California hospitals are a critical element within the disaster
medical response system and work collaboratively with local
government, other health care providers and other agencies to
plan, prepare for and respond to the needs of victims of natural
or man-made disasters, bioterrorism, and other public health
emergencies. Hospital emergency preparedness is a priority for
government at all levels, as well as a key focus of regulatory
and accrediting agencies.
Information to help health care providers prepare and care for
patients potentially exposed to and diagnosed with novel
coronavirus. Get the latest updates, guidance, travel alerts, and
other information related to the virus.
HHS Announces Nearly $4.9 Billion Distribution to SNFs
Impacted by COVID-19
The U.S. Department of Health and Human Services (HHS)
announced today that it has begun distributing billions in
additional relief funds to skilled-nursing facilities (SNFs),
including distinct part nursing facilities. The funding is
intended to help nursing homes address critical needs such as
labor, scaling up their testing capacity, acquiring personal
protective equipment, and a range of other expenses directly
linked to this pandemic. HHS will distribute funding to all
certified SNFs with six or more certified beds on both a fixed
basis and variable basis. Each SNF will receive a fixed
distribution of $50,000, plus a distribution of $2,500 per
bed.
California Receives Additional Remdesivir
Allocation
California’s allotment of remdesivir was significantly increased
from 1,200 vials last week to 17,000 vials this week. The
California Department of Public Health (CDPHi) has issued
guidance and additional information about the distributions,
and county-by-county allocations can be found
here.
CDPH Anticipates Extending Suspension of Hospital
Licensing Requirements, Enforcement
In response to an inquiry from CHA, CDPH has communicated that it
anticipates extending — with possible modifications —
All-Facilities Letter (AFL) 20-26. This AFL temporarily
waives hospital licensing requirements and suspends regulatory
enforcement of the requirements, with certain exceptions. It
expires June 30, unless extended by CDPH, which has this
authority through the period of the declared emergency. CHA will
continue to advocate with CDPH for an extension that creates the
regulatory environment hospitals need to respond to the COVID-19
crisis and the forecasted resurgences.
DMHC All Plan Letter Encourages Health Plans to Help
Providers
On Wednesday, the Department of Managed Health Care (DMHC) issued
an
All Plan Letter that will help hospitals negotiate with
health plans on claims, advance payments, and administrative
burdens. In the letter, DMHC notes it will closely monitor plans’
compliance with timely claims processing and other activities.
The letter:
Reminds these plans of their duty to maintain adequate
networks that provide enrollees with medically necessary services
in a timely manner, especially in a period when hospitals and
other providers are reporting significant financial
difficulties
Mandates that all plans with commercial lines of business
submit an informational filing to DMHC explaining the steps the
plan has taken, and/or will take, to ensure continued network
adequacy.
Strongly encourages these plans and risk-based organizations
to take steps to:
Expedite claims review and payment to decrease the
accounts receivables owed to providers
Identify and remove administrative burdens that may be
delaying providers’ abilities to submit and be paid for
claims
Work with their contracted providers to give the
providers advance payments when feasible and desired
Amend coordination of benefit procedures in situations
where the enrollee has not yet verified they do not have
alternative coverage, such that the default is to pay the
claim
CHA Asks State for Support in Access to SNF
Care
CHA has sent
a letter to leadership at the California Health and Human
Services Agency and CDPH, requesting that the state consider two
actions to support post-hospital access to SNF care during the
current COVID-19 public health emergency. Specifically, CHA
requested that CDPH establish an easily accessible list of
COVID-ready facilities, including admission policies and patient
criteria, as well as significantly increase the availability of
training and support resources for infection prevention practices
in SNFs.
CMS Issues Guidance on Outpatient Therapy Coding and
Billing
The Centers for Medicare & Medicaid Services (CMS) has
issued guidance on coding and billing for outpatient therapy
services, including services provided remotely. The additions to
the therapy code list reflect those made in calendar year 2020
for the COVID-19 public health emergency.
Health Affairs Article Demonstrates Racial and
Ethnic Inequities in COVID Patients
A recent article published in Health Affairs found that African American patients
are nearly three times as likely to be hospitalized with COVID-19
as non-Hispanic whites. The article describes how African
American patients with COVID-19 are accessing health care at a
point where they are more seriously ill and more likely to be
hospitalized. It also explores possible explanations, including
societal factors that result in barriers to timely access to care
or create circumstances in which patients view delaying care as
the most sensible option.
Resources Available for Reducing Risk Among Drug
Users
The Harm Reduction Coalition has published a
series of resources aimed at reducing risk and minimizing
infection complications for drug user. Materials are available in
English, Spanish, Portuguese, and Arabic.
May 20:
CMS Provides Payment Information for COVID-19 Serology
Tests
The Centers for Medicare & Medicaid Services (CMS) has updated
its
fact sheet on COVID-19 diagnostic test pricing with CPT codes
for nucleic acid and serology tests. Specifically, the American
Medical Association developed CPT code 87635 for infectious agent
detection by nucleic acid tests, and CPT codes 86769 and 86328
for serology tests. CMS notes that local Medicare administrative
contractors (MACs) are responsible for developing payment amounts
for the newly created codes in their respective jurisdictions
until Medicare establishes national payment rates. Noridian,
California’s MAC, has set the payment rate for code 87635
(nucleic acid test) at $51.31, code 86769 (serology test) at
$42.13, and code 86328 (serology test) at $45.23.
Prior to this update, laboratories could bill for COVID-19
diagnostic tests using the code U0001 for tests developed by the
Centers for Disease Control and Prevention (CDC) and code U0002
for non-CDC developed tests. The payment rate for CDC tests is
$35.91 and for non-CDC tests is $51.31.
CMS Issues Guidance for Reopening SNFs
CMS has issued
guidance and
frequently asked questions for state and local officials
about reopening of skilled-nursing facilities (SNFs).
Recommendations include a phased process for relaxing certain
restrictions, visitation, and service changes, and for restoring
survey activities.
Rural Health Clinics to Receive $225 Million to Expand
Testing
The U.S. Department of Health and Human Services (HHS), through
the Health Resources and Services Administration (HRSA),
has announced $225 million to support COVID-19 testing
efforts and expand access to testing at more than 4,500 rural
health clinics (RHCs) nationwide. The funding is part of the
Paycheck Protection Program and Health Care Enhancement Act. HRSA
will also award $500,000 to support technical assistance efforts
to the RHCs as they expand testing capabilities. This includes
activities such as conducting webinars, providing resources and
guidance for implementation, and management of testing programs.
A state-by-state breakdown of the funding can be found
here.
New Guidance on Swing Bed Waiver
CMS has released
guidance on the
blanket waiver that expands hospitals’ ability to offer
skilled-nursing level care through the use of swing beds for
patients who do not require acute care but cannot find nursing
home placement during the COVID-19 public health emergency. The
guidance includes information on how hospitals can request
approval for swing beds through their MAC, clarifications on the
waiver’s requirements, and information on hospital billing and
payment for swing bed services.
FAQs Available on Workers’ Compensation
Presumption
The Division of Workers’ Compensation has issued
frequently asked questions related to the Governor’s May 6
Executive Order, which created a workers’ compensation
presumption for COVID-19 claims.
Upcoming CMS Calls
CMS will host several calls over the next two days — one for
hospitals and health systems, one for nurses, and a third that
will cover lessons from the front lines. Call details are as
follows:
Today’s Data Reporting Deadline for Remdesivir
Distribution Canceled
On Friday, CHA informed members about a deadline today for
submitting data related to the allocation of remdesivir.
The U.S. Department of Health and Human Services (HHS)
has now canceled that request, so hospitals do not need to submit
data today.
Over the weekend, HHS determined that it did not need the
additional data at this time. We recognize the frustration many
members are experiencing over the uncertainty of these data
requests. HHS has indicated it intends to ask for updated data
again soon; CHA will share that request and any additional
information as soon as it is available. More information,
including a link to the HHS notification, is available in
this Special Bulletin from the American Hospital
Association.
DHCS Updates on State Plan Amendment and
More
The Department of Health Care Services has provided
website updates with new and additional information for
providers. The updates include the May 13 Centers for Medicare &
Medicaid Services (CMS) approval of California’s State Plan
Amendment (retroactive to March 1), a county operations survey
summary, fee-for-service pharmacy benefits, pharmacy coverage
clarifications, and the Telehealth for Billing Option
Program.
Slides Available from State Testing Task Force Meeting
with Hospitals
On May 14, CHA member hospitals had an opportunity to meet with
members of the state’s
COVID-19 Testing Task Force — including CHA President & CEO
Carmela Coyle and task force co-chairs Dr. Charity Dean,
assistant director of the California Department of Public Health
(CDPH), and Paul Markovich, CEO of Blue Shield California. The
call included a briefing on the Testing Task Force’s progress
toward statewide testing capacity and goals, as well as questions
from hospitals for the task force members. The slide deck from
that call is
available here. Questions can be emailed to testing.taskforce@state.ca.gov.
Summary of May 12 CDPH Call
CDPH has provided
a summary of its weekly call with health facilities.
Next CDPH Call: May 19, 8-9 a.m. (PT)
Dial: (844) 721-7239
Passcode: 7993227
Upcoming CMS Calls
CMS will host several calls over the next two days, one for
hospitals and health systems and others for home health/hospice
providers, dialysis organizations, and nursing homes. Call
details are as follows:
Hospitals and Health Systems: May 19 at 2 p.m.
(PT)
Dial: (833) 614-0820
Passcode: 1908409
Audio webcast
Home Health and Hospice Providers: May 19 at noon
(PT)
Dial: (833) 614-0820
Passcode: 6477704
Audio webcast
Nursing Homes: May 20 at 1:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 4879622
Audio webcast
Dialysis Organizations: May 20 at 2:30 p.m.
(PT)
Dial: (833) 614-0820
Passcode: 3287645
Audio webcast
May 15:
Next Data Reporting Deadline is Monday for Remdesivir
Allocation
The U.S. Department of Health and Human Services (HHS) has
announced that the next deadline for submitting data to aid in
its allocation of the drug remdesivir is Monday, May 18
at 8:59 p.m. (PT). Hospitals are being asked to provide,
on a weekly basis, the number of hospitalized coronavirus
patients and, of those admissions, the number who currently
require placement in an intensive care unit. Data should be
submitted using the TeleTracking web portal.
Hospitals that already use TeleTracking for their daily reporting
do not need to do anything differently for this remdesivir data
collection, other than ensure their data are submitted on time.
For more information about TeleTracking and the HHS announcement
about availability of remdesivir, see the
American Hospital Association’s Special Bulletin.
CMS Confirms Continuing “Enforcement Discretion” and
Limited Survey Activity
CHA has confirmed that the general
enforcement discretion announced by the Centers for Medicare
& Medicaid Services (CMS) on March 23 has been extended
indefinitely. It 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)
For targeted infection control surveys of acute and long-term
care providers
For initial certification surveys
The streamlined infection control review tool and explanation are
included with the CMS announcement. The California Department of
Public Health (CDPH) may also use this
entrance checklist. While it is labeled for skilled-nursing
facilities (SNFs) and references “residents,” it is being used
for both SNFs and hospitals. CDPH might also use the acute care
worksheets issued by
CMS.
State Testing Task Force Members Brief Hospitals on
Testing Capacity, Statewide Goals
CHA member hospitals conferenced yesterday with members of the
state’s COVID-19
Testing Task Force — including CHA President & CEO Carmela
Coyle and task force co-chairs Dr. Charity Dean, assistant
director of CDPH, and Paul Markovich, CEO of Blue Shield
California. The co-chairs explained the task force’s objectives,
as well as its progress on achieving the Governor’s proposed
daily testing numbers. Notably, the state is establishing more
sites to ensure equitable access, and progress has been made on
securing scarce collection supplies such as swabs and reagents.
The co-chairs also discussed improving the process, facilitating
innovation, and using data and analytics to reach goals. In
addition, hospitals had an opportunity to ask questions of the
task force members.
Subsequent meetings with task force members will be held
biweekly rather than weekly, as originally scheduled. The next
meeting will take place May 28 from 3 to 4 p.m. (PT). To
participate:
CDPH has issued All
Facilities Letter (AFL) 20-43.2, which provides information
about the requirement that all SNFs submit daily COVID-19
facility data via an online survey. The updated AFL reflects
additional information from the recently released
interim final rule from CMS.
