to the Governor’s Executive Order of March 15, 2020. The CDC has issued guidance based on the exposure risk. With respect to health care workers who have COVID-19 symptoms, whether they have been tested or not, CDC guidance provides two methods for determining when they can return to work. (4/9)

I received a notice of complaint from the Division of Occupational Safety and Health (DOSH) alleging that my hospital is violating the Cal/OSHA Aerosol Transmissible Disease Standard. I thought hospitals were permitted to move to droplet precautions.

On March 28, Cal/OSHA updated its guidance on COVID-19 for health care facilities with respect to respirator use, stating that surgical masks may be used for low hazard tasks involving patient contact when the respirator supply is insufficient for anticipated surges, or when efforts to optimize the efficient use of respirators does not resolve the respirator shortage. This guidance brings Cal/OSHA in closer alignment with California Department of Public Health guidelines for infection control.  Read more (4/9)

FAQs: Vulnerable Populations

My ED is overwhelmed. How is California’s homeless care law being enforced during this crisis? 

Due to the COVID-19 pandemic, the California Department of Public Health has taken the unprecedented step of suspending most hospital licensing requirements. The homeless patient discharge planning law is one of the requirements that is suspended until June 30, 2020. (4/9)

How can we best communicate with EMS and others about prioritization of patients and alternate destinations?  

The California Emergency Services Authority (EMSA) has issued guidance  allowing EMTs and paramedics to transport patients to alternate destinations. The Local Emergency Services Agency (LEMSA) has to submit a written request to EMSA. You can alert your LEMSA about this option. (4/9)

What information about the Medi-Cal program is available for providers and program partners?

The Department of Health Care Services has posted a comprehensive web page of links, resources, and waiver information. (4/9)

For hospitals near California’s state prisons: when and how will prisons transfer sick inmates to hospitals? Will there be communication ahead of time?

California Correctional Health Care Services has instructed prisons to send COVID-19 positive inmates to the hospital if they have severe respiratory symptoms that warrant a higher level of care. Hospitals are contacted in advance; patients and correctional officers have prison-issued personal protective equipment. (4/9)

How can I help people experiencing homelessness find shelter during this time?

A regional or local Continuum of Care (CoC) — a planning body that coordinates housing and services funding for people experiencing homelessness — can help during this time to support the placement of unsheltered individuals and families. A list of local CoCs and contact information is available here. (3/31)

May telehealth be used to place and release involuntary holds on individuals as per Welfare and Institutions Code (WIC) 5150, and are these services are billable to Medi-Cal?

According to the Department of Health Care Services: “WIC 5150 evaluations may be performed by authorized providers face-to-face via telehealth as per WIC 5008(a). This may include releases from involuntary evaluation and treatment, as appropriate. These services are billable to Medi-Cal regardless of whether they are provided in person or through telehealth as long as the individual has Medi-Cal coverage for the service and all Medi-Cal requirements are met. That said, assessments required by WIC 5151 are to be completed in person and, as such, shall not be provided using telehealth.” (3/31)

How can we help our patients with behavioral health needs during this time, including through telemedicine? Are there any new waivers or other rules we should know about?

Yes, the Department of Health Care Services has issued FAQs with several updates for behavioral health providers, including:

FAQs: Post-Acute Care

Can patients with COVID-19 be discharged to skilled-nursing facilities (SNFs)?

Yes, as long the appropriate level of transmission-based precautions can be maintained. The Centers for Disease Control and Prevention (CDC) has provided interim guidance on discontinuing transmission-based precautions and disposition of patients with COVID-19 in health care settings. If a patient is being discharged to a SNF and transmission-based precautions are still required, they should go to a facility that’s to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19 residents.

The California Department of Public Health (CDPH) has also issued guidance to SNFs on admission after hospitalization: SNFs can be expected to accept a resident who is still requiring transmission-based precautions for COVID-19 as long as the facility can follow CDC infection prevention and control recommendations. According to CDPH, patients with confirmed or suspected COVID-19 should not be sent to a SNF via hospital discharge, inter-facility transfer, or readmission after hospitalization without first consulting the local health department.

Can patients under investigation (PUIs) be discharged to a SNF?

No. CDPH guidance states that PUIs with test results pending should not be transferred to SNFs until the results are available. Investigated patients with negative test results may be transferred from hospitals to SNFs following usual procedures.

