The Centers for Disease Control and Prevention (CDC) as well as other state and federal agencies have issued health advisories, guidelines, travel alerts and other information on the Zika virus. The Zika virus is a mosquito-borne flavivirus primarily transmitted by Aedes aegypti mosquitoes. Infection with Zika virus is asymptomatic in most cases. When Zika virus does cause illness, the most common symptoms are fever, rash, joint pain, and conjunctivitis (red eyes). Severe ailments requiring hospitalization are uncommon. Recent evidence suggests a possible association between maternal Zika virus infection and adverse fetal outcomes, such as congenital microcephaly and a possible association with Guillain-Barré syndrome. No vaccine or medication exists at this time to prevent or treat Zika virus infection. Persons residing in or traveling to areas of active Zika virus transmission should take steps to prevent Zika virus infection through prevention of mosquito bites. CHA will continue to share information and resources as they become available.
For more information, including Zika guidelines and resources, please visit CHA’s Emergency Preparedness website at calhospitalprepare.org.
The Centers for Disease Control and Prevention (CDC) as well as
other state and federal agencies have issued health advisories,
guidelines, travel alerts and other information on the Zika
virus. The Zika virus is a mosquito-borne flavivirus primarily
transmitted by Aedes aegypti mosquitoes. Infection with Zika
virus is asymptomatic in most cases. When Zika virus does cause
illness, the most common symptoms are fever, rash, joint pain,
and conjunctivitis (red eyes). Severe ailments requiring
hospitalization are uncommon. Recent evidence suggests a
possible association between maternal Zika virus infection and
adverse fetal outcomes, such as congenital microcephaly and a
possible association with Guillain-Barré syndrome. No vaccine or
medication exists at this time to prevent or treat Zika virus
infection. Persons residing in or traveling to areas of active
Zika virus transmission should take steps to prevent Zika virus
infection through prevention of mosquito bites. CHA will continue
to share information and resources as they become available.
For more information, including Zika guidelines and resources,
please visit CHA’s Emergency Preparedness
website at calhospitalprepare.org.
What should hospitals do if a local public health order contains a requirement that differs from state guidance?
First, read the local public health “order” very carefully. Many documents issued by public health officers (PHOs) are actually “advisories” or “guidance,” rather than orders that carry the force of law.
The teams are made up of active duty military medical providers including two MDs, two mid-level providers, two respiratory therapists, and 14 Registered Nurses.
Is there a difference between a Disaster Medical Assistance Team (DMAT) and a DoD Team?
Yes, DMATs are medical professionals and support personnel who operate under the Department of Health and Human Services National Disaster Medical System, and DoD teams are active military personnel.
What are the criteria determining which hospitals receive a DoD medical team?
Hospitals have been chosen in collaboration with the California Department of Public Health (CDPH) Center for Healthcare Quality, county Medical Health Operational Area Coordinators (MHOACs), and Regional Disaster Medical and Health Specialists and represent large hospitals that have licensed ICU beds that they are unable to staff.
What should we expect from the team?
Teams are being deployed to expand ICU capacity in strategic areas by bolstering ICU staff.
How are the teams managed?
The teams fall fully under the operational coordination of California Emergency Medical Services Authority (EMSA) and the Department of Defense. Hospitals will be responsible for onsite management of the teams.
How long will the teams be at the hospital?
They are on a 30-day mission assignment.
What supplies will the team need when it arrives?
All PPE, scrubs, and required working supplies need to be provided by the hospitals. If hospitals need help with extra supplies, they can request this through the MHOAC Program.
Can hospitals get lead information on the team so they can start emergency credentialing?
All state licensing is being coordinated by EMSA with the CDPH Licensing & Certification program.
Does the team have professional liability coverage?
Professional liability coverage is covered by the military, as they are active duty military.
Is there a cost to hospitals for the staff?
No, the cost share is between the state and federal governments.
Do they provide their own housing?
With the exception of scrubs and PPE, the DoD covers all logistical needs of its personnel.
The Department of Health Care Services (DHCS) has provided various program flexibilities and waivers for providers to ensure that Medi-Cal beneficiaries have access to medically necessary COVID‑19 testing and care. See CHA’s FAQs.
How many doses of remdesivir has California received?
On July 13, California was allocated 354 cases, or approximately 14,000 doses. The specific county allocations will be available soon on the CDPH Remdesivir Guidance site under “Other.” (7/21)
How will remdesivir be allocated to our hospital?
As explained in the guidance for counties, the most recent COVID-19-positive hospital census data will be used to proportionally distribute the drug. (7/21)
How should our hospital determine how to allocate remdesivir to patients in our hospital?
CDPH has issued guidance for hospitals regarding allocation of scare medications for COVID-19. These recommendations are designed to help maximize transparent and fair allocation of remdesivir or other scare medication in a way that provides the greatest overall clinical benefits to patients with COVID-19, avoids bias, and mitigates health care disparities. (6/4)
What if our hospital doesn’t need its allotted remdesivir?
If the hospital decides not to purchase their allotment they must immediately contact their Medical Health Area Operational Coordinator so the unused portion can be returned to the reallocating county or the state. This is imperative in order for the state to prevent losing any remdesivir doses to other states. (7/21)
Where did the supply of remdesivir come from?