EDs Eligible for Federal Grants Supporting Suicide
Prevention Efforts
Recognizing that the current crisis will cause increases in
depression, anxiety, trauma, grief, isolation, loss of
employment, financial instability, and other challenges that can
lead to suicide and suicide attempts, the Substance Abuse and
Mental Health Services Administration is accepting applications
for fiscal year 2020 COVID-19
Emergency Response for Suicide Prevention grants. The grants
are intended to support efforts to prevent suicide and suicide
attempts among adults age 25 and older. Emergency departments are
eligible for the grants, which are anticipated to be for 16
months at up to $800,000 per grantee. Applications are due May
22.
May 13:
CHA Urges California Representatives to Support New
Congressional Funding Proposal
Today, CHA today
sent a letter to the California congressional delegation in
support of a new House of Representatives bill. The
Health and Economic Recovery Omnibus Emergency Solutions (HEROES)
Act, H.R. 6800 is the Democrats’ legislative effort to
provide relief during the pandemic and financial crisis facing
the nation. The House expects to vote on the bill May 15, marking
the beginning of what promises to be a partisan negotiation;
hospitals are urged to respond to CHA’s
alert from last week before the vote on Friday.
Last week CHA
sent a letter to the delegation outlining our priorities and,
while the HEROES Act does not address all of them, it takes the
critical step of not only adding $100 billion to the provider
relief fund but also targeting those funds toward hospitals that
made significant investments to prepare for the pandemic. The
measure also prioritizes funding for lost revenues.
CDPH Announces Remdesivir Distribution in
California
On May 11, the California Department of Public Health (CDPH)
announced that a limited supply of remdesivir is anticipated
to be sent to California this week, with additional allotments to
be sent regularly going forward. For each allotment received from
the federal government, CDPH will use the most recent hospital
census data to proportionately distribute remdesivir to the
counties’ Medical and Health Operational Area Coordinator
(MHOAC). Details about the first distribution are available
here.
Until the number of patients who are eligible for remdesivir
treatment under the federal emergency use authorization no longer
significantly outstrips the available supply, CDPH recommends a
random allocation among each county’s acute care hospitals that
are treating COVID-19 patients. Counties should track the
cumulative distribution of the medication to each hospital. CDPH
advises that hospitals should consider an ethical framework for
the distribution of remdesivir to patients, and refer to the
California SARS-CoV-2 Crisis Care Guidelines and
California Guidance for Hospitals Regarding Allocation of Scarce
Medications for COVID-19.
CDPH Updates Staffing Resources Letter, Quick Reference
Guide
CDPH has updated
AFL 20-46.1 on requests by health care facilities (e.g.
hospitals, skilled-nursing facilities) for urgent COVID-19
staffing resources, to include a
quick reference resource on multi-jurisdictional responses to
emergencies and disasters in California, as well as for clarity.
Specifically, it now includes that, “If a facility requires
ongoing staffing support and a local resource’s ability to
continue supplying supplemental staff changes during that period,
the MHOAC should work to locate and coordinate supplemental staff
through alternate local resources.”
Waiver, Guidance for Pharmacies and Pharmacy
Staff
The Department of Consumer Affairs has
waived regulations so pharmacists may order and collect
specimens for authorized COVID-19 tests. The order terminates 60
days from the date it was issued (May 12), unless further
extended. In addition, CDPH has
issued guidance for pharmacies and pharmacy staff on
operations during the public health emergency, in order to
minimize their risk of exposure and reduce customer risk. The
guidance emphasizes principles of infection prevention and
control, as well as physical distancing.
CDPH Guidance for SNF Mitigation Plans
CDPH has issued
All Facilities Letter (AFL) 20-52, which advises
skilled-nursing facilities to submit a COVID-19 mitigation plan
within 21 days. The plan must include several specific elements,
including items addressing infection prevention and control,
plans to ensure adequate access to personal protective equipment,
space for separation of infected patients, and more. The AFL also
provides comprehensive updated infection control guidance.
FAQs Clarify COVID-19 Diagnostic Testing Price
Transparency Requirements
The Department of Health and Human Services (HHS) has issued
FAQs about recent federal legislation related to coverage of
COVID-19 diagnostic testing. The FAQs clarify price transparency
requirements of the Coronavirus Aid, Recovery, and Economic
Security Act, which mandates that providers post the cash price
for a COVID-19 diagnostic test on their website from March 27
through the end of the public health emergency. Providers that do
not comply with the requirement and have not completed a
corrective action plan could be subject to civil monetary
penalties in an amount not to exceed $300 per day that the
violation is ongoing.
CalOES Announces Webinars for FEMA Funding
Applicants
The California Governor’s Office of Emergency Services (CalOES)
has announced it will act as the grantee for Federal Emergency
Management Agency’s public assistance program and is ready to
assist potential applicants with applying for a public assistance
subgrants and understanding eligibility requirements. CalOES will
present applicant briefings to provide an overview of the program
process and requirements at upcoming webinars. The webinars for
private non-profits, which includes non-profit hospitals, will be
held:
CMS Reaches Out to Nursing Home Staff, Issues New
Toolkit
The Centers for Medicare & Medicaid Services (CMS) Administrator
Seema Verma has
sent a letter to nursing home management and staff expressing
gratitude for their “unwavering dedication and commitment to
keeping residents safe.” The letter also includes links to and
information about CMS guidance, flexibilities, recommendations,
and other information specific to nursing homes.
CMS will host several calls over the next two days — one for
hospitals and health systems, one for nurses, and a third that
will cover lessons from the front lines. Call details are as
follows:
Hospitals and Health Systems: May 14 at 2 p.m.
(PT)
Dial: (833) 614-0820
Passcode: 5688374
Audio webcast
Lessons from the Front Lines: May 15 at 9:30 a.m.
(PT)
Dial: (877) 251-0301
Passcode: 8983296
Audio webcast
May 6:
Executive Order Extends Workers’ Compensation Benefits to
Workers Who Report to Work During Shelter-in-Place
Order
Today, Gov. Newsom signed an
Executive Order to extend workers’ compensation benefits to
all employees who were required to report to work outside their
homes from March 19 through July 3. While CHA has not had an
opportunity to fully analyze the order, here are the significant
points:
Applies to all sectors, not just first responders and health
care
Requires the employee to have tested positive or be diagnosed
by a physician, followed by a positive test within 30 days
Requires the employee to have performed work at the place of
employment and at the employer’s direction within 14 days of a
positive test or diagnosis
Allows employers to present evidence to show the virus
exposure did not occur at work
Requires employees to exhaust COVID-19 specific supplemental
paid sick leave (FFRCA, etc.) before receiving temporary
disability benefits. If no such benefits are available, there is
no waiting period to receive temporary disability benefits.
Employers have 30 days to reject a claim.
Allows for recertification of temporary disability every 15
days, for the first 45 days
The Department of Industrial Relations intends to provide
additional guidance in the next few days. There are many
questions from the provider and the employer sides, as well; CHA
is working to have these addressed.
CDC Revises Return-to-Work Criteria for Health Care
Workers
The Centers for Disease Control and Prevention has further
revised
its guidance for return-to-work criteria for health care
workers with confirmed or suspected COVID-19. Of note, the
guidance moves to “symptom-based” and “time-based” strategies.
For symptomatic workers, the timeframe to return to work under
the symptom-based strategy has increased from seven to 10
days.
CMS Extends Regulatory Enforcement
Discretion
On March 23, the Centers for Medicare & Medicaid Services (CMS)
announced general regulatory enforcement discretion for at
least three weeks. CHA has confirmed with CMS that this has been
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.
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.
Updated Guidance on Transfers to Alternate Care
Sites
CDPH has issued revised
All Facilities Letter (AFL) 20-48.1, providing guidance for
the transfer of COVID-19 positive patients and residents to
alternate care sites.
Summary of May 5 CDPH Call
CDPH has
provided a summary of its weekly call with health
facilities.
Upcoming CMS Calls
CMS will host several calls over the next two days for hospitals
and health systems, nurses, and a third that will cover lessons
from the front lines. Call details are as follows:
Hospitals and Health Systems: May 7 at 2 p.m.
(PT)
Dial: (833) 614-0820
Passcode: 1181167
Audio webcast
Nurses: May 7 at noon (PT)
Dial: (833) 614-0820
Passcode: 5486361
Audio webcast
Lessons from the Front Lines: May 8 at 9:30 a.m.
(PT)
Dial: (877) 251-0301
Passcode: 9146779
Audio webcast
May 4:
CDPH Updates Visitor Guidance
The California Department of Public Health (CDPH) has updated its
visitor guidance by issuing
All Facilities Letter (AFL) 20-38.1, which supersedes AFL
20-38. The updated AFL recommends that facilities allow support
persons to accompany patients with physical, intellectual, or
developmental disabilities and patients with cognitive
impairments, when medically necessary and appropriate.
CHA and Coalition Recommend State Action on
PPE
CHA has signed on to a
coalition letter to the Governor, asking the state to ensure
adequate personal protective equipment (PPE) for all essential
workers. Specifically, the letter recommends that the state:
Provide regular reports on the current inventory of PPE in
the state stockpile and the status of those supplies.
Create a supply chain strike team within the administration,
designate a lead to coordinate the expansion of PPE supply in the
state stockpile, and ensure a comprehensive and equitable
distribution process.
Other coalition members include Service Employees International
Union California, California Association of Health Facilities,
and California Health Advocates.
Public Hospital Eligibility for Paycheck Protection
Program
The Small Business Administration (SBA) has issued
updated FAQs that address eligibility for certain public
hospitals under the Paycheck Protection Program (PPP). For the
purposes of the PPP, the SBA will treat a nonprofit hospital
exempt from taxation under section 115 of the Internal Revenue
Code — related to tax exemption of governmental organizations —
as meeting the definition of “nonprofit organization” if the
hospital reasonably determines, in a written record maintained by
the hospital, that it is an organization described in section
501(c)(3) of the Internal Revenue Code.
CMS Commission on Nursing Home Safety
The Centers for Medicare & Medicaid Services (CMS) has
established an independent commission to conduct a
comprehensive assessment of the nursing home response to the
pandemic and provide recommendations to help inform immediate and
future responses. The new commission is expected to convene in
late May and will include leading industry experts, family
members, clinicians, resident/patient advocates, medical
ethicists, administrators, academicians, infection control and
prevention professionals, state and local authorities, and other
selected experts.
Next CDPH Call: May 5, 8-9 a.m. (PT) Dial: (844) 721-7239 |
Passcode: 7993227
Upcoming CMS Calls
CMS will host several calls over the next two days, one for
hospitals and health systems and others for home health/hospice
providers, dialysis organizations, and nursing homes. Call
details are as follows:
Hospitals and Health Systems: May 5 at 2 p.m Dial: (833) 614-0820 | Passcode:
3996146
Audio webcast
CDPH Updates Visitor Guidance
The California Department of Public Health (CDPH) has updated its
visitor guidance by issuing
All Facilities Letter (AFL) 20-38.1, which supersedes AFL
20-38. The updated AFL recommends that facilities allow support
persons to accompany patients with physical, intellectual, or
developmental disabilities and patients with cognitive
impairments, when medically necessary and appropriate.
CHA and Coalition Recommend State Action on PPE
CHA has signed on to a
coalition letter to the Governor, asking the state to ensure
adequate personal protective equipment (PPE) for all essential
workers. Specifically, the letter recommends that the state:
Provide regular reports on the current inventory of PPE in
the state stockpile and the status of those supplies.
Create a supply chain strike team within the administration,
designate a lead to coordinate the expansion of PPE supply in the
state stockpile, and ensure a comprehensive and equitable
distribution process.
Other coalition members include Service Employees International
Union California, California Association of Health Facilities,
and California Health Advocates.
Public Hospital Eligibility for Paycheck Protection
Program
The Small Business Administration (SBA) has issued
updated FAQs that address eligibility for certain public
hospitals under the Paycheck Protection Program (PPP). For the
purposes of the PPP, the SBA will treat a nonprofit hospital
exempt from taxation under section 115 of the Internal Revenue
Code — related to tax exemption of governmental organizations —
as meeting the definition of “nonprofit organization” if the
hospital reasonably determines, in a written record maintained by
the hospital, that it is an organization described in section
501(c)(3) of the Internal Revenue Code.