Can SNFs require testing for all admissions from the hospital?

No. CDPH guidance advises that SNFs may not require a negative test result as criteria for admission or readmission of residents hospitalized with no clinical concern for COVID-19. Hospitals are not required to perform COVID-19 testing on patients solely for discharge considerations unless they develop new respiratory infection symptoms.

Should SNFs send residents to the hospital emergency department for testing?

No. If clinically stable, residents with suspected or confirmed COVID-19 should remain at the SNF with appropriate infection prevention and control measures. According to CDPH, residents with suspected or confirmed COVID-19 should be transferred to the hospital emergency departments only when clinically indicated.

I have a COVID-19 patient who is ready to go to a SNF, but our local SNFs will not accept them because they don’t have the facilities or equipment to handle confirmed or suspected COVID-19. What should I do?

Consult with your local health department, which will provide support and assistance, and may direct placement of the patient at a facility that has already cared for COVID-19 cases, or that has a specific unit designated to care for COVID-19 residents.

What steps should SNFs take to prepare for patients with confirmed or suspected COVID-19?

See the CDPH guidance that advises SNFs on how to prepare to care for patients with confirmed or suspected COVID-19. Additionally, CMS has provided updated infection control guidance.

What are state and federal leaders doing to improve access to SNFs for confirmed or positive patients? 

CMS has directed SNFs to work with state and local leaders to designate separate facilities or units to separate COVID-19-negative residents from COVID-19-positive residents and individuals with unknown COVID-19 status. CHA is engaged in ongoing communication with the California Association of Health Facilities (CAHF), LeadingAge California, and CDPH to support this effort. 

Has CMS expanded the availability of respiratory-related devices and oxygen services during this public health emergency?

Yes, in CMS’ recent interim final rule, the agency removed coverage restrictions that limited access to respiratory-related devices and oxygen services to Medicare beneficiaries with certain clinical characteristics. During the public health emergency, Medicare will cover equipment such as non-invasive ventilators multi-function ventilators, respiratory assist devices, continuous positive airway pressure devices – as well as oxygen services – for any medical reason as determined by a clinician.  (4/7)

What federal waivers are available for inpatient rehabilitation facilities, skilled-nursing facilities, home health agencies and hospices, and long-term care hospitals?

Federal legislative and regulatory action has included several important provisions affecting inpatient rehabilitation facilities, home health agencies and hospices, SNFs, and long-term care hospitals. As the crisis continues and additional areas emerge, additional waivers may be forthcoming. To read more about each type of facility, see: (4/7)

    FAQs: Supplies

    I’m running low on PPE. Are there any recommendations for prioritizing its use or decontaminating and reusing them?

    Yes, the CDC has issued detailed strategies for optimizing supplies of eye protection, isolation gowns, face masks, and N95 respirators.

    In addition, the California Department of Public Health (CDPH) has released All Facilities Letter 20-36, which provides instructions for preserving used N95 respirators now in order to decontaminate them in the near future. The state is working with Battelle Memorial Institute to deploy its Food and Drug Administration (FDA)-authorized emergency use decontamination system in California. The Battelle method, a vaporous hydrogen peroxide system, received FDA authorization March 29. CDPH will provide additional guidance on the specifics of how the state plans to transport, decontaminate, and reissue used N95 respirators. (4/9)

    Q:  We’ve heard a lot about various companies and organizations offering to donate supplies. Who can we contact to potentially access those donations?

    The best way is to request them through the Medical and Health Operational Area (MHOAC) Coordinator Program. See CHA’s Resource Request page for instructions on requesting supplies through MHOAC. (4/9)

    Can I request pharmaceuticals or other supplies from the Strategic National Stockpile?

    Yes. Hospitals need only attempt to first secure resources on their own and then, if unable to secure what they need, contact their county MHOAC Program for any resource (PPE, equipment and supplies, personnel, pharmaceuticals, acute care transfer, beds, transportation, etc.). They do not need to choose how the MHOAC can fulfill that request, such as through the Strategic National Stockpile. See CHA’s Resource Request page for instructions on how to request items through the MHOAC Program. (4/9)

    One of our suppliers has suddenly tripled its prices. Is that legal?