Gilead Science donated the initial 1.5 million vials worldwide. Now ,AmerisourceBergen Corporation is manufacturing and selling remdesivir in the commercial marketplace. (7/21)
Is remdesivir an experimental drug?
Yes. However, the FDA has allowed emergency use authorization of the drug, as explained in its fact sheet.
How long does it take for COVID-19 symptoms to appear after exposure to the virus, and what symptoms should I look for?
The Centers for Disease Control and Prevention has updated its list of COVID-19 symptoms, broadening the range from mild to severe illness. In recent guidance, the California Department of Public Health identifies the symptoms in two categories: 1) symptoms — such as cough, shortness of breath, fever, chills, muscle pain, sore throat, and new loss of taste or smell, and 2) emergency warning signs — such as trouble breathing, persistent pain or pressure in the chest, new confusion, or bluish lips or face — that require medical attention immediately. (5/13)
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 #CaliforniansForAll 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 (5/1)
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. As much as possible, stay in a specific room and away from other people and pets in your home. If possible, you should use a separate bathroom. If you need to be around other people or animals in or outside of the home, wear a cloth face covering. Cover your coughs and sneezes. Wash your hands often. And clean high-touch surfaces frequently. Follow care instructions from your health care provider. More information from the CDC. (7/20)
If I have symptoms of COVID-19, should I get tested?
The California Department of Public Health recommends first prioritizing testing of hospitalized individuals with signs or symptoms of COVID-19 infection followed by testing of other symptomatic individuals and higher risk asymptomatic individuals and then other asymptomatic individuals when certain conditions exist. (7/20)
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.
Hospitals have implemented a variety of new safety measures to keep non-COVID and COVID patients from coming into contact. If you’re in need of care, especially for pre-existing or chronic conditions that need follow-up attention, please don’t hesitate to seek it in the appropriate care setting. Delaying care could put you at a higher risk for complications later on.
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 COVID-19. AARP is also conducting weekly town hall on this topic.
The Family Caregiver Alliance has posted several articles and resources to its website, including monthly livestream educational topics that have 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?
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, here are the COVID-19 websites for these entities: (4/9)
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)
How can hospitals access the $175 in federal funding authorized under the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act?
The U.S. Department of Health and Human Services (HHS) has automatically distributed funding to hospitals via two rounds of general allocations – totaling $50 billion – and several targeted allocations. As of July, HHS has announced targeted allocations for hospitals in high-impact COVID-19 areas, safety-net hospitals, rural hospitals, rural health clinics, and other hospitals that serve rural communities, skilled-nursing facilities, and Medicaid and CHIP providers. As of July, approximately $120 billion of the $175 billion remains unallocated. Additional information on how the allocations were distributed is available in CHA’s summary of the Provider Relief Fund. CHA continues to advocate for a balanced, fair, and inclusive distribution of the remaining Provider Relief Funds for hospitals that have been left out of previous distributions. (7/22)
What steps must hospitals take to attest to receipt of Provider Relief Funds, and what are the reporting requirements to document how the funds are spent?
Within 90 days of receiving a payment from the Provider Relief Fund, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The CARES Act Provider Relief Fund Payment Attestation Portal is open, and providers should review the terms and conditions for various distributions. 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.
Recipients that received one or more payments exceeding $10,000 in the aggregate from the Provider Relief Fund will be required to submit reports to HHS on how the funds have been expended. Providers will report information via a portal beginning October 1. HHS has announced it will release detailed instructions on the reporting requirements August 17, and will host educational sessions for providers prior to the submission deadline.
Provider Relief Fund recipients will be required to provide information on their expenditures through December 31, within 45 days of the end of the calendar year (February 15, 2021). Recipients who have expended funds in full prior to December 31 may submit a single final report at any time during the window that begins October 1, but no later than February 15, 2021. Recipients with funds unexpended after December 31, must submit a second and final report no later than July 31, 2021. For more information, view HHS’ responses to frequently asked questions. (7/22)
Who can I contact if I have questions about my Provider Relief Fund payments?
HHS has established the CARES Act Provider Hotline at (866) 569-3522. (7/22)
Has HHS provided data on how much money each hospital has received?
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 CARES Act 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. CMS has published guidance to hospitals on implementation of the 20% add-on payment. On May 11, CMS provided additional guidance on how this applies to payments made by Medicare Advantage plans. (7/22)
I’m worried that given the nationwide crisis, $175 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)
How can hospitals seek reimbursement for providing care to uninsured patients with COVID-19?
Health care providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after February 4, 2020, can request claims reimbursement through the COVID-19 Uninsured Program electronically and will be reimbursed generally at Medicare rates, subject to available funding. To participate, providers should register with the COVID-19 Uninsured Program Portal. Both CHA and HRSA have developed comprehensive FAQs on this topic. (7/23)
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?
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. However, on April 26, CMS announced it will suspend and reevaluate the Accelerated and Advanced Payment programs in light of the funding provided by the CARES Act and subsequent legislation. (4/29)
Are our pharmacists allowed to order and collect COVID-19 testing specimens?
Yes, the Department of Consumer Affairs issued a waiver and guidance allowing them to do this if they are competent and trained to collect the specimen necessary to perform the test, and the specimen is collected consistent with the provisions of an Emergency Use Authorization issued by the FDA. This waiver expires on Sept. 9, but the federal government has issued a similar waver that preempts state licensing laws (see CHA’s list of federal waivers). (7/20)
How can pharmacists minimize their risk of exposure to the virus that causes COVD-19?