CMS Commission on Nursing Home Safety
The Centers for Medicare & Medicaid Services (CMS) has
established an independent commission to conduct a
comprehensive assessment of the nursing home response to the
pandemic and provide recommendations to help inform immediate and
future responses. The new commission is expected to convene in
late May and will include leading industry experts, family
members, clinicians, resident/patient advocates, medical
ethicists, administrators, academicians, infection control and
prevention professionals, state and local authorities, and other
selected experts.
Next CDPH Call: May 5, 8-9 a.m. (PT)
Dial: (844) 721-7239 |
Passcode: 7993227
Upcoming CMS Calls
CMS will host several calls over the next two days, one for
hospitals and health systems and others for home health/hospice
providers, dialysis organizations, and nursing homes. Call
details are as follows:
Hospitals and Health Systems: May 5 at 2 p.m. Dial: (833) 614-0820 Passcode: 3996146
Audio webcast
Home Health and Hospice Providers: May 5 at noon Dial: (833) 614-0820 Passcode: 7844154
Audio webcast
Nursing Homes: May 6 at 1:30 p.m. (PT) Dial: (833) 614-0820 Passcode: 8899983
Audio webcast
Nursing Homes: May 6 at 1:30 p.m. Dial: (833) 614-0820 |
Passcode: 8899983
Audio webcast
Dialysis Organizations: May 6 at 2:30 p.m. Dial: (833) 614-0820 |
Passcode: 8278522
Audio webcast
May 1:
HHS Begins Distributing Payments to Hospitals with High
COVID-19 Admissions, Rural Providers
The U.S. Department of Health and Human Services (HHS)
announced today that it is processing payments from the
Provider Relief Fund to hospitals with large numbers of COVID-19
inpatient admissions through April 10, as well as to rural
providers. California hospitals and rural providers will receive
$543.2 million of the $22 billion total.
HHS is distributing $12 billion to 395 hospitals that provided
inpatient care for 100 or more COVID-19 patients through April
10. Of those funds, $2 billion will be allocated based on the
hospitals’ Medicare and Medicaid disproportionate share and
uncompensated care payments. Recipients of the $10 billion rural
distribution will include rural acute care general hospitals and
critical access hospitals, rural health clinics (RHCs), and
community health centers located in rural areas. Hospitals and
RHCs will each receive a minimum base payment plus a percent of
their annual expenses.
These hospitals will begin receiving funds via direct deposit in
the coming days. A state-by-state breakdown of high-impact
hospitals and rural providers is
available here.
Updated Testing Prioritization Released
The California Department of Public Health has released
updated guidance for public health officials, health care
providers, and laboratories for prioritizing specific groups for
PCR molecular testing when testing availability is limited.
Compared to its interim guidance released April 19, this guidance
combines the prior four priority groups into Tier 1 (e.g.,
hospitalized patients, health care personnel, persons at risk for
severe COVID-19 illness, and others), and has a Tier 2 consisting
of low-risk asymptomatic individuals.
State Portal for Finding Childcare Options
Gov. Newsom
announced yesterday that the state has
launched a new portal to help parents find safe and reliable
childcare options. The portal follows previous action by the
Governor to expand childcare subsidies and after-school programs
for essential workers.
Updated EMTALA Guidance
The Centers for Medicare & Medicaid Services has released a
new and comprehensive set of FAQs about the Emergency Medical
Treatment and Labor Act (EMTALA). Topics covered include patient
presentation to the emergency department, where EMTALA applies,
qualified medical professionals, medical screening exams, patient
transfer and stabilization, telehealth, Section 1135 waivers, and
more.
Online COVID-19 Resource Center for Nurses and Nursing
Students
HealthImpact has launched a
COVID-19 Resource Center with toolkits, guidance, and
additional resources to help guide hospitals’ nurses and nursing
students on all aspects of the
Governor’s Executive Order to increase the workforce. The
toolkits and guidance were created by a coalition of academic,
clinical practice, workforce, and nursing leaders, including
CHA.
CHA Letter on Increasing Nursing Workforce CHA
has submitted
a letter to Gov. Newsom urging an increase in the
COVID-19
Board of Registered Nursing waiver for simulation hours from
50% to 75%. Such an increase would allow fourth-year students to
complete their clinical rotations this year and graduate on time,
helping to secure a viable acute care nursing workforce for
hospitals.
Behavioral Health Best Practices and Protocols
Available
The Rapid Response Network — a partnership between the Mental
Health Services Oversight and Accountability Commission (MHSOAC)
and Social Finance, a nonprofit organization — was established to
help county behavioral health departments and their community
partners respond to the evolving demands of the pandemic and its
aftermath. MHSOAC has published
Rapid Response Network’s answers to COVID-related questions
from the field, which include quarantine protocols for serving
the homeless, guidance for inpatient psychiatric facilities, best
practices in behavioral telehealth, and more.
New Publishing Schedule for Coronavirus
Response
Beginning May 4, Coronavirus Response will be published
on Monday, Wednesday, and Friday. As a reminder, key updates for
hospitals and FAQs on a broad range of topics related to the
pandemic are available and continually updated on
CHA’s website.
April 30:
CMS Announces Additional Flexibilities for
Hospitals
The Centers for Medicare & Medicaid Services (CMS) has issued an
interim final rule providing hospitals and health care
providers with additional flexibilities to respond to the
COVID-19 public health emergency. The new regulatory waivers and
rules — most of which apply immediately and for the duration of
the public health emergency — include provisions to support and
expand COVID-19 diagnostic testing, increase hospital capacity,
augment the health care workforce, reduce administrative burden,
and expand Medicare telehealth services. CHA has advocated for
many of these changes and will provide members with additional
details in the coming days. Key hospital provisions are
listed here. CMS has updated its list of
blanket waivers and flexibilities, and more information is
available in a
CMS press release.
CDPH Conducting Infection Control Surveys
The California Department of Public Health (CDPH) is conducting
targeted infection control surveys at the direction of CMS. CDPH
has been conducting the surveys for both skilled-nursing
facilities (SNFs) and hospitals, using this
entrance checklist. While the checklist is labeled for SNFs
and references “residents,” it is being used for both SNFs and
hospitals.
Cal/OSHA Issues Forms on Respirator
Availability
Earlier this week, Cal/OSHA began using a
Certification of Extreme Respirator Shortage form when
processing complaints that a hospital is not following the
Aerosol Transmissible Disease Standard with respect to
respiratory protection. It is CHA’s understanding that the form
is intended to create a consistent approach in handling such
complaints. CHA’s review of the form, however, has raised several
concerns, which we have shared with Cal/OSHA. Until there is
clarification, hospitals should consult with their legal counsel
and consider their unique circumstances and risk tolerance before
signing the form. Hospitals may decide to submit their own
certification form that is consistent with
the April 2, 2020, Cal/OSHA guidance.
Cal/OSHA has also created a
Respirator Inventory Worksheet, making it clear that the
document is voluntary and hospitals are not required to use it.
Note that the Centers for Disease Control and Prevention has a
PPE burn rate calculator that may be easier to use.
CMS to Host ‘Lessons from the Front Lines’ Call May
1
CMS will host the next in its series of “Lessons from the Front
Lines” calls from 9:30 to 11 a.m. (PT) on May 1. The calls are a
joint effort between CMS, the Food & Drug Administration, and the
White House Coronavirus Task Force. Physicians and other
clinicians are invited to share their experiences, ideas,
strategies, and insights related to their COVID-19 response, and
participants have an opportunity to ask questions of presenters.
Participants may join by phone or web link.
HRSA to Host Call Tomorrow on COVID-19 Uninsured
Program
On April 30 from 11 a.m. – noon (PT), the Health Resources and
Services Administration (HRSA) will host a webinar about the
COVID-19 Uninsured Program. As authorized by the Coronavirus Aid,
Relief, and Economic Security Act, the program allows every
health care provider who has provided treatment for uninsured
COVID-19 patients on or after February 4 to be reimbursed at
Medicare rates, subject to available funding. Information about
joining the call is
available here.
CDC Expands List of COVID-19 Symptoms
The Centers for Disease Control and Prevention (CDC) has added to
its
list of possible symptoms that could indicate COVID-19.
Previously, the CDC listed three possible symptoms — fever,
cough, and shortness of breath — and has now added six new
symptoms: chills, repeated shaking with chills, muscle pain,
headache, sore throat, and new loss of taste or smell.
Summary of April 28 CDPH Call
The California Department of Public Health has
provided a summary of its weekly call with health facilities,
held April 28.
CMS to Host Two Calls on April 30
The Centers for Medicare & Medicaid Services (CMS) will host the
next in its series of calls for hospitals and health systems at 2
p.m. (PT) on April 30. The call will allow participants to ask
questions of agency officials about the temporary actions that
empower providers to increase capacity, rapidly expand the health
care workforce, put patients over paperwork, and further promote
telehealth in Medicare.
CMS will also host a call at noon (PT) on April 30 for nurses.
The call will provide updates on the agency’s latest guidance, as
well as best practices shared by leaders in the field.
CDPH Reverts to Original All-Facilities Letter on
Licensing Requirements
The California Department of Public Health (CDPH) has rescinded
All-Facilities Letter (AFL) 20-26.1. As a result,
AFL 20-26 is in effect through June 30. AFL 20-26 temporarily
waives licensing requirements and suspends regulatory enforcement
of all licensing requirements for hospitals, with certain
exceptions. This includes the waiver of nurse staffing ratios
while no longer explicit.
Reminder: Free N95 Decontamination Program for Health
Care Facilities
Today, on CDPH’s weekly call with health care facilities, a
representative from the Governor’s Office of Emergency Services
reminded facilities that the state is making the Battelle
Memorial Institute’s N95 decontamination system available for
health care facilities free of charge.
There are four steps for health care facilities to take: 1) sign
the
agreement and email to Jon Cartlidge at cartlidgej@battelle.org; 2)
label with the three-digit identifier Battelle assigns to your
facility; 3) collect the used N95 respirators (free of makeup);
and 4) ship the N95 respirators via UPS using the account
provided by the state. The federal government pays for the
cleaning and system, and the state pays for the shipping costs to
and from the decontamination sites. Battelle should be able to
turn them around within 24 hours of receipt, so a hospital could
have them back within three days depending on shipping times.
Federal Blueprint to Support Testing
Yesterday, the President released his
Blueprint for Testing Plans and Rapid Response Programs,
which describes how the federal government plans to support state
and local governments, and partner with private entities, for a
nationwide testing strategy. The blueprint is intended to support
the administration’s Opening Up America Again
guidelines.
California’s Testing Task Force continues to meet to increase
testing capacity and availability within the state.
‘Care for the Caregiver’ Webinar Recording
Available
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.
Researching the Pandemic’s Effects on Health Care
Workers’ Mental Health
The National Institutes of Health is conducting a study to learn
about how the COVID-19 pandemic affects the mental health of
health care workers over time. Participation involves health care
workers completing online questionnaires every one to three
months for 12 months; each questionnaire takes about 30 minutes
to complete. Participation is voluntary and may be withdrawn at
any time. Learn more at
covidhcwstudy.ctss.nih.gov and email questions about
participating to covidhcwstudy@nih.gov.
CMS to Host Two Calls April 29
The Centers for Medicare & Medicaid Services (CMS) will host two
calls on April 29, one for dialysis organizations and one for
nursing homes. The calls will provide updates on the agency’s
latest guidance, as well as best practices shared by leaders in
the field.
State Guidelines for Resuming Preventive Health
Care
The California Department of Public Health (CDPH) today released
guidelines for gradually resuming, “as soon as practicable,”
the many health care services that have been deferred in response
to the surge of COVID-19 patients. CHA worked closely with the
Governor’s team on these guidelines, which offer a statewide
framework while noting that all facilities should comply with
local guidelines and recognize local or regional circumstances
that require different timelines for resumption of services.
Among the other considerations for health care facilities that
the guidelines describe for a gradual reintroduction of services:
COVID-19 indicators (e.g., infection rates, hospitalizations,
emergency department admissions, ICU beds, and skilled-nursing
facility [SNF] outbreaks)
Adequate personal protective equipment
Availability of testing when knowing the COVID-19 status of
staff or patients is important for clinical care and infection
control
Consultation with local public health officers
Availability of qualified staff
Having patient flow systems and infection control precautions
in place
The guidelines also address care prioritization and scheduling,
outpatient visits, hospital and outpatient surgery care, dental
services, SNF operations, and more.