    Price gouging is illegal, and the California attorney general is conducting surveillance on potential price gouging in the marketplace for medical supplies and other goods and services being sold to hospitals, health care providers, and others. If you have information or leads that you would like to share, please contact the California Department of Justice at oag.ca.gov/report.

    In addition, the U.S. Department of Justice and the U.S. Department of Health and Human Services are aggressively pursuing cases to prevent the hoarding or price gouging of medical supplies and drugs essential to combat COVID-19, as well as other fraud related to the pandemic. If you have been the target or victim of price gouging, or are aware of the hoarding of essential medical supplies or drugs necessary to fight the virus, please report it to the National Center for Disaster Fraud Hotline at (866) 720-5721 or via email at disaster@leo.gov. For more information, visit www.justice.gov/coronavirus. (4/12)

      FAQs: Contributions

      How can I contribute supplies, manufacturing expertise, or professional medical experience, or volunteer my time?

      To facilitate a streamlined process for collecting supplies and leveraging individual and corporate expertise, the state of California has established separate portals for contributions (4/9):

      FAQs: Testing

      We need to test many more people — how can we best direct people to get the coronavirus tests?

      Testing is being done through a prioritization process as described in guidance from the California Department of Public Health (CDPH). (4/12)

      If a test comes back positive, what should our immediate next steps be?  

      The CDPH has allowed that hospitals that complete the CHA COVID-19 tracking tool on a daily basis do not need to report COVID-19 positive and suspected patients to CDPH, but they should continue to report them to the local public health officer. Instructions for the tool are available here.​ (4/12)

      I see that the CDPH suspended a lot of Health and Safety Code laws.  Do we still need to report positive COVID-19 test results to the local public health officer?

      Yes. Positive COVID-19 test results must be reported to the local public health officer  Your report to your  CDPH district office is made using the CHA COVID-19 Tracking Tool. (4/9)​

      When will more testing kits become available, and how can we access them?  

      Contact your local health department for the tests and information about when more will be available. (4/12)

      Who should we test?   

      CDPH has provided details about who to test in its recent guidance. (4/12)

      FAQs: Pharmacy

      As a pharmacist, I’m concerned that an in-person oral medication consultation may place the requestor, or me, at risk for exposure to COVID-19. What should I do?

      If the pharmacist-in-charge makes the determination that a face- to-face consultation will put the patient or pharmacist at risk, then the consultation may be waived following the guidance in the Board of Pharmacy’s waiver instructions. (4/12)

      We don’t have the required personal protective equipment (PPE) needed for compounding in a compounding aseptic or compounding aseptic containment isolator. What should we do? 

      If the pharmacist-in-charge has made the determination that there is insufficient stock of PPE (everything except sterile gloves), the PPE requirements may be waived under the conditions outlined in the Board of Pharmacy’s waiver instructions. (4/12)

      I am a pharmacist and my BLS certification expires on March 15. I need this certification to initiate and administer immunizations.

      The Board of Pharmacy has authorized that pharmacists may waive their BLS certification until July 4, 2020, in order to  continue to initiate and administer immunizations. (4/12)

      We have run out of sterile disinfecting agents to wipe down our work table surfaces, carts, and counters after cleaning. What can we do?

      The Board of Pharmacy has waived the use of sterile alcohol-based disinfectant on work table surfaces, carts, and counters after cleaning and will allow for the use of non-sterile alcohol-based disinfectant after cleaning under the following conditions:

      • The pharmacist-in-charge has determined that the current and potential stock of sterile alcohol (sIPA) on hand is insufficient to maintain the requirements established in the regulation.
      • The surface or equipment is not contained within an ISO Class 5 environment.
      • Surface sampling schedule is reviewed for the possible need to increase the frequency of cleaning and disinfection.
      • Documentation indicating the duration of time the pharmacy is operating under this waiver is maintained. (4/12)

      I am a retired pharmacist, and my pharmacy license has expired. Can I practice?

      If you have retired within the past five years, and at the time of cancellation or transition to retired status your license was not subject to any disciplinary conditions or proceedings, you may apply by completing the “Application to Restore Your License” at www.pharmacy.ca.gov, located under COVID-19 Information. (4/12)

      Are there any accommodations for pharmacy staffing during the COVID-19 emergency?