CDPH has issued guidance for pharmacies and pharmacy staff to minimize their risk of exposure when serving customers. It includes principles of infection prevention and control, as well as physical distancing. (5/13)
I am an intern pharmacist. Will the role of my supervising pharmacist change during the COVID-19 state of emergency?
No. Although the Board of Pharmacy had allowed a pharmacist to supervise an additional intern temporarily during the pandemic, that waiver expired on June 24. In addition, the Board’s waiver to allow general rather direct supervision of a pharmacist intern expired on July 19. (7/20)
I am a pharmacist and my sterile compounding competency requirements are due, but I don’t have time to complete them during COVID-19. Is there any accommodation for this?
Under a waiver by the Board of Pharmacy, — which expires August 12 — the semi-annual and annual reassessment, revalidation, or re-evaluation requirements for sterile compounding can be waived for up to an additional 90 days under the following conditions:
The pharmacist-in-charge makes a determination that such a suspension in the reassessment, revalidation, or re-evaluation frequency is necessary and appropriate, balancing site-specific limitations and current staff competencies.
The pharmacist-in-charge ensures only properly trained persons are allowed to perform compounding.
Documentation is maintained identifying when reassessments, revalidations, or re-evaluations pursuant to this waiver were extended for each staff member involved in sterile compounding. Such documentation must be maintained for three years from the date of making. (7/21)
We need to apply for an automated drug delivery system (ADDS) license for several of our automated patient dispensing systems (APDS). We are relocating in our facility due to COVID-19 — do we need a prelicensure inspection?
No, the Board of Pharmacy has authorized a waiver until October 2 of the prelicensure inspection if the pharmacy submits the following:
A description of the proposed ADDS location with pictures, video, and/or a floor plan with the surrounding areas labeled and how the ADDS is secured
A copy of the pharmacy’s policies and procedures to operate the ADDS regarding security, safety, accuracy, accountability, patient confidentiality, maintenance, maintaining the quality, potency and purity of the dangerous drugs and devices, restocking, record keeping, and quality assurance
Proof of training or plans for training pharmacy staff on the policies and procedures at the pharmacy applying for the proposed ADDS location
A statement that a copy of the policies and procedures will be maintained as required by Business and Professions Code section 4427.3(c)
Policies and procedures that include:
criteria used to determine which drugs are placed in the APDS
methods of ensuring patients are aware that consultation is available;
a description of assignments of responsibility
training on using the APDS
plans for orienting participating patients, ensuring delivery of drugs when the APDS is disabled or malfunctioning, and for handling of complaints, errors, omissions and other incidents with the use of the APDS.
A statement explaining how a written consent from participating patients is obtained and what means are used to identify the patient or patient’s agent before releasing the drug
A statement confirming the APDS has a two-way audio and video for consultation; records are maintained for all transactions; child resistant containers are used; drug warning labels are used for drugs causing risk of overdose, addiction, impairment while operating a vehicle, and risk if alcohol is consumed; a sign is prominently posted on the APDS with the pharmacy’s name, address, and phone number; the prescription label meets the patient-centered labeling requirements; and translation and interpretive services are available. (7/21))
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?
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. This order expires August 5. (7/21)
We have run out of sterile disinfecting agents to wipe down our work table surfaces, carts, and counters after cleaning. What can we do?
Although the Board of Pharmacy had issued a statewide waiver of the requirement to use sterile alcohol-based disinfectant on certain surfaces after cleaning, that waiver expired on July 1. A pharmacy that has run out of sterile disinfecting agent should contact the Board of Pharmacy for an individual waiver. (7/20)
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 — until October 1 — by completing the “Application to Restore Your License” at www.pharmacy.ca.gov, located under COVID-19 Information. (7/21)
Are there any accommodations for pharmacy staffing during the COVID-19 emergency?
No. The Board of Pharmacy had issued a statewide waiver to allow a pharmacist to supervise an additional pharmacy intern or technicians temporarily during the pandemic. However, that waiver expired on June 24. A pharmacy that would like its pharmacists to supervise an additional intern or technician should contact the Board of Pharmacy for an individual waiver. (7/20)
What are the hospital lab requirements to perform COVID-19 testing?
Four criteria are used to screen labs for readiness to receive COVID-19 testing:
Lab has obtained a California clinical laboratory license and Clinical Laboratory Improvement Amendments (CLIA) certificate for high or moderate complexity testing (depending on test categorization)
Lab is running FDA EUA RT-PCR molecular or antigen-based tests approved for clinical diagnostic use
Lab is registered with Laboratory Field Services for COVID-19 testing
Lab is submitting data to the California Reportable Disease Information Exchange (CalREDIE)
More information is available here and from the COVID-19 state Testing Task Force website. (6/8)
What type of COVID-19 tests are available?
There are two different types of tests: diagnostic tests and antibody tests. Diagnostic tests are classified as either a molecular test or an antigen test. The molecular (RT-PCR) test detects the virus’ genetic material, and the antigen test detects specific proteins on the surface of the virus.
Antibody tests detect antibodies that are made by the immune system in response to a threat, such as a specific virus. Antibody tests are called serology tests and should not be used to diagnose an active coronavirus infection. For more information, visit www.fda.gov/consumers/consumer-updates/coronavirus-testing-basics. (6/8)
What types of molecular test kits are available, and what are their specifications for turn-around time, sensitivity, sample method, etc.?