Medicare Accelerated and Advanced Payment Programs
Suspended The Centers for Medicare & Medicaid Services
(CMS) has announced it will suspend and re-evaluate its
Accelerated and Advanced Payment Programs in light of the $175
billion for provider relief payments under the Coronavirus Aid,
Relief, and Economic Security (CARES) Act and the Paycheck
Protection Program and Health Care Enhancement Act. CMS says it
will re-evaluate all pending and new applications under the
Accelerated Payment Program for Part A providers and will not
accept any new applications under the Advanced Payment Program
for Part B providers. More information is available in CMS’
updated
fact sheet.
Testing Task Force Issues Updates
In its recent
newsletter, California’s COVID-19 Testing Task Force details
testing supply guidelines. In these guidelines, they state
they are making progress to secure additional testing supplies
(e.g., swabs and viral transport medium) from multiple
manufacturers. The state intends to use the existing Medical and
Health Operational Area Coordination (MHOAC) Program
infrastructure to equitably distribute limited sample collection
supplies across the state. The newsletter also includes updates
on the state’s testing sites, options, and processing. See the
task force
website for more information about its testing goals, how
testing data are tracked, and more.
Provider Registration Opens for COVID-19 Uninsured
Program
As authorized by the CARES Act, every health care provider who
has provided treatment for uninsured COVID-19 patients on or
after February 4 can request claims reimbursement through the
COVID-19 Uninsured Program and will be reimbursed at Medicare
rates, subject to available funding. Beginning today, hospitals
can register to participate via the Health Resources and Services
Administration (HRSA)
COVID-19 Uninsured Program Portal. Additional information is
available on
HRSA’s website.
CMS to Host Two Calls April 28
CMS will host the next in its series of calls for hospitals and
health systems at 2 p.m. (PT) on April 28. The call will allow
participants to ask questions of agency officials about the
temporary actions that empower providers to increase capacity,
rapidly expand the health care workforce, put patients over
paperwork, and further promote telehealth in Medicare.
CMS will also host a call at noon (PT) on April 28 for home
health and hospice providers. The call will provide updates on
the agency’s latest guidance, as well as best practices shared by
leaders in the field.
CHA Urges DMHC to Issue Directives to Health
Plans
CHA today
sent a letter to the Department of Managed Health Care (DMHC)
explaining some of the serious issues facing hospitals and
describing how health plans can support hospitals and their
patients. The letter urges the department to direct all health
plans that DMHC regulates — including commercial, Medi-Cal, and
behavioral health carveout plans — to:
Resolve all unpaid claims to hospitals within 30 days
Support hospitals by offering voluntary advance payment
programs
Remove administrative barriers to speed payment to
hospitals
Details for Participating in N95 Decontamination
Program
Earlier this month, the California Department of Public Health
(CDPH) issued an
All Facilities Letter about preserving used N95 respirators
in order to decontaminate them. The state is working with
Battelle Memorial Institute to deploy its Food and Drug
Administration-authorized emergency use decontamination system in
California. 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. Each compatible N95 respirator can be
decontaminated up to 20 times.
Emergency Childcare Subsidies for Health Care
Workers
The emergency childcare funding made available to health care
professionals as essential workers during the COVID-19 crisis —
through an Executive Order by the Governor — has recently been
allocated for distribution to county Resource and Referral
Networks. Hospital staff are encouraged to take advantage of
available vouchers to support childcare expenses by contacting
their county
Resource and Referral Network and referring to the statewide
member directory. If they have difficulty connecting with the
county Resource and Referral Network, they can also contact their
county
Local Planning Council. More details are available in a
bulletin from the California Department of
Education.
The funding is intended to support childcare options that best
meet the needs of the family — whether they are licensed
childcare centers, licensed family childcare, or a family,
friend, or neighbor. While vouchers will be limited, all
interested parties are encouraged to apply so that each region
can gather accurate information about the ongoing need, which
will help with future advocacy efforts for additional
funding.
Interim Guidance for SNFs on Transfer of
Residents
CDPH has issued an
All Facilities Letter (AFL) providing interim guidance for
transfer and continuity of care of residents with suspected or
confirmed COVID-19, including admission of COVID-19-positive
residents following hospitalization who still need
transmission-based precautions. The AFL also clarifies that the
guidance applies when residents are transferred from an alternate
care site; that SNFs must accept the return of a resident from a
hospital or alternate care site; and that residents may be
transferred between facilities for the purposes of cohorting
COVID-19 patients.
Billing Instructions for COVID-19 Presumptive
Eligibility
The Department of Health Care Services (DHCS) issued
billing instructions for presumptive eligibility (PE) for
COVID-19, noting the new aid code V2 to identify this population.
The code is limited to diagnostic testing, testing-related
services, and treatment, including all medically necessary care
such as the associated laboratory services, or office, clinic, or
emergency room visits related to COVID-19. Providers must include
ICD-10 diagnosis code U07.1 on all claims for reimbursement of
COVID-19 medically necessary care for PE individuals in aid code
V2. The department has also
posted new information for qualified providers for the PE for
Pregnant Women program, including aid code (code 7F) and
procedures.
Billing-related questions can be directed to the telephone
service center at (800) 541-5555, 8 a.m. to 5 p.m. (PT) Monday
through Friday.
Behavioral Health Updates from DHCS
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
Rural Hospitals to Receive Stimulus Funds
The Small Business Administration has issued an
interim final rule clarifying that hospitals owned by a state
or local government are eligible for the Paycheck Protection
Program (PPP) if the hospital receives less than 50% of its
funding from state or local government sources, exclusive of
Medicaid. The PPP was authorized by the Coronavirus Aid, Relief,
and Economic Security Act; the Paycheck Protection Program and
Health Care Enhancement Act signed today allocated an additional
$321 billion in funding to the PPP, because previous funding was
depleted last week. For more information about federal funding
opportunities for hospitals, see
CHA’s summary.
White House Reaffirms Substance Use Disorder Treatment as
Essential
The White House’s Office of National Drug Control Policy (ONDCP)
has reaffirmed that substance use disorder treatment is an
essential medical service. In a
letter to colleagues, the ONDCP noted that, while it already
supports emergency federal exemptions to increase access and use
of telemedicine to treat substance use disorder during the
COVID-19 pandemic, in-person patient/provider interactions will
inevitably occur and require appropriate personal protective
equipment.
April 22:
CARES Act Funding Details
Today, the U.S. Department of Health and Human Services (HHS)
released an outline describing how the $100 billion Public
Health Social Services Emergency Fund will be distributed to
providers. Note that these are the funds provided in the
Coronavirus Aid, Relief, and Economic Security (CARES) Act and do
not include the additional $75 billion in the package currently
being considered by Congress. Please refer to the
CHA Alert sent earlier today for additional information about
submitting data — by 11:59 p.m. (PT) on April 23
— for one of the distributions. CHA will continue to work with
HHS to learn more about the allocations and distributions and
will share information as soon as it becomes available.
State Resources for Health Care Facilities with Urgent
Staffing Needs
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 their
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 area, region, or state.
State resources include the California Emergency Medical Services
Authority’s California Medical Assistance Teams, the California
Health Corps, and other staffing contracts.
Waiver for Intern Pharmacists
The Board of Pharmacy has
issued a waiver to allow for general supervision of an intern
pharmacist at the discretion of the supervising pharmacist if:
The pharmacy documents the need for the supervision
modification due to COVID-19
The intern pharmacist meets certain criteria
The pharmacy maintains documentation of the general
supervision activities performed under the waiver
The supervising pharmacist is generally aware of all
activities performed by the intern pharmacist
CMS to Host Two Calls on April 23
The Centers for Medicare & Medicaid Services (CMS) will host the
next in its series of calls for hospitals and health systems at 2
p.m. (PT) on April 23. The call will allow participants to ask
questions of agency officials about the temporary actions that
empower providers to increase capacity, rapidly expand the health
care workforce, put patients over paperwork, and further promote
telehealth in Medicare.
CMS will also host a call at noon (PT) on April 23 for nurses.
The call will provide updates on the agency’s latest guidance, as
well as best practices shared by leaders in the field. Dial: (833) 614-0820
| Passcode: 6004019
Audio webcast
April 21:
Urge Congress to Vote for Additional Funding for Health
Care Providers
Federal lawmakers have
reached a deal to expand the
Paycheck Protection Program and Health Care Enhancement Act
with an additional $75 billion for health care providers. The
Senate is expected to vote today; the House is scheduled to vote
on Thursday. There is still time before Thursday’s vote to urge
House members to vote yes on the package and articulate
hospitals’ need for additional funding. Find your
representative’s
contact information here, and see the
template letter CHA has provided for members’ use.
When the first draft of this expansion of the PPP was announced,
there was no additional funding for hospitals. House Speaker
Nancy Pelosi pushed for $100 billion in additional funds for
hospitals, and Minority Leader Kevin McCarthy has endorsed the
final package. CHA worked closely with congressional leaders to
ensure these additional funds would be included.
Crisis Care Guidelines
The California Department of Public Health (CDPH) has released
California State SARS-CoV-2 Pandemic Health Care Surge and Crisis
Care Guidelines. In addition to providing an overview of
surge capacity and crisis care operational considerations for
health care facilities, the document includes detailed processes
and guidelines for allocating potentially insufficient critical
care/ventilators during the current public health emergency, as
well as other pandemic patient care strategies for addressing
scarce resource situations. CHA is planning to host a webinar
about the guidelines and will provide details in a future edition
of Coronavirus Response.
Second Tranche of Federal Funding to Be Distributed
Soon
The federal Department of Health and Human Services (HHS)
announced it will soon make targeted distributions to hospitals
and other facilities that have been affected by the increased
burden of caring for those with COVID-19. This funding is part of
the second round of the $100 billion authorized by the
Coronavirus Aid, Relief, and Economic Security Act for health
care providers. HHS is asking hospitals to provide the agency
with specific data to inform this targeted distribution.
Specifically, HHS asks that hospitals report the following
information for each facility with a Medicare tax identification
number:
Total number of Intensive Care Unit beds as of April 10, 2020
Total number of admissions with a positive diagnosis for
COVID-19 from Jan. 1-, April 10, 2020
National Provider Identifier
CHA does not know the amount of the distribution (the first
distribution was $30 billion), nor do we know what other factors
(e.g., Medicaid revenue, Medicare Advantage, or rural status) may
be used to calculate the allocations.
Hospital information must be submitted by 11:59 p.m. on
April 23 through an authentication portal established by
an HHS vendor, TeleTracking. Hospital administrators should have
already received an email from TeleTracking — as part of previous
federal data collection efforts — to register for access to the
TeleTracking portal. Questions about the registration process can
be directed to TeleTracking Technical Support at (877)
570-6903.
Hospital Coalition Urges Financial Stabilizing Medi-Cal
Policies
CHA has joined a coalition of hospital groups in requesting that
the Department of Health Care Services (DHCS) make several
Medi-Cal policy changes in response to the COVID-19 crisis. In
a letter sent yesterday, the coalition urges DHCS to help
stabilize existing programs and increase the predictability of
vital funding sources hospitals need. The request follows the
first round of federal funding last week, of which less than 5%
was allocated to California’s hospitals. In addition, the
smallest proportion of that funding went to providers that
deliver the largest share of services to Medi-Cal
beneficiaries.
Health Care Facilities Must Certify Employees for Hotel
Rooms
The state’s
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. CDPH
has issued an
All-Facilities Letter notifying health care facilities that,
in order for their employees and staff to participate in the
program, they must certify that employees within their facility
have presumably been exposed to COVID-19.
CHA has prepared a
template letter for health care facilities to submit to the
Governor’s Office of Emergency Services at HealthcareNCS@caloes.ca.gov
by April 30. CDPH recommends saving and printing
the completed and signed letter on official letterhead. The
letter must be signed by a leading or supervisory medical
official (e.g., chief medical officer, rather than administrative
official).
CMS to Host Two Calls April 22
CMS will also host two call on April 22, one for dialysis
organizations and one for nursing homes. The calls will provide
updates on the agency’s latest guidance, as well as best
practices shared by leaders in the field.