      The Board of Pharmacy has authorized a waiver of the ratio of pharmacists to pharmacy technicians to allow for one additional pharmacy technician for each supervising pharmacist under certain conditions:

      • The pharmacy documents the need for the ratio modification due to the COVID-19 public health emergency. Examples of documentation may include, but are not limited to, an increased prescription volume or limitation on staff availability because of quarantine.
      • The supervising pharmacist, exercising their professional judgment, may refuse to supervise the additional pharmacy technician and tell the pharmacist-in-charge of this determination. When making such a determination, the supervising pharmacist must specify the circumstances of concern with respect to the pharmacy and patient care implications. (4/12)

      FAQs: Health Plans & Insurers

      Are health plans offering any relief during this time for prior authorizations, member cost sharing, or other policies?

      Many health plans have announced they’re suspending prior authorization requirements and waiving cost sharing for certain services, as well as offering other temporary support. More details about each plan are here. (4/12)

      FAQs: Federal Funding

      How can I find out what sources of federal funding are available to my hospital during this time?

      See CHA’s overview of federal funding opportunities. (4/12)

      Now that the federal relief package has passed, and $100 billion in emergency funds has been allocated for hospitals and other health care providers, when will that money actually start to flow to individual hospitals and health systems?

      The Coronavirus Aid, Relief, and Economic Security (CARES) Act does not specify a time frame for releasing these funds. Rather, it instructs the federal Health and Human Services (HHS) Secretary to release funding on a rolling basis and through “the most efficient payment systems practicable to provide emergency payment.”

      The Centers for Medicare & Medicaid Services (CMS) recently distributed the first round of funding –$30 billion – to hospitals via direct grants based on the proportion of Medicare fee-for-service revenue received by the hospital. CMS has stated that future funding will be targeted to providers not helped by the Medicare fee-for-service methodology and hospitals in COVID-19 hot spots. (4/12)​

      How will these funds be allocated? What factors will the government use in determining how much relief each organization receives? 

      Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare fee-for-service reimbursements in 2019. Total fee-for-service payments were approximately $484 billion in 2019. Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13 and will be linked on this page. According to the CARES Act, the funds may be used for building or construction of temporary structures; leasing of properties, medical supplies and equipment, personal protective equipment and testing supplies; increased workforce and training; emergency operation centers; retrofitting facilities; and surge capacity.

      Information on the remaining $70 billion will be provided when details are available. CHA expects future rounds will be targeted to providers in areas particularly impacted by the COVID-19 outbreak, rural providers, providers of services with lower shares of Medicare reimbursement or who predominantly serve the Medicaid population, and providers requesting reimbursement for the treatment of uninsured Americans. (4/12)

      Are these funds specifically for hospitals that have treated COVID-19 positive patients, or will all hospitals receive some funds?

      The emergency funds are available to all Medicare or Medicaid enrolled providers and suppliers that provide diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. The emergency funds must compensate providers for health care-related expenses or lost revenue directly attributable to COVID-19 and not reimbursed from other sources. (4/12)

      Did the recent federal legislation increase Medicare payments to hospitals? 

      The CARES Act includes a number of provisions that will increase payments for hospitals caring for Medicare patients, including the elimination of the 2% sequestration cut from May 1 to December 31, 2020, a 20% add-on payment to the DRG rate for patients with COVID-19 at rural and urban IPPS hospitals, and expanded options for the Medicare accelerated payment program for children’s hospitals, cancer hospitals, and critical access hospitals. (4/12)

      I’m worried that given the nationwide crisis, $100 billion will be insufficient. Are there plans for additional funding support for hospitals in the future? 

      CHA will continue to work with congressional leadership and the delegation to address the growing needs of California’s health care delivery system. (4/12)

      Are there other channels for hospitals to request funding to purchase PPE?

      The Federal Emergency Management Agency Public Assistance Program is a grant program that may assist nonprofit hospitals and health systems in covering 75% of the cost of emergency protective measures. (4/12)

      Can hospitals receive accelerated or advanced payments from Medicare to assist with cash flow while elective and other procedures are on hold?

      Yes, the CARES Act authorized inpatient acute care, critical access, children’s, and cancer hospitals to request up to six months of accelerated payments, based on historical payment amounts. Other providers, including long-term care hospitals, inpatient rehabilitation facilities, and inpatient psychiatric facilities, can request up to three months of advanced payments. Hospitals should contact Noridian – California’s Medicare administrative contractor – to apply for these funds.  (4/12)

      FAQs: Postmortem

      What do I do if my hospital is running out of space in the morgue?