The California COVID-19 Testing Task Force has developed a PCR Test Analysis spreadsheet explaining the individual tests. (6/8)
How are testing needs being addressed across the state?
The state has been rapidly increasing its testing capacity through the work of the COVID-19 Testing Task Force, a public-private collaboration of stakeholders that is co-chaired by Dr. Charity Dean, assistant director of the California Department of Public Health, and Blue Shield of California President and CEO Paul Markovich. It was initiated on April 4 with the goal of ensuring California has the lab capacity to rapidly produce test results and increase capacity strategically to meet demand. By the end of May, the task force had met its goal of 60,000 tests per day. (6/4)
The California Department of Public Health (CDPH) released updated testing guidance in July that includes four tiers of testing priority, with the first tier being hospitalized individuals with signs or symptoms of COVID-19; people being tested as part of the investigation and management of outbreaks, including contact tracing; and close contacts of confirmed cases. (7/15)
How are testing sites determined?
See the “finding a test site” section on testing task force website to locate testing sites in your area. Hospitals that need additional resources should continue to work with their local health officer and send their concerns to the testing task force at firstname.lastname@example.org. (6/4)
How do testing supplies get distributed when the task force identifies them?
The testing task force assesses the field and uses collected data to understand testing capacity and supply issues, and then determines, through the Governor’s Office of Emergency Services’ system, what the Medical Health Operational Area Coordinator (MHOAC) and state and national supplies are, and where the distribution will occur. Decisions by the task force are always made by state officials. Individuals from the private sector are providing important support and do not make decisions. Hospitals can request testing supplies through their MHOAC. (6/5)
Do our labs need to report testing information and, if so, where?
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. In addition, your hospital reports the number of COVID-19-positive patients to CDPH daily using the CHA COVID-19 Tracking Tool. (7/20)
When will more testing kits become available, and how can we access them?
Contact your local health department for the information, and check the updated information on the state testing task force website. (6/4)
Are hospitals required to provide testing to skilled-nursing facilities (SNFs), which must implement comprehensive testing programs, including baseline testing of all their residents and staff and residents by the end of June, as well as ongoing surveillance and other training?
No, hospitals are not required to do so. However, many SNFs and local health departments are asking hospitals to assist by providing testing for SNFs in their regions. While some hospitals are able to provide testing support, others are declining, based on limited resources and/or concerns they will not be able to disengage in the future. (6/8)
What can be done if a supply shipment is delayed at a point of entry?
If a shipment of COVID-19 supplies, such as personal protective equipment (PPE) or test kits, is held up at a port of entry, please contact the Food and Drug Administration office covering your port of entry or email COVID19FDAImportInquiries@fda.hhs.gov with the entry number, port of entry, and other shipment details. More information is available here. (4/22)
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 Food and Drug Administration (FDA) has issued emergency use authorization for various mask and respirator decontamination systems. In early June, the FDA reissued emergency use authorizations that revise policy on the types of N95 respirators that can be decontaminated for reuse. Per the CDC, use of respirators that have been decontaminated should be reserved as a crisis strategy.
The California Department of Public Health (CDPH) has collaborated with Battelle Memorial Institute to deploy its FDA-authorized emergency use decontamination system in California. The Battelle method, a vaporous hydrogen peroxide system, received FDA authorization March 29, although as noted above, the respirators that may be used with this system may have changed. Participation in the program is free to hospitals. The federal government is paying for the cleaning and system, and the state is paying for the shipping costs to and from the decontamination sites. For details about participating, see the information packet, infographic on the sign-up process, and sample service agreement. Signed service agreements and questions can be directed to Jon Cartlidge at email@example.com. (6/11)
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)
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 firstname.lastname@example.org. For more information, visit www.justice.gov/coronavirus. (4/12)
What are the requirements for testing skilled-nursing facility (SNF) residents?
SNFs are required to include a plan for resident and staff testing as one of the elements in a facility-specific COVID-19 mitigation plan. CDPH has issued recommendations for ongoing baseline, surveillance, and response-driven testing for SNFs to prevent spread of infection. (7/22)
At my acute care hospital, we have several Medicare patients who need continued care at a skilled nursing level, but there are no local SNFs willing to admit patients, due to the public health emergency. Is there a way we can continue to provide the necessary care and get reimbursed?
Yes. On May 20, The Centers for Medicare & Medicaid Services issued a blanket waiver to allow acute care hospitals, excluding inpatient psychiatric hospitals and long-term care hospitals, to establish swing beds to provide skilled nursing care for hospitalized patients who don’t need continued acute care but cannot transition to a SNF during the COVID-19 public health emergency. Hospitals establishing swing bed SNF services will receive reimbursement via the SNF prospective payment system. Noridian, the Medicare administrative contractor for most California hospitals, has provided additional provider education and outreach on this matter. (5/28)
Our hospital has a patient who no longer needs acute care. We gave her the “Important Message from Medicare,” and she has not appealed the discharge decision. However, she refuses to consent to the skilled-nursing facility placement we secured. What can we do?
During the COVID-19 pandemic, many statutes and regulations regarding discharge planning and consent for transfer have been waived. Read more
What personal protective equipment (PPE) should be provided to employees working in SNFs?