Initial CMS Recommendations for Re-Opening
Facilities
The Centers for Medicare & Medicaid Services (CMS) has
issued recommendations for a phase one re-opening of
facilities to provide non-emergent non-COVID-19 health care. The
recommendations apply if states or regions have passed the gates
in the
White House Opening Up America Again Guidelines announced
April 16. These guidelines recommend a phased approach
implementable on a statewide or county-by-county basis at
Governors’ discretion.
CMS notes this is the first in what will be a series of
recommendations to guide health care systems and facilities as
they consider resuming in-person care for non-COVID-19 patients
in regions with low incidence of COVID-19. CMS still strongly
encourages “maximum use of all telehealth modalities.”
State Task Force on Business and Jobs
Recovery
Gov. Gavin Newsom has announced a state Task Force on Business
and Jobs Recovery. The task force will work to develop actions
government and businesses can take to help Californians recover
as fast as safely possible from the COVID-19-induced recession.
The group will meet twice a month throughout 2020 and will be
co-chaired by the Governor’s Chief of Staff, Ann O’Leary, and
businessman Tom Steyer. More details are available in this
press release, and a full list of task force members is
available here.
Revised Guidance on Daily Hospital ReportingThe
California Department of Public Health (CDPH) has issued
All Facilities Letter (AFL) 20-31.1, which supersedes AFL
20-31 and modifies previous daily reporting information for
general acute care hospitals (GACHs). It notifies GACHs of the
need to have daily updates on the number and status of COVID-19
patients, bed capacity, and personal protective equipment (PPE).
It also notes that CDPH will submit data on behalf of hospitals
through the National Healthcare Safety Network COVID-19 module
per the Centers for Disease Control and Prevention’s (CDC’s)
instructions.
Updated State Testing Prioritization
CDPH
AFL 20-44 provides guidance to support local public health
departments, health care providers, and laboratories in
determining prioritization of specific groups for testing and
provides four specific levels of testing priorities. Priority 1
is hospitalized patients, symptomatic health care workers, and
residents and staff in high-risk settings (e.g., congregate
living facilities and correctional facilities).
The guidance will be reassessed on a weekly basis based on
California’s evolving situation and input from stakeholders. The
prioritization categories are suggested as guidance to sequential
expansion of testing. As capacity increases, testing should
expand accordingly at the discretion of the local health officer.
Solid and Medical Waste Determination for
PPE
The CDPH Medical Waste Management Program has
issued a memo recognizing that not all PPE used in connection
with COVID-19 testing, treatment, specimen handling, and cleaning
is mandated to be managed as medical waste based on current
Occupational Safety and Health Administration (OSHA) and CDC
guidelines. It applies to any business generating PPE waste,
including all types of health care facilities.
The memo states that the facility/company shall determine the
waste management procedures for PPE, meaning it can determine
whether the PPE should be disposed of as medical or solid waste.
It directs that solid waste should be placed in a lined
container, preferably with a lid/cover, and the bag disposing the
solid waste items into the solid waste bin should be tightly
closed. The CDC recommends anyone handling these items should
clean their hands with soap and water for 20 seconds (preferred)
or alcohol-based hand sanitizer immediately after handling.
Increased Reporting Requirements for Skilled-Nursing
Facilities (SNFs)|
CDPH has
issued AFL 20-43, requesting that SNFs provide via an
online survey a daily report of staffing levels, equipment
availability, the number of COVID-19 residents — including
confirmed positive and suspected — and other facility needs.
CMS has
issued a memo and will soon issue a regulation requiring
SNFs to report COVID-19 cases to the CDC and to
residents/families. CDC reporting will be done through the
National Healthcare Safety Network system. This reporting is
additional to reporting to local public health and the CDPH
district office. In addition, SNFs will have to report a
confirmed positive case to residents within 12 hours. Residents
must also be notified within 72 hours if three or more
staff/residents have new onset respiratory symptoms.
CMS to Host Two Calls April 21
CMS will host the next in its series of calls for hospitals and
health systems at 2 p.m. (PT) on April 21. The call will allow
participants to ask questions of agency officials about the
temporary actions that empower providers to increase capacity,
rapidly expand the health care workforce, put patients over
paperwork, and further promote telehealth in Medicare.
Participants may join by
audio webcast or by phone:
Dial: (833) 614-0820
| Passcode: 963515
CMS will also host a call at noon (PT) on April 21 for home
health and hospice providers. The call will provide updates on
the agency’s latest guidance, as well as best practices shared by
leaders in the field. Join by
audio webcast or by phone:Dial: (833)
614-0820 | Passcode:
9895252
Next CDPH Call: April 21, 8-9 a.m.: Dial: (844) 721-7239 |
Passcode: 7993227
CHA Urges Governor to Issue
Executive Order to Support Hospitals During COVID-19
Crisis
CHA sent a
letter to the Governor urging him to issue an Executive Order
that directs insurance companies and health plans to:
Resolve all unpaid claims to hospitals within 30 days
Support hospitals by offering voluntary advance payment
programs
Remove administrative barriers to speed payment to hospitals
The letter notes that during this time of crisis, insurance
companies and health plans have continued to receive premiums,
while claims for care services have significantly reduced. A few
insurance companies and health plans have taken immediate, yet
small steps to rebalance cash flow by providing loans or
accelerated payments to hospitals, but it’s time for all
insurance companies and health plans to quickly do more.
The California Department of Public Health (CDPH) has updated
the
All Facilities Letter (AFL) providing a temporary waiver of
regulatory requirements. Specifically, it clarifies that
hospitals experiencing a COVID-19 related surge of patients or
staffing shortages resulting from COVID-19 impacts — including,
but not limited to, staff testing positive, staff exposures to
COVID-19, school closures, and other COVID-19 related impacts —
may temporarily operate without meeting mandatory staffing
ratios. Hospitals are to resume mandatory staffing ratios as
soon as feasible. A hospital whose operation is not impacted by
COVID-19 is not eligible for waiver of staffing ratios.
CDPH has issued an
AFL notifying acute psychiatric hospitals (APHs) of the
need to submit information about bed space, the number of
COVID-19 patients — both confirmed positive and suspected —
equipment availability, and other urgent facility needs to
CDPH. Information for this one-time
survey should be submitted no later than 5 p.m. (PT) on
April 24. All other reporting requirements to CDPH district
offices will continue using the standard reporting process.
CDPH has issued an
AFL that states the facility cannot charge for any
federally supplied medical assets or pharmaceuticals received
from the Strategic National Stockpile (SNS). Under federal
billing rules, health care facilities cannot charge patients
for any federally supplied medical assets or pharmaceuticals,
but they may charge patients a fee for administering medical
countermeasures. A facility may charge a patient for
administration; however, if that medication came from the
federal government (e.g., pharmaceuticals from the SNS), the
facility cannot charge the patient for the actual medication.
Judicial Council Issues Advisory Memo on Mental Health
Proceedings
The Judicial Council of California has issued an
advisory to assist the courts in responding to both criminal
and civil cases involving individuals with behavioral health
issues. The advisory addresses the steps courts can take to
protect the rights of involuntarily detained individuals without
putting judicial officers and court staff at risk and states that
technology should be used to facilitate remote proceedings
whenever possible.
Flexibilities for Rural Health Clinics and Federally
Qualified Health Centers
The Centers for Medicare & Medicaid Services (CMS) has
issued guidance for rural health clinics and federally
qualified health centers related to flexibilities under the
Coronavirus Aid, Relief, and Economic Security (CARES) Act,
including new payment for telehealth and virtual communication
services, billing for visiting nursing services furnished to
homebound individuals, and accelerated or advanced payments.
Resources for Behavioral Health Facilities
The Department of Health Care Services has shared some resources
on COVID-19 mitigation in behavioral health facilities:
The National Council on Behavioral Health’s (NCBH)
COVID-19 guidance for behavioral health residential
facilities, which is designed to help facilities improve
infection control and prevention practices to prevent the
transmission of COVID-19 and includes guidance for visitation
In addition, the NCBH is ordering bulk personal protective
equipment (PPE) from China and re-distributing to U.S. behavioral
health organizations. NCBH anticipates having a link set up in
the next few days at which organizations — both outpatient and
inpatient — can order PPE.
Reminder: Final ‘Care for the Caregiver’ Webinar on April
21
The third and final “Care for the Caregiver” webinar will be held
from 9 a.m. to noon (PT) on April 21. This complimentary webinar
is designed to provide “psychological first aid” to health care
workers navigating through the COVID-19 pandemic. Hear more about
the webinar in this
video with CHA President & CEO Carmela Coyle and Hospital
Quality Institute President Robert Imhoff.
Details and registration information can be found
here.
April 16:
Updated All Facilities Letter has Toolkit for
Skilled-Nursing Facilities
The California Department of Public Health has issued an updated
All Facilities Letter that provides a toolkit for managing
exposures and recognized cases in skilled-nursing facilities and
congregate living settings. The toolkit includes topics such as
preparing to receive residents with suspected or confirmed
COVID-19, preparing to care for residents with suspected or
confirmed COVID-19 infection, preventing spread of COVID-19
within a facility, and notifying residents’ family members or the
resident’s representative if there is a COVID-19 positive health
care worker or resident in their facility.
FDA Actions Authorize Serology Tests, N95 Decontamination
Process
The Food and Drug Administration (FDA) has issued a pair of
emergency use authorizations (EUAs) for serology tests to detect
for the presence of coronavirus antibodies. The EUAs were issued
to
Ortho-Clinical Diagnostics, Inc. and
Chembio Diagnostic Systems, Inc.
The FDA also
authorized the emergency use of Stryker Instrument’s
Sterizone VP4 Sterilizer1 N95 Respirator Decontamination Cycle.
This device uses vaporized hydrogen peroxide and ozone to
decontaminate N95 or N95-equivalent respirators.
Final ‘Care for the Caregiver’ Webinar on April
21
The third and final “Care for the Caregiver” webinar will be held
from 9 a.m. to noon (PT) on April 21. This complimentary webinar
is designed to provide “psychological first aid” to health care
workers navigating through the COVID-19 pandemic. Hear more about
the webinar in this
video with CHA President & CEO Carmela Coyle and Hospital
Quality Institute President Robert Imhoff. Details and
registration information can be found
here.
Upcoming Calls and Webinars
The National Emerging Special Pathogens Training and
Education Center: At 9 a.m. (PT) on April 17. The
webinar will cover the what, how, and why of masks for health
care workers during the COVID-19 outbreak. More information and
registration details are available
here.
Centers for Medicare & Medicaid Services “Lessons from
the Front Lines: COVID-19”: From 9:30 to 11 a.m. (PT)
on April 17. This call series is an opportunity to hear
physicians and other clinical leaders share their experiences,
best practices, strategies, and insights related to COVID-19.
Participants may join by
audio webcast or by phone: Dial-In: (877) 251-0301
| Access Code: 8672948
The Centers for Disease Control and Prevention
Clinician Outreach and Communication Activity: From 11
a.m. to noon (PT) on April 17. Hear about the current impact of
the COVID-19 pandemic on health care systems in the United
States. More information and registration details are available
here.
April 15:
Billing Guidance — Inpatient Prospective Payment
System/Long-Term Care Hospitals
The Centers for Medicare & Medicaid Services (CMS) has
issued guidance on the implementation of Coronavirus Aid,
Relief, and Economic Security (CARES) Act provisions that
increase payments to inpatient prospective payment system (IPPS)
hospitals and long-term care hospitals (LTCHs).
The guidance includes implementation of the 20% add-on payment
under the IPPS for individuals diagnosed with COVID-19 and the
waiver of site-neutral payment provisions of the LTCH prospective
payment system. CMS will reprocess claims for inpatient
discharges and LTCH admissions on or after January 27, as
necessary. CMS also provides guidance on the waiver of the
inpatient rehabilitation “3-Hour Rule,” as authorized by the
CARES Act.
Increased Medicare Lab Payment for Certain COVID-19
Tests
CMS has
announced it will increase Medicare payment for clinical
laboratory diagnostic tests that use high-throughput technologies
to detect COVID-19. CMS will pay laboratories for the tests at
$100, effective April 14, through the duration of the COVID-19
national emergency. For other COVID-19 laboratory tests, local
Medicare administrative contractors (MACs) remain responsible for
developing the payment amount in their respective jurisdictions.