      You can try to lease appropriate storage space, although it is in short supply in many parts of the state. You can also call your county coroner or medical examiner. The county coroner or medical examiner has the ability to request help from the California Governor’s Office of Emergency Services if necessary. (4/9)

      Can funeral homes/mortuaries refuse to accept the bodies of those who died of COVID-19?

      The existing state and federal guidance does not support funeral homes, mortuaries, or death care workers refusing to accept the bodies of those who died of COVID-19. Rather, the existing state and federal guidance provides that death care workers need only follow routine infection prevention and control precautions. Read more  (4/9)

      FAQs: For The Public

      I am interested in contributing my time and expertise within my hospital community. What volunteer opportunities are available?

      Many California hospitals have suspended their volunteer programs. Until hospitals begin accepting new volunteers, here are some ways you can make a difference:

      • Sign up with California Volunteers: Governor Gavin Newsom launched the program to encourage Californians to help their communities during the pandemic.
      • Donate blood: Healthy individuals are encouraged to contact the American Red Cross to schedule an appointment.
      • Deliver meals: Meals on Wheels organizations throughout your community are seeking individuals to deliver food to vulnerable seniors.  
      • Donate to and/or volunteer at your local food bank (4/9)

      I’m sick and think I might have coronavirus. What should I do?

      Stay home, as most people who are mildly ill with COVID-19 can recover at home. Do not leave, except to get medical care. Be sure to get care if you have trouble breathing, have any other emergency warning signs, or if you think it is an emergency. If you need to call 911, notify the operator that you have or think you might have COVID-19.  If possible, put on a cloth face covering that covers your nose and mouth to protect other people. Follow care instructions from your health care provider and local health department. More information from the CDC  (4/9)

      If I have symptoms of COVID-19, should I get tested?

      California is expanding its testing capacity. For now, testing is being conducted on those with signs and symptoms compatible with COVID-19 in one of the following groups:

      • Hospitalized patients who have signs and symptoms compatible with COVID-19, in order to inform decisions related to infection control or medical management
      • Residents and staff of long-term care facilities with signs and symptoms compatible with COVID-19
      • Others at higher risk for severe infection, including adults over age 65 and individuals with chronic medical conditions
      • Residents and staff of correctional facilities and other congregate settings 
      • Health care personnel (4/9)

      People in these categories with mild illness should contact their health care provider by phone to discuss the need for testing. Learn more

      I don’t have coronavirus, but I have another health care need. Who should I call?

      If you are feeling sick with flu-like symptoms, please first call your doctor, a nurse hotline, or an urgent care center. If you need to go to the hospital, call ahead so they can prepare for your arrival. If you need to call 911, tell the 911 operator the exact symptoms you are experiencing so the ambulance provider can prepare to treat you safely.

      Non-essential medical care like eye exams, teeth cleaning, and elective procedures must/should be cancelled or rescheduled. If possible, health care visits should be done remotely. Contact your health care provider to see what services they are providing. More information on the Director of the California Department of Public Health’s stay home order. (4/9)

      What resources are available for family caregivers? 

      The American Association of Retired Persons (AARP) has posted to its website a number of resources for family caregivers, including items dealing with coronavirus. AARP is also conducting weekly town hall on this topic.   

      The Family Caregiver Alliance has pasted several articles and resources to its website, including monthly livestream educational topics including tips for caregivers about COVID-19, as well as podcasts and multilingual short video caregiving tips and infographics on Facebook, YouTube, and Twitter. (4/9)

      What if I can’t work because I’m ill with COVID-19 or caring for a family member?

      In California, if you’re unable to work due to having or being exposed to COVID-19 (certified by a medical professional), you can file a Disability Insurance claim. If you’re caring for an ill or quarantined family member with COVID-19 (certified by a medical professional) you can file a Paid Family Leave claim.

      To learn more about what to do if you think you’re sick, tips for staying healthy and protecting your family, details on health insurance coverage of different types, and more, the COVID-19 websites for these entities:  (4/9)

      Contact Us

      Our team is here to help with operational or policy questions related to COVID-19. You can reach us by email at info@calhospital.org.

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