Cal/OSHA’s Aerosol Transmissible Disease Standard applies to SNFs and specifies what PPE is appropriate in a variety of circumstances. Cal/OSHA has developed specific guidance for SNFs and has indicated it intends to focus more attention on these workplaces.
Do SNFs have to report cases to COVID-19?
Yes, SNFs are required to report communicable diseases, health care-associated infections, and potential outbreaks to state and local health departments. CDPH has released All Facilities Letter 20-43 requesting that SNFs provide, via an online survey, a daily report of staffing levels, the number of COVID-19 residents — including confirmed positive and suspected residents — equipment availability, and other facility needs. Additionally, beginning July 20, SNFs are required to submit the results of required COVID-19 surveillance or response driven testing data to the CDPH on a weekly basis. (7/22)
What should I do if I become aware of an unsafe situation in a skilled-nursing facility?
Contact the District Office for the CDPH Licensing and Certification Program. Contact information for district offices is located here. (4/20)
What is the impact of recent CMS waivers on discharge planning and patient determination of their post-acute care destination?
CMS has waived certain aspects of the discharge planning process, most notably the requirement that hospitals provide a patient in need of post-acute care services a complete list of certified providers in their area, and the requirement to use and share data on quality and resource use measures. (4/20)
Is there a waiver for the inpatient rehabilitation facility “3-hour rule?”
Yes. During the COVID-19 public health emergency, the Coronavirus Aid, Relief, and Economic Security Act waives the provision generally required for payment — that patients of an inpatient rehabilitation facility receive at least 15 hours of therapy per week.
Can patients with COVID-19 be discharged to 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 is able 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.
CDPH has also issued interim guidance for transfer and continuity of care of residents with suspected or confirmed COVID-19 infection, including admission of COVID-19-positive residents following hospitalization who still need transmission-based precautions. Unless otherwise directed, hospital personnel must consult with their local health department when discharging a COVID-19-positive patient from the hospital to a SNF. (7/22)
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?
Recent CDPH guidance recommends that all SNF residents be tested prior to admission or readmission. If the transferring hospital does not test the patient, the SNF must test and quarantine upon admission. While CDPH guidance states that hospitals are not required to perform COVID-19 testing on patients solely for discharge considerations, acute care hospitals may choose to, in order to facilitate care coordination and SNF admission. (6/11)
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 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 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)
What are clinical considerations for giving long-acting injectables (LAIs) during the COVID-19 public health emergency?
Since these antipsychotics need to be administered in person, planning can help assure continuity of treatment if a patient is uncomfortable coming to clinic. Here are some considerations from SMI Adviser:
Create a spreadsheet to make sure nobody falls through the cracks.
For patients who usually travel to a clinic, arrange for more local injections.
Check with pharmacies to see if they may be able to administer injections.
Set up and coordinate outreach with services such as visiting nurses, if possible.
Consider medication changes during the pandemic.
If appropriate, give a higher dose than the usual maintenance dose to provide a buffer in case the next injection is delayed.
As a last resort, family members with some medical background could be trained to give an injection.
If giving a LAI is not possible, temporarily prescribe oral medications again. (4/21)
My emergency department (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 (CDPH) 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 (DHCS) 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, and more resources for providers and those experiencing homelessness are available here. (722)
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 DHCS, 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. (4/27)
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?
DHCS has updated its website with new information related to behavioral health and COVID-19, including:
Flexibility for residential mental health facilities and for alcohol and other drug facilities
FAQs for mental health and psychiatric health facilities, narcotic treatment programs, and medication-assisted treatment via telehealth
Behavioral health services for formerly homeless persons under Project Roomkey (4/27)
What personal protective equipment (PPE) should be provided to employees working in skilled-nursing facilities (SNFs)?
Cal/OSHA’s Aerosol Transmissible Disease Standard applies to SNFs and specifies what PPE is appropriate in a variety of circumstances. Cal/OSHA has developed specific guidance for SNFs and has indicated it intends to focus more attention on these workplaces. (4/22)
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. The Centers for Disease Control and Prevention (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)
My hospital received a notice of complaint from the Division of Occupational Safety and Health alleging that my hospital is violating the Cal/OSHA Aerosol Transmissible Disease Standard due to my respirator conservation strategies. What are my options for respirator use and conservation given the continuing shortage?
Some hospital employees want to stay at a hotel, concerned about exposing their family members to the virus. Are there any resources for that?
Yes. These resources offer free or discounted rooms for exposed or COVID-19 positive health care workers: (8/12)
The Non-Congregate Sheltering for California Healthcare Workers Program provides hotel rooms to front-line health care workers who are exposed to or test positive for COVID-19 and do not have the ability to self-isolate or quarantine at home. The cost is covered by the federal or state government.
In order for an employee to qualify for the program, the employing hospital must have a certification letter on file with the Office of Emergency Services (OES). The certification letter is referenced in the April 20, California Department of Public Health (CDPH) All Facilities Letter. If a hospital has not yet submitted a certification letter, they may do so at any time. Once that letter is on file, the hospital does not need to submit another one. he letter should be sent by email to the California Department of General Services (DGS) at email@example.com in addition to sending to OES at HealthcareNCS@caloes.ca.gov.
Employees may continue to make reservations directly with CalTravelStore. They will be required to provide a credit card upon check in to be pre-authorized for the full amount of the stay. If the pre-authorization declines, the employee will not be permitted to check in. Upon check-out, and with no reported policy violations (hotel’s policy and guest obligations), the charges for room and tax will be paid for by the state if the employee meets income eligibility. All participants will be required to pay for incidental charges.