Currently, MACs are paying approximately $51 for those tests.
Pharmacy Waiver for Automated Drug Delivery System
Locations
The Board of Pharmacy has waived certain requirements for
prelicensure inspection of proposed automated drug delivery
system locations. More details are
available here.
Regulatory Requirements Suspended for Nurse Assistant
Training Programs
The California Department of Public Health has issued an
All Facilities Letter that suspends regulatory requirements
for nurse assistant training programs, including requirements for
theory and clinical training, staff recruitment, in-service
training, and orientation.
Upcoming CMS Calls
CMS will host the next in its series of calls for hospitals and
health systems at 2 p.m. (PT) on April 16, providing an
opportunity to directly engage with agency leadership on
questions related to COVID-19 waivers and regulatory
flexibilities. Participants may join by
audio webcast or by phone:
Dial: (833) 614-0820 |
Passcode: 2395745
CMS will also host a call for nurses at noon (PT) on April 16.
Join by
audio webcast or by phone:
Dial: (833) 614-0820
| Passcode: 5058949
Telehealth Resources
The National Telehealth Policy Resource Center’s Center for
Connected Health Policy has developed a
summary of coverage policies and a
guide to state actions to assist providers in delivering
telehealth services.
Behavioral Health Resources
Psych Hub, a digital platform for education about mental health,
has launched a collection
of free digital resources to address behavioral health needs
during the pandemic. The site, which is a collaboration of
advocacy groups, health care payers and the Department of
Veterans Affairs, includes resources for behavioral health and
health care professionals, individuals, educational institutions,
veterans, and others.
New FAQs
CHA’s Coronavirus Response web page now features new navigation
to streamline information hospitals need as they navigate this
public health emergency. New FAQs include:
Childcare resources available for health care workers in
different parts of the state (see
Human Resources)
Updates on federal funding to support hospitals (see
Federal Funding)
Details of a new pharmacy waiver of prelicensure inspection
of automated drug delivery systems and automated patient
dispensing systems (see
Pharmacy)
Information on discounted and free hotel rooms for COVID-19
exposed or positive health care workers (see
Human Resources).
April 14:
New Waivers by the Department of Consumer
Affairs
The Department of Consumer Affairs has
waived the following:
The cap on the number of physician assistants, nurse
practitioners, and certified nurse midwives that a physician may
supervise
The requirement for a physician assistant to have a practice
agreement with a specific physician. Physician supervision is
still required, but that supervision can be provided by any
physician, and no written practice agreement is required.
Updated and New CDC Guidance
Universal source control: The
Centers for Disease Control and Prevention (CDC) has released
updated guidance for health facilities on interim infection
prevention and control. It recommends source control for
everyone entering a health care facility (e.g., staff,
patients, visitors) regardless of symptoms. Recognizing this
could exacerbate the shortage of facemasks, the CDC provides
that a cloth face covering may be appropriate for visitors and
patients if they arrive at the facility with one. However,
hospital facemasks should be used for staff. This revised
guidance is in addition to other steps health care facilities
can take, including symptom checks and temperature
screening.
Mitigating staffing shortages: The CDC has
released guidance on mitigating health care personnel
staffing shortages. The guidance gathers options for both
contingency capacity and crisis capacity strategies and may be
useful as hospitals continue to develop staffing plans.
CDPH Issues Visitor Limitations Guidance
The California Department of Public Health (CDPH) has issued
new visitor limitations guidance, striving to limit the
spread of COVID-19 while still ensuring the support visitors
provide for the mental wellbeing of pediatric, labor and
delivery, and end-of-life patients. CDPH recommends limiting the
patient to one visitor/support person except for pediatric
patients undergoing a prolonged hospitalization, for whom two
designated support persons are recommended so long as only one is
present at a time.
The guidance provides that all support persons may be screened
before entering the clinical area, must be asymptomatic for
COVID-19 and not be a suspected or recently confirmed case, must
comply with any health facility instructions on personal
protective equipment, and must stay in the patient’s room.
CDPH encourages facilities, including skilled-nursing facilities,
to create opportunities for residents and patients to have
frequent video and phone call visits (using appropriate infection
control measures on shared devices).
Federal Guidance Issued for Testing Provisions of New
Laws
The American Hospital Association (AHA) has developed a
special bulletin about jointly issued
guidance from the Departments of Health and Human Services,
Labor, and Treasury, implementing COVID-19 diagnostic testing and
services provisions from the Families First Coronavirus Response
Act and the Coronavirus Aid, Relief, and Economic Security Act.
The guidance principally implements the requirement for group
health plans and group and individual health insurance (health
plans) to cover both certain diagnostic testing and certain
related items and services provided during a medical visit with
no cost sharing. AHA’s bulletin offers a summary of the key
provisions.
Board of Pharmacy Lists Outsourcing Facilities and
Available Compounded Preparations
As hospitals and health systems report low supplies of drugs used
to care for COVID-19 patients, the Board of Pharmacy has
compiled a list of California licensed outsourcing facilities
and compounded preparations that may be available from the
facilities. Developed from information provided to the Food and
Drug Administration, the list is not a full representation of all
preparations available but includes preparations that appear to
be in high demand.
CHA and Our Health California Launch Appreciation
Campaign for Health Care Workers
Our Health California (OHC), supported by hospitals and CHA,
has launched an appreciation campaign to recognize the hospital
workers and their families who are working day and night to keep
our community safe and healthy through this outbreak. A digital
community of more than 1 million Californians, OHC is asking
community members, the hospital family, and all Californians to
sign and send digital messages of thanks to hospital staff and
their families throughout the state.
Supporters will have an opportunity to select their
preferred card and message, and even
write a message of their own. The notes of appreciation will
then be digitally passed on to hospitals and health care workers,
and posted on OHC’s website. Additionally, CHA will package and
deliver the notes of appreciation to hospitals so they can be
displayed in highly visible areas.
CMS to Host Call for Nursing Homes Tomorrow
The Centers for Medicare & Medicaid Services (CMS) will host a
call at 1:30 p.m. (PT) on April 15 for nursing homes. The call
will provide updates on the agency’s latest guidance, as well as
best practices share by leaders in the field. Join by
audio webcast or by phone:
Dial: (833) 614-0820
| Passcode: 3770227
April 13:
CHA Submits New Waiver Request to CMS
CHA has submitted a
fourth waiver request to the Centers for Medicare & Medicaid
Services (CMS), in conjunction with the Washington State Hospital
Association. CHA’s first waiver request was approved in full;
many of the requests in the second and third letters have been
granted, while others are still pending. The most recent letter
asks CMS to grant the outstanding waiver requests and provide
additional waivers as described in the letter. CHA has updated
its
lists of approved state and federal waivers and
flexibilities, which include links to source documents, the
status of related laws, and other helpful information.
CHA Requests Liability Protections for
Hospitals
Based on growing concerns from health care providers about
potential liabilities as they manage care during this crisis, CHA
has requested that the state expand current law to address needed
liability protections for providers.
Updates on Personal Protective Equipment (PPE)
Optimization and Reuse
The California Department of Public Health (CDPH) has issued
a revised
All Facilities Letter 20-36 to update its previous guidance
on decontaminating and reusing N95 respirators. CDPH is
recommending that, even if a hospital does not plan to reuse
N95 respirators, it collects used ones so the state can
decontaminate them and allocate them to areas where there’s a
need. It also removes the previously issued information that
the state will track, through the manufacturer number on the
mask, the number of decontamination cycles, and that N95
respirators will be disposed after 20 decontamination cycles.
The Food and Drug Administration has issued emergency use
authorizations for two respirator decontamination products:
Advanced Sterilization Products
STERRAD Sterilization Cycles and STERIS Corporation’s
STERIS V-PRO 1 Plus.
Funding for Hospitals’ Telecommunications
Needs
The Federal Communications Commission (FCC) has begun
accepting applications for its COVID-19 Telehealth Program.
As authorized by the Coronavirus Aid, Relief, and Economic
Security Act, the program provides immediate support to eligible
health care providers responding to the COVID-19 pandemic. It
fully funds — until funds are expended or the pandemic has ended
— the devices and telecommunications and information services
necessary to provide critical connected care services. The FCC
has provided
guidance on the application process, and additional questions
can be submitted to EmergencyTelehealthSupport@fcc.gov.
AHA App Matches PPE Donors with Hospitals
The American Hospital Association (AHA) has a new app to further
coordinate efforts around its
100 Million Mask Challenge, which calls on manufacturers, the
business community, and individuals to rapidly produce needed PPE
on a large scale. AHA has partnered with Kaiser Permanente,
consulting firm Kearney, Microsoft, Merit Solutions, Goodwill,
and UPS to launch HealthEquip™, a smart app that will
match individuals and organizations donating PPE with local
hospitals based on their need. The app also will track PPE
donations and manage shipping to each hospital through UPS.
Hospitals and health systems can begin registering and submitting
requests for PPE immediately. To register, visit
www.health-equip.com. For more information, see AHA’s
video guide and
frequently asked questions.
CMS to Host Two Calls Tomorrow
CMS will host the next in its series of calls for hospitals and
health systems at 2 p.m. (PT) April 14. The call will allow
participants to ask questions of agency officials about the
temporary actions that empower providers to increase capacity,
rapidly expand the health care workforce, put patients over
paperwork, and further promote telehealth in Medicare.
Participants may join by
audio webcast or by phone:
Dial: (833) 614-0820
| Passcode: 2395745
CMS will also host a call at noon (PT) tomorrow for home health
and hospice providers. The call will provide updates on the
agency’s latest guidance, as well as best practices shared by
leaders in the field. Join by
audio webcast or by phone:
Dial: (833) 614-0820
| Passcode: 9466917
Price Gouging and Hoarding
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 medical supplies or drugs
necessary to fight the virus, please call the National Center for
Disaster Fraud Hotline at (866) 720-5721 or email disaster@leo.gov. For more
information, visit
www.justice.gov/coronavirus.
The California Attorney General is also conducting surveillance
on potential price gouging in the of medical supplies and other
goods and services being sold to hospitals, health care
providers, and others. To share information or leads, use the
Attorney General’s
complaint intake portal.
Hospitals Should See First Allotment of Federal Funding
Today
As reported yesterday, the first portion – $30 billion – of a
total $100 billion in emergency relief for hospitals from the
federal Coronavirus Aid, Relief and Economic Security (CARES) Act
started flowing to providers today. California hospitals’
estimated share is $2.9 billion. The funds will be distributed
through direct deposit, paid via the Centers for Medicare &
Medicaid Services Automated Clearing House account, and will be
from Optum Bank with “HHSPAYMENT” as the payment
description.
To get money to hospitals quickly,
CMS apportioned the funds based on Medicare beneficiaries
served. This does not address the needs of hospitals with few or
no Medicare patients or those that have significant Medicare
Advantage or Medicaid patients. CMS and congressional leadership
well understand this shortcoming and have committed to CHA that
the second allocation of funds will help these providers.
As a condition of receiving these funds, hospitals must agree not
to seek collection of out-of-pocket payments from a COVID-19
patient that are greater than what the patient would have
otherwise been required to pay if the care had been provided by
an in-network provider. Also, within 30 days of receiving the
payment, providers must sign an attestation confirming receipt
and agreeing to the terms and conditions. The portal for signing
the attestation will be open the week of April 13 and will be
linked from this
page.
Hotel Rooms for Exposed or Positive Health Care
Workers
Today, the state launched the Non-Congregate Sheltering for
California Healthcare Workers Program. This provides hotel rooms
to frontline 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. These workers can call 1-877-454-8785 to
make a reservation. A fact sheet about this program, including
information health care workers should have on hand when they
call, is available
here.
CMS Waivers Expand Scope of Practice
CMS has issued additional
blanket waivers that:
Waive the requirement that a physician must be physically
present to provide medical direction and supervision for critical
access hospital patients, allowing for radio, telephone, or
online communication
Expand the scope of practice for nurse practitioners,
physician assistants, and clinical nurse specialists in
skilled-nursing facilities, and occupational therapists in home
health assessments
CDPH Guidance Notes Imported KN95 Respirators Approved
During Shortages
The California Department of Public Health (CDPH) has revised
All Facilities Letter 20-15, noting that previously issued
Cal/OSHA guidance expands the types of respirators that can be
used to comply with Cal/OSHA standards during the COVID-19 public
health emergency. While KN95 respirators from China are not
currently certified by the National Institute for Occupational
Safety and Health (NIOSH), they may be acceptable if
NIOSH-certified respirators are not available because of a
shortage and prioritization of approved respirators for health
care workers providing direct care to patients with COVID-19. As
with N95s, KN95s should be fit tested to comply with a Cal/OSHA
respiratory protection standard that requires fit testing.