Alternatively, hospitals may make reservations for employees directly. If a hospital wants to do that, it must designate a point of contact and notify DGS at COVID19Lodging@dgs.ca.gov. Reservations should be made using the reservation request form, which the point of contact should submit to COVID19Lodging@dgs.ca.gov. If a hospital makes a reservation on behalf of an employee, the employee will still be required to provide a credit card upon check-in, but the card will be held for incidentals only. Room and tax charges will immediately go to the state’s account.
Finally, if a hospital has a relationship with a hotel that is interested in participating in the statewide travel program, the hotel should contact Kelly Bouchard, statewide program manager, at Kelly.Bouchard@dgs.ca.gov or (916) 376.399. The state’s sourcing team will follow up by sending to the hotel a Request for Proposal (RFP). Upon review and acceptance of the hotel’s proposal by the state, the hotel may participate in the program and will be reimbursed by the state according to the terms and conditions of the RFP.
The program is authorized on a monthly basis, and authorization for the following month may not occur until the last day of the preceding month — making it difficult to determine how long the program will continue. If you have any questions about the program contact Gail Blanchard-Saiger or Teri Hollingsworth.
2. The American Hospital Association has provided this list of hotels, airlines, and food service companies that are offering discounts or complementary services for health care workers. Note, however, that not all hotels with in a group are participating in the discount program.
Our staff needs help with childcare. What resources are available?
The Governor’s Executive Order N-62-20 implemented a presumption in the workers’ compensation system that expires on July 5, and the Division of Workers Compensation recently issued FAQs to assist employer in complying with it.
While the order has not been extended beyond July 5. three bills are pending in the Legislature that seek to create a presumption, each with varying scope, conditions, and requirements. It is unlikely that any legislation, even if passed, would be signed before September. Because workers’ compensation legislation can be applied retroactively, hospitals need to decide how to handle COVID-19-related workers’ compensation claims during the period from July 6 through September — specifically, whether to continue to apply the presumption assuming a new law will pass, or whether to discontinue applying a presumption with the understanding that, if a new law passes, they will likely need to convert some situations as covered by workers’ compensation. (7/5)
I am concerned about the emotional well-being of my staff. Are there resources beyond my Employee Assistance Program benefits?
The Hospital Quality Institute’s “Care for the Caregiver” webinar is now available as an on-demand recording. The webinar includes practical and necessary tools to assist hospitals and their employees in creating a peer support model for adverse events such as the COVID-19 pandemic. Additionally, the training offers information on how to engage in empathic conversation with both patients and families. More information and the recording are available here.
Various associations representing California’s licensed mental health professionals have joined together to provide support to health professionals, first responders, and essential workers on the front lines fighting the COVID pandemic. On this website, health care workers can locate licensed providers who are offering services for free during the crisis.
In addition, behavioral health professionals in the Bay Area have created a pro bono project for Bay Area front-line health care workers. The COVID-19 Pro Bono Counseling Project is a project devoted to helping health care workers locate free convenient short-term psychotherapy during the COVID19 crisis. For more information, email firstname.lastname@example.org. A short video on the program is also available. (7/14)
Are there any resources to help hospitals understand the Paycheck Protection Program in the CARES Act?
The American Hospital Association hosted a webinar to explain this new law, which provides forgivable loans when the funds are used for payroll and other allowable costs.
In March, the federal government 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. The Department of Labor originally adopted emergency regulations that created a very broad definition of “health care provider” to include anyone who works in a hospital or other facility related to health care. However, on August 3, a federal judge concluded the department exceeded its authority in applying such a broad definition and invalidated that portion of the regulations. Read more (9/16)
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 to 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?
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 California’s hundreds of employment laws and are strategizing on ways to limit liability. We will keep hospitals posted about any developments. (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)
I see that the California Department of Public Health (CDPH) issued All Facilities Letter (AFL) 20-26.3, which notifies hospitals of a temporary waiver of licensing requirements from July 1, 2020, through March 1, 2021. Does this AFL waive all hospital licensing requirements?
No, it doesn’t. It is a narrower waiver than the one in effect from March 20 through June 30, 2020, although it still waives significant requirements, including:
Space. Requirements related to the configuration and use of physical space and classification of beds in a hospital.
Discharge planning. Requirements for detailed discharge planning and the provision of nonmedical services to homeless individuals.
Services. Requirements for detailed public notification when a hospital plans to downgrade, change, or eliminate a level of service are modified (not eliminated).
License. Hospitals seeking initial licensure or to change beds/services on their license must submit an online application, but do not need CDPH approval before providing care.
Some of the requirements that were previously waived, but are no longer waived include:
Nurse staffing ratios. Hospitals must bring staffing levels into state ratio compliance by July 17. A hospital experiencing a COVID-19-related patient surge or staff shortage may request a waiver of nurse-staffing ratios or any other hospital licensing requirement from CDPH by submitting CDPH form 5000A and providing supporting documentation to the CDPH Center for Health Care Quality duty officer at CHCQDutyOfficer@cdph.ca.gov and to the hospital’s CDPH district office.
Requirement to report privacy breaches to CDPH (although the deadline to report breaches related to telehealth is lengthened from 15 days to 60 days pursuant to the Governor’s Executive Order)
Requirement to give handouts: Patients’ Rights, observation, Sudden Infant Death Syndrome, brain death
Requirement to post signage in observation units
Quarterly reporting of health-care-associated MRSA bloodstream, clostridium difficile, and Vancomycin-resistant enterococcal bloodstream infections
Requirements regarding family caregivers
RN orientation to unit and demonstrated competency
Medical staff and credentialing
What else is not waived by this AFL?
Federal laws (although many federal agencies have also issued waivers)
State requirements to report infectious diseases, including COVID-19 positive test results, to the local public health officer and to the hospital’s CDPH district office. However, hospitals that complete the CHA COVID-19 Tracking Tool do not need to report COVID-positive patients to their CDPH district office.
Wage and hour laws
Requirements about involuntary mental health patients
Other state laws not under CDPH’s jurisdiction (although other state agencies have also issued waivers)
Local ordinances, including the Los Angeles ordinance about discharging patients across state lines (7/5)
What acute care hospital surveys are being conducted by CDPH?
CDPH is currently conducting surveys on behalf of the Centers for Medicare & Medicaid Services (CMS) where it evaluates hospitals for compliance with federal laws. In addition, CDPH is conducting limited surveys to evaluate hospitals for compliance with state laws.
Federal – survey activity on behalf of CMS
On March 23, CMS announced general regulatory enforcement discretion for at least three weeks – later extended indefinitely. The enforcement discretion applies to hospitals, long-term care facilities, home health agencies, hospices, and laboratories. No surveys will be conducted except:
In response to complaints and facility-reported incidents that CMS believes may constitute an immediate jeopardy. A streamlined infection control review tool will be used during these surveys, regardless of the allegation. Hospitals are, therefore, able to prioritize infection control and responding to the COVID-19 pandemic over less important regulatory requirements.
Targeted infection control surveys of acute and long-term care providers. The streamlined infection control review tool included with the CMS announcement will be used. The California Department of Public Health (CDPH), as the CMS contractor, may use this entrance checklist as it conducts infection control surveys of both skilled-nursing facilities (SNFs) and hospitals. While the checklist is labeled for SNFs and references “residents,” it is being used for both SNFs and hospitals. CHA has received clarification that CDPH surveyors may use the hospital-specific information on “Focused Survey for Acute and Continuing Care Providers” on pages 19-28 of CMS’ Survey and Certification Memo to State Survey Agencies QSO 20-20.
Initial certification surveys.
In addition, on June 1 CMS issued a memo allowing states, at their discretion, to also perform the following hospital surveys:
Complaint investigations that are triaged as Non-Immediate Jeopardy-High
Revisit surveys of any facility with removed Immediate Jeopardy (but still out of compliance)
CDPH has told CHA that when its surveyors visit a hospital for a CMS infection control survey, the surveyors may also bring older complaints or facility-reported events that haven’t been closed out, so they can try to complete any work needed on them. The surveyors have been directed to be doing as much work off-site as possible and enter hospitals as infrequently as possible.
State survey activity
The Governor’s Executive Order of March 15 directs CDPH and Cal/OSHA staff to focus on providing technical assistance and support to health care facilities. It also limits agencies’ enforcement activity to allegations of the most serious violations impacting health and safety.
CDPH has told CHA that it is configuring data to create various indicators to proactively identify facilities that may be having patient surges, staffing shortages, or other problems. CDPH staff will call these facilities to see how they’re doing and ask what CDPH can do to help. These calls are expected to be supportive and provide technical assistance, in line with the Governor’s Executive Order. They are not supposed to be punitive or enforcement-oriented. CDPH expects this to begin in in mid-August.
CDPH has no plans to undertake relicensing surveys at this time. (7/27)
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. See CHA’s list of federal waivers.
CMS on March 23 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 CDC 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. As of June 8, CMS had not announced whether it has extended its survey suspension or proceed in a different manner. The Joint Commission has announced a plan to commence surveys in appropriate geographic areas in mid-June. (7/20)
Is the requirement to report privacy breaches to CDPH waived?
No. This requirement – found in Health and Safety Code Section 1280.15 – was waived between March 20 and June 30, 2020. CDPH has told CHA it does not expect hospitals to go back and report breaches that were discovered during that time period. Starting July 1, hospitals were again required to comply with this breach reporting requirement, except that if a breach is related to telehealth, the hospital’s deadline to report to CDPH and to the patient is extended from 15 days to 60 days pursuant to Gov. Newsom’s Executive Order of April 3, 2020. (7/1)
What is the status of Medicaid requests?
The Department of Health Care Services (DHCS) has submitted three 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 on March 19; and the third on April 10.
On March 23, DHCS received the approval from CMS in response to its 1135 waiver requests submitted the week before. DHCS received its second 1135 approval on May 8. Both approvals consist of flexibilities for the Medi-Cal program, seeking temporary relief of existing administrative requirements to rapidly increase access to medical services.
Based on guidance received from CMS, DHCS also submitted a state plan amendment requesting additional flexibilities to waive or modify certain requirements of California’s State Plan. CMS approved the request on May 13. (6/11)
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)
What tools are available to support hospitals as they surge their capacity to care for patients?
CHA has created a guide to state waivers, which identifies state laws and regulations that have been suspended during the COVID-19 State of Emergency.