Unemployed Workers to Receive an Additional $600 Per
Week
Gov. Newsom announced yesterday that, starting April 12,
California workers receiving unemployment benefits will begin
receiving an extra $600 on top of their weekly amount, as part of
the new Pandemic Additional Compensation initiated by the federal
CARES Act. More information on these unemployment benefits and
the additional $600 payments is available on the
EDD website.
Mental Health Guide for Health Care Workers
The San Francisco Veterans Administration Health Care System has
produced
this guide to mental health resources for health care
employees during the COVID-19 pandemic. It includes self-care
strategies and addresses the challenges of front-line staff, as
well as provides wellness resources, guidance for leading
front-line staff, and more.
April 9:
Federal Funding — Public Health and Social Services
Emergency Funding (PHSSEF)
Hospitals should prepare for the Centers for Medicare & Medicaid
Services (CMS) to issue approximately $30 billion of the PHSSEF
as early as tomorrow. The funds are expected to be allocated to
hospitals based on their 2019 Medicare Part A and Part B
payments. It’s expected that CMS will release the payments
through direct deposit paid via their Automated Clearing House
account from Optum Bank, with “HHSPAYMENT” as the payment
description.
This $30 billion is part of $100 billion in total funds made
available to hospitals, health systems, and other providers
through recent legislation, including the Coronavirus Aid,
Relief, and Economic Security Act. To find out more about PHSSEF,
see
CHA’s summary.
Ambulatory Surgical Clinics Asked to Complete Ventilator
Inventory Survey
The California Department of Public Health (CDPH) is taking
inventory of ventilators (e.g., anesthesia, medical, and
transport) from ambulatory surgical clinics (ASCs) across the
state that may be able to be redeployed to hospitals and other
facilities caring for COVID-19 patients. CDPH requests that all
ASCs complete this
Ventilator Equipment Inventory Survey, regardless of
involvement in regional/Medical Health Operational Area
Coordinator (MHOAC) plans or hospital surge plans, by 5 p.m. on
April 15.
Statewide, National Data on Diversity Among COVID-19
Patients
Today, CDPH released confirmed COVID-19 cases and deaths by
race and ethnicity. CDPH states that this initial information,
representing 54% of COVID-19 cases and 53% of deaths, shows the
data are roughly in line with the diversity of California
overall. Yesterday was the first time CDPH released these
demographic data. For details, see the
press release.
Yesterday, the Centers for Disease Control and Prevention
(CDC) released a
report on the demographics of hospitalized patients with
confirmed COVID-19 cases. The report shows African Americans
significantly overrepresented in hospitalizations (33% of all
patients for which there were race and ethnicity data).
Three-quarters of hospitalized patients were age 50 and over,
and over half were male. It also notes that additional data are
needed to confirm the impact of sex and race. The data are from
hospitals in the CDC’s Coronavirus Disease 2019 – Associated
Hospitalization Surveillance Network and cover geographic areas
that represent 10% of the country’s population. It is a sample,
comprised of counties in 14 states. Participating counties in
California are San Francisco, Alameda, and Contra Costa.
CDC Posts New Guidance and Tools
Inpatient obstetric health care settings: The
CDC has issued new
interim considerations for health care facilities providing
obstetric care for pregnant persons under investigation or with
confirmed COVID-19. The April 4 guidance offers clarification
on the following:
Visitors and essential support persons
Prioritized testing of pregnant women with suspected
COVID-19 at admission or who develop symptoms of COVID-19
during admission
Testing and isolation of infants with suspected COVID-19
Determination of whether to keep a mother with known or
suspected COVID-19 and her infant together or separated after
birth on a case-by-case basis, using shared decision-making
between the mother and the clinical team
Outpatient and ambulatory care settings: This
new
interim guidance reflects the need to minimize disease
transmission to patients, health care personnel, and others;
identify persons with presumptive COVID-19 disease and
implement a triage procedure; reduce negative impacts on
emergency department and hospital bed capacity; and maximize
the efficiency of personal protective equipment (PPE)
utilization across the community health system while protecting
health care personnel.
PPE burn rate calculator: The updated
PPE Burn Rate Calculator is a spreadsheet-based model
designed to help health care facilities plan and optimize the
use of PPE for response to COVID-19.
Details of Main Street Lending Program
The Federal Reserve today announced the
terms of the Main Street Lending Program, which will enhance
support for small and mid-sized businesses. This includes
borrowers who obtain loans through the Paycheck Protection
Program administered by the Small Business Administration and
larger borrowers with up to 10,000 employees or $2.5 billion in
annual revenues. The term sheet specifies that these loans will
be available to businesses without specifically addressing, or
excluding, non-profits.
In an April 3
letter to the treasury secretary and Federal Reserve
chairman, the American Hospital Association (AHA) urged them to
implement this loan program quickly and make it available to
hospitals of all ownership types, including municipal, county,
and other public hospitals.
New Resource for State and Federal Waivers
CHA has compiled comprehensive lists of licensing and
certification waivers, including survey activity, enforcement
discretion, and the like in two separate documents – one for
state actions and one for
federal actions. Both are available from the “State and
Federal Waivers” button on the
Coronavirus Response web page.
Blue Shield Loans to Assist Hospitals
Blue Shield of California
has announced that it will make available up to $200 million
in direct support to health care providers and hospitals through
financing guarantees, advance payments, and restructuring of
contracts to help offset some of the heavy losses hospitals and
doctors are enduring as they suspend normal operations before the
expected surge of COVID-19 patients. Details for its medical
providers (clinicians and hospitals) will be confirmed this week
and communicated as they are finalized. CHA released a
media statement about the announcement yesterday.
UnitedHealth Group Accelerates Nearly $2 Billion in
Payments to Health Care Providers
UnitedHealth Group
announced today that it will immediately begin to accelerate
payments and other financial support to medical and behavioral
health providers to help address the short-term financial
pressure caused by the COVID-19 emergency. The move applies to
UnitedHealthcare’s fully insured commercial, Medicare Advantage,
and Medicaid businesses.
Mark Your Calendars: Weekly CDPH Call
The California Department of Public Health has confirmed that it
will conduct its conference call for health care facilities every
Tuesday at 8 a.m.until further notice. Mark your calendars for
this standing event with the following access information: Dial-in: (844) 721-7239
| Access Code: 7993227
CMS to Host Call Tomorrow for Nursing Home
Leaders
The Centers for Medicare & Medicaid Services (CMS) will host a
call April 8 at 1:30 p.m. (PT) for nursing home leaders. The call
with include updates on the latest CMS guidance and a discussion
among providers interested in sharing best practices with their
peers. To join by phone, dial (833) 614-0820; to join by web
link,
click here and use conference ID 6798274.
CDC Update Call for Rural Providers
The Centers for Disease Control and Prevention will host a call
April 8 at 1 p.m. (PT) to share guidance for public health
practitioners and health care providers in rural communities. To
submit questions in advance, e-mail ruralhealth@cdc.gov with
“Rural Health Update 4/8” in the subject line.
Register here.
Pharmacy, Volunteer FAQs Added to CHA
Website
New FAQs have been added to CHA’s
Coronavirus Response web page. They include pharmacy-related
information about in-person consultations and whether retired
pharmacists can practice during this time, as well as information
in the public section about how to volunteer time and services.
The page features frequently updated FAQs and guidance on a broad
range of topics; hospitals are encouraged to bookmark it as a
resource.
April 6:
Executive Order on Telehealth Services
Gov. Newsom
issued an Executive Order on April 3 that makes the following
changes related to telehealth services:
Suspends the requirement to obtain oral or written consent
from a patient for telehealth services
Allows health care providers to use video chats and other
applications to provide health services consistent with federal
HIPAA guidelines and waivers
Suspends penalties for privacy breaches related to telehealth
services, as well as penalties for late notifications
Lengthens the time frame — from 15 to 60 days — for notifying
the California Department of Public Health (CDPH) and patients of
telehealth-related breaches. This may cause confusion because
CDPH waived the breach notification requirements on March 20 in
AFL 20-26. Because HIPAA breach notification requirements are not
suspended, CHA recommends notifying CDPH at the same time the
patient is notified, to the extent staff is able to do so.
Certain CNA Requirements Waived
CDPH has
temporarily waived certain certified nursing assistant (CNA)
requirements and suspended regulatory enforcement of the
following for nursing assistants and CNAs:
Allows a CNA whose certificate expired within the past two
years or whose certificate will expire during the emergency to
work without renewing; facilities must check CDPH’s online
verification page to verify employment eligibility.
Allows a CNA certificate to be renewed without continuing
education units. The units may be completed at any time during
the two-year recertification period and may be completed online
or by distance learning.
Allows a CNA student to provide patient care prior to having
a test for tuberculosis infection.
Allows a licensed vocational nurse or registered nurse with a
license issued by another state or foreign country, whether
active or expired within the last two years, to work as a CNA
immediately upon submission of an application to CDPH.
Waives the requirement to submit a Live Scan until 30 days
after the emergency ends.
Allows a CNA student to continue to work during the emergency
for more than three months after starting employment, even if
training requirements are not completed. The CNA may render
services only at the competency level confirmed by the training
program on a competency checklist to be issued by CDPH.
Extends the time frame for a CNA to notify CDPH of a change
of address. They must notify CDPH as soon as practicable, but no
later than 30 days after the emergency ends.
Reduced Clinical Care Requirement for Nursing
Students
The Department of Consumer Affairs has
reduced the direct clinical patient care requirement for
obstetrics, pediatrics, and mental health/psychiatric nursing
students from 75% to 50%. Special accommodations may be made for
geriatric and medical/surgical hours, too.
Executive Order Expanding Child Care for Essential
Workers
Gov. Newsom signed
an Executive Order April 4 that will facilitate child care
for children of essential critical infrastructure workers. The
order allows the California Department of Education and
California Department of Social Services flexibility to waive
certain programmatic and administrative requirements, which will
expand eligibility for child care and prioritize essential
workers — including health care professionals, emergency response
personnel, law enforcement, and grocery workers. Guidance from
the departments will be issued April 7.
Daily Updated Statewide, County Hospital
Data
CDPH has publicly released
new hospital data sets using data the department collects and
data from the
CHA COVID-19 Tracking Tool. Data include a daily statewide
update of hospital status, aggregated to the county level,
depicting total confirmed cases, total deaths, positive and
suspected positive COVID-19 patients, as well as Intensive Care
Unit positive and suspected positive COVID-19 patients. These are
posted to the California Health and Human Services Agency’s Open
Data Portal.
Webinar: Preparing Perinatal Units to Respond to
COVID-19
The California Maternal Quality Care Collaborative — a
multi-stakeholder organization committed to ending preventable
morbidity, mortality, and racial disparities in California — will
host a webinar April 10 at noon (PT) on “Preparing your Perinatal
Unit to Respond to COVID-19.” The webinar will be presented by a
team from UC Davis, who will explain the protocols and guidelines
being implemented at UC Davis Medical Center to care for pregnant
women and infants who test positive or may have been exposed to
COVID-19. The webinar will also include a Q&A session with
the panelists. Details and registration information
are here.
New Resources
Summary of employment law issues: The AHA has
issued a summary of the various employment law issues raised in
recent federal legislation related to COVID-19.
Online compendium for addressing the needs of Medicaid
populations: The Center for Health Care Strategies has
compiled a
compendium of resources aimed at reducing the impact of
COVID-19 on Medicaid populations, particularly those at the
highest risk. Resources include key guidance, reference
materials, and tools.
Next CDPH Call: April 7, 8-9 a.m.
Dial: (844) 721-7239 | Passcode: 7993227
The phone number and passcode are the same each week. We
encourage you to add this information to your calendars.
Hospitals that would like to pose questions in advance and
anonymously can send them to questionsforcdph@calhospital.org.