The California Department of Public Health (CDPH) released guidance to counties on COVID-19 surge planning dated July 15. The guidance advises counties to consult with the state before issuing local health orders. It also clarifies that counties should consider the impact of local health orders that cancel scheduled surgeries and non-emergency procedures, or that furlough potentially exposed asymptomatic health care workers, on the ability to provide medically necessary care. Other key points from the document include:
Hospital surge capacity should be implemented in real time to maintain the ability to provide medically necessary care for all Californians.
County health care coalitions and local health officers should co-convene hospitals to review the guidance by Aug. 14.
Counties should recognize four surge status levels that outline the roles of county health departments, hospitals, and the state based on dynamic local conditions.
The meeting the county will convene would provide a good opportunity for the hospital to better understand how the hospitals and county will work together on surge planning.
CDPH has also developed a COVID-19 Health Care System Mitigation Playbook with mitigation strategies for health care facilities. Numerous licensing and certification requirements at both the state and federal levels have been suspended during this public health emergency, which can support health care facilities in surging their capacity. CHA has developed a summary of the state waivers and federal waivers. (7/20)
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)
Can hospitals bill Medicare for telehealth or other virtual services when provided to patients in their own homes?
CMS’s COVID-19 FAQs on Medicare Fee-for Service Billing provide responses to questions on when hospitals can bill Medicare for services provided to a patient in their home when the patient’s home has been made a provider based department of the hospital. (7/22)
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?
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. CMS guidance provides more information on payment and billing for telehealth services provided by RHCs and RQHCs. (4/20)
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)
The blanket waiver expired on June 30. However, CDPH issued an All Facilities Letter on July 3, which addresses ratios, among other licensing requirements. A hospital experiencing a COVID-19 related patient surge or staff shortage may request a staffing waiver by submitting a CDPH form 5000A. (7/14)
I’m a nursing student and have applied for a preceptorship at an area hospital, but the Board of Registered Nursing has not approved the hospital site. Can I still perform the preceptorship?
Yes, as long as the hospital clinical setting gets approval from your school’s nursing education consultant. Additional details are available here. (7/2)
Do we know how hospitals can get staffing from Health Corps?
The California Department of Public Health (CDPH) has issued All Facilities Letter 20-46, which outlines the process for health care facilities experiencing an urgent staffing shortage to request staffing resources from the state. Health care facilities must report these as unusual occurrences to the CDPH Licensing and Certification District Office. CDPH, in collaboration with the local public health department, will assess the situation and determine whether the facility can continue to operate safely.
At the same time, the local public health department will contact the Medical Health Operational Area Coordinator to begin the process of locating resources within the local area, region, or state. State resources include the California Emergency Medical Services Authority’s California Medical Assistance Teams, the California Health Corps, or other staffing contracts. (4/22)
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. (7/21)
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. (7/2)
Our staff needs help with childcare. What resources are available?
In addition, all levels of government are working on childcare solutions for health care workers. Currently, several resources are available. Read more (6/8)
Have physician credentialing and privileging requirements at hospitals been waived?
No. These requirements were waived from March 20 until June 30, but that waiver has expired. (7/20)
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. In addition, the Office of the Inspector General (OIG) announced it will exercise enforcement discretion not to impose penalties under the federal anti-kickback statute for payments related to eleven of the self-referral waivers. To use one of the other seven waivers, OIG suggests providers consult them beforehand.
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. (4/27)
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 (DCA), 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, this waiver does not apply to certified nursing assistants, paramedics, or emergency medical technicians; they are licensed/certified by other state agencies that have issued different waivers. See CDPH All Facilities Letter 20-35 for information about certified nursing assistants, and the Emergency Medical Services Administration’s website for information about paramedics and emergency medical technicians.
DCA 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. (4/27)
Are there any accommodations for pharmacy staffing during the COVID-19 emergency?
The Board of Pharmacy previously authorized numerous waivers to accommodate pharmacy staffing issues due to COVID-19. Those waivers have expired, and the Board of Pharmacy encourages you to request an invidual waiver as described below.
How to Request a Pharmacy Law Waiver Related to COVID-19 Emergency
Gov. Gavin Newsom declared a statewide emergency March 4, 2020, to help the state prepare for the broader spread of COVID-19. Under the provisions of Business and Professions Code section 4062, the Board has authority to waive provisions of Pharmacy Law or regulations adopted pursuant to it if, in the Board’s opinion, the waiver will aid in the protection of public health or provision of patient care. Under the Board’s policy, such a determination may be made at the discretion of the Board President for a period of up to 30 days.
Licensees may submit a request for a waiver to email@example.com. (Note: This email address is for any type of waiver, not just compounding.) The request should include the following information:
A brief statement regarding the extent of the waiver requested
A brief statement detailing how the declared emergency caused the need for the waiver
Relevant laws that the licensee is requesting be waived
Authorized contact person – any owner, officer, member, pharmacist-in-charge, or other individual otherwise authorized to act on behalf of the licensee
Board staff will respond to the authorized contact via email (7/21)
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 up 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)
On June 21, 2016, the Centers for Disease Control and Prevention
(CDC) announced that Zika virus infection testing using real-time
reverse-transcription polymerase chain reaction (rRT-PCR)
molecular assays is now commercially available. This Health Alert
Network (HAN) update intends to further disseminate CDC’s
recommendations for Zika immunoglobulin M (IgM) antibody