FAQs on CHA Website
CHA’s
Coronavirus Response web page features updates and guidance
in a Q&A format by subject area. Topics include staffing,
testing, licensing and certification, persons under
investigation, human resources, supplies, pharmacy, vulnerable
populations, telehealth, and more. The site also includes links
to detailed information on federal funding opportunities, Federal
Emergency Management Agency reimbursement, resource requests, and
more.
April 2:
Hospital Data Submission
The
CHA COVID-19 Tracking Tool has reached sufficient
utilization, so hospitals can now stop other data submission to
the California Department of Public Health (CDPH) — including to
the District Office — as long as they continue to submit via the
CHA tool. Hospitals are still required to report COVID-19
positive patients to the local public health officer.
State Guidance on Public Use of Face
Coverings
The CDPH has
released guidance on Californians’ use of cloth face
coverings to protect against COVID-19 when they must leave their
homes. The guidance does not require the use of
face coverings, nor is it intended as a substitute for social
distancing guidelines. The state does not recommend the use of
N95 or surgical masks for anyone who is not a health care
worker.
CDC Updates:
Decontaminating N95 masks: The Centers for
Disease Control and Prevention (CDC) has
issued guidelines for decontaminating and reusing N95 masks
during crisis situations when shortages exist. Based on these
guidelines, a collaborative of researchers at UC San Francisco,
UC Berkeley, Stanford, and other universities has published
fact sheets and technical reports on three N95 reuse
methods: Heat and Humidity, UV-C, and Hydrogen Peroxide Vapor &
Hydrogen Peroxide Gas Plasma.
COVID-19 ICD-10-CM code: Yesterday, the CDC
posted official guidelines for the new ICD-10-CM code,
which will help capture and report surveillance data for the
virus. These are effective April 1 and are to be used through
Sept. 30, 2020.
Health Plans Waiving Prior Authorization, Cost
Sharing
Centene Corp.
has announced it will waive prior authorization and member
cost sharing for COVID-19 related screening, testing, and
treatment for all Medicare, Medicaid, and Exchange members.
Centene will also provide additional support to safety-net
providers, including assistance in securing small-business
loans for behavioral health providers, obtaining personal
protective equipment, and providing data and other support.
UnitedHealthcare
has announced it will waive cost sharing through May 31 for
COVID-19 testing, treatment, early prescription refills, and
telehealth visits for Medicare Advantage, Medicaid, and
commercial plan members.
Cigna and
Humana have announced plans to waive cost sharing for
COVID-19 testing, early prescription refills, and FDA-approved
medications or vaccines when they become available. Cigna is
waiving cost sharing until May 31. Humana has not set an end
date.
Professional Licensure – Renewal/Reactivation of
Licenses
The Department of Consumer Affairs has
waived examination and continuing education requirements for
certain health care professionals whose licenses expire between
March 31 and June 30, 2020. The waiver applies to physicians,
nurses, pharmacists, mental health professionals, physician
assistants, respiratory therapists, clinical lab
scientists/bioanalysts, optometrists, dieticians, physical
therapists, occupational therapists, speech-language
pathologists, perfusionists, and other professionals licensed
under Division 2 of the Business and Professions Code. This
waiver does not apply to certified nursing
assistants, paramedics, or emergency medical technicians, as they
are licensed/certified by other state agencies. Licensees must
submit their required renewal form on time and must satisfy any
waived exam or continuing education requirements by Oct. 1,
unless an additional extension is issued.
The department also
waived continuing education requirements and fees for health
care professionals licensed in the past five years who want to
reactivate or restore a retired, inactive, or canceled license.
This includes renewal, delinquency, penalty, late, or any other
fees. The waivers do not apply to licenses that were surrendered
or canceled for disciplinary reasons. A reactivated or restored
license is valid until Oct. 1 or when the State of Emergency
ends, whichever is sooner. The licensee must comply with any
other reactivation or restoration requirements, including
submitting required forms or notices to their licensing agency.
BRN Approval for Nursing Students
The Board of Registered Nursing has
announced that during a pandemic, nursing services may be
provided by unlicensed persons, including student nurses. The
board has
developed a chart showing the types of services student
nurses can provide depending on the coursework they’ve
completed.
SNF Transfer and Continuity of Care
CDPH has
issued guidance clarifying the expectation for transfer and
continuity of care for skilled-nursing facility (SNF) residents
with suspected or confirmed COVID-19, including admission
following hospitalization. CDPH specifies that SNFs may not
require a negative test result as a criteria of admission for
patients who have no clinical concern for COVID-19, and that
patients with confirmed or suspected COVID-19 can be accepted as
long as the facility can follow infection prevention control
recommendations from the CDC. Patients under investigation should
not be transferred to SNFs. Hospitals and SNFs should consult the
local health department when considering the transfer of a
patient with confirmed or suspected COVID-19.
HIPAA Enforcement Discretion
The federal Health and Human Services Office for Civil Rights
announced it will exercise enforcement discretion for
violations of certain provisions of the HIPAA privacy rule
related to uses and disclosures of protected health information
during the COVID-19 public health emergency.
Hospital Presumptive Eligibility Flexibilities
Approved
The Department of Health Care Services (DHCS) has approved
immediate enrollment flexibilities for hospital presumptive
eligibility (HPE) providers, in order to limit potential exposure
to COVID-19. Enrolling providers can use telephonic signatures
for HPE applications, noting in the case file “COVID-19
protocol.” Providers may also obtain an authorized representative
form for the applicant, allowing an individual acting on behalf
of the applicant to provide the required information to assist
with enrollment. Questions about HPE flexibilities or processes
should be sent to DHCSHospitalPE@dhcs.ca.gov.
Recordings of CMS Calls
The Centers for Medicare & Medicaid Services has been hosting
regular calls with a variety of clinicians, hospitals, other
facilities, and states to keep stakeholders updated on COVID-19
efforts. Recordings of the calls, along with transcripts, are
available here.
COVID-19 California Tracker
This dashboard of COVID-19 cases in California provides
county-level data on confirmed cases and deaths over time and
mapped statewide.
Summary of This Week’s CDPH Call
CDPH has provided
this summary of the call it held with health care providers
on March 31.
FAQs on CHA Website
CHA’s
Coronavirus Response web page features updates and guidance
in a Q&A format by subject area. Topics include staffing,
testing, licensing and certification, persons under
investigation, human resources, supplies, pharmacy, vulnerable
populations, telehealth, and more. The site also includes links
to detailed information federal funding opportunities, Federal
Emergency Management Agency reimbursement, resource requests, and
more.
April 1:
Grant Money Available to Local Hospitals
The Assistant Secretary for Preparedness and Response (ASPR) is
authorized to distribute $50 million in grants to state hospital
associations with the direction that they distribute the funds
within 30 days to local hospitals. $4.1 million has been
allocated to CHA to distribute to hospitals in California. CHA
must formally apply for the funds and will do so by the April 3
deadline. Once the application is approved, it is expected that
ASPR will distribute the funds to CHA by mid-April. CHA will then
send a letter to each hospital with their grant amount and
instructions for participating in the program. Hospitals will
need to complete federal forms before CHA can distribute the
checks.
Hospitals Recommended to Report Data to HHS and
CDC
In a
letter sent to hospitals on March 29, Vice President Mike
Pence requested hospitals that conduct in-house COVID-19 testing
to report their data daily to the U.S. Department of Health and
Human Services (HHS). This reporting would be in addition to the
daily reports hospitals submit on bed capacity and supplies to
the Centers for Disease Control and Prevention (CDC) National
Healthcare Safety Network COVID-19 Patient Impact and Hospital
Capacity Module. CHA recommends hospitals submit this data at the
federal level, as well as on the
CHA COVID-19 Tracking Tool for the state. It is CHA’s
understanding that Federal Emergency Management Agency (FEMA)
officials will base their decisions on the allocation of
resources from the Strategic National Stockpile on data they have
received from hospitals.
CHA Issues Summaries of Recent Federal
Legislation
CHA has issued a members-only summary — prepared by Health Policy
Alternatives — that provides details of two recently enacted laws
in response to the COVID-19 pandemic: The Families First
Coronavirus Response Act and the Coronavirus Aid, Relief, and
Economic Security Act. The summary includes all aspects of the
legislation, including health care and non-health care related
provisions. Members can view the summary
here.
Social Media Movement Claims COVID-19 Is a
Hoax
CHA has received reports from local law enforcement of a social
media movement — #filmyourhospital — that is designed to prove
the COVID-19 pandemic is a hoax. Supporters are encouraged to
openly confront hospital staff while filming and demand to see
evidence of the pandemic. The videos are then uploaded to social
media. Based on descriptions from around the country,
#filmyourhospital adherents will ignore requests to leave the
hospital and will often accuse staff of engaging in a conspiracy.
Their behavior may require a response from on-site security or
even law enforcement.
FAQs on CHA Website
CHA’s
Coronavirus Response website features updates and guidance in
a Q&A format by subject area. Topics include staffing,
testing, licensing and certification, persons under
investigation, human resources, supplies, pharmacy, vulnerable
populations, telehealth, and more. The site also includes links
to detailed information on federal funding opportunities, FEMA
reimbursement, resource requests, and more.
March 30:
Governor Signs Executive Order to Add Health Care Workers
to Staff 50,000 Additional Beds
Gov. Newsom today issued an
Executive Order intended to expand California’s health care
workforce and recruit health care professionals with an active
license, public health professionals, medical retirees, medical
and nursing students, or members of medical disaster response
teams in California. Interested health care professionals are
encouraged to visit healthcorps.ca.gov.
CMS Announces New Waivers
The Centers for Medicare & Medicaid Services (CMS) has
announced new regulatory flexibilities — including
waivers and an
interim final rule — to support the health care system in
increasing capacity to absorb and manage surges of COVID-19
patients. Under CMS’ temporary new rules, hospitals may transfer
patients to outside facilities, such as ambulatory surgery
centers, inpatient rehabilitation hospitals, hotels, and
dormitories, while still receiving hospital payments under
Medicare. In addition, new guidelines allow health care systems,
hospitals, and communities to set up testing and screening sites
exclusively for the purpose of identifying COVID-19 positive
patients and describe circumstances in which hospital emergency
departments can test and screen patients for COVID-19 at
drive-through and off-campus test sites. CMS also announced a
number of other changes to expand the workforce, reduce
administrative burden, and further promote telehealth services.
CHA is reviewing the waivers and regulations and will provide
members with additional details in the coming days.
President Signs Federal Economic Relief
Legislation
On Friday, the House passed the Senate’s
Coronavirus Aid, Relief, and Economic Security (CARES) Act,
and the President signed it. The legislation includes several
measures of importance to the hospital community; the American
Hospital Association has provided additional
detail and insight.
Noridian COVID-19 Hotline
California’s Medicare administrative contractor, Noridian, has
established a COVID-19 hotline to help hospitals with questions
on provisional billing privileges and enrollment flexibilities
afforded by the COVID-19 waivers for health care facilities and
providers. The hotline is also available to assist with questions
on Medicare Part A, B, and durable medical equipment accelerated
payments related to COVID-19. The hotline is open from 6 a.m. to
5 p.m. (PT); the phone number is (866) 575-4067.
Updated Information on Reporting Cases to Local Public
Health
In the March 29 edition of Coronavirus Response, it was stated
that hospitals that complete the
CHA COVID-19 Tracking Tool no longer need to report COVID-19
cases to their local public health officer. This information has
changed. The California Department of Public Health (CDPH)
released an update to
All Facilities Letter 20-31 on March 29 clarifying that,
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.
Reminders About Non-Discrimination in Medical
Treatment
The Departments of Health Care Services, Public Health, and
Managed Health Care have
issued guidance reminding health care providers and payers
that rationing care based on a person’s disability status is
impermissible and unlawful under both federal and state law. The
federal Health and Human Services Office of Civil Rights issued a
similar reminder on Saturday.
Telehealth Toolkit for Long-Term Care Nursing
Homes
CMS has issued an
electronic toolkit for telehealth and telemedicine for
long-term care nursing home facilities. CMS has broadened access
to Medicare telehealth services so that beneficiaries can receive
a wider range of services from their doctors without having to
travel to a health care facility. Most of the toolkit is directed
toward providers who may want to establish a permanent
telemedicine program, but it also includes information that will
help in the temporary deployment of a telemedicine program.
March 29:
Definition of Health Care Provider for Federal Paid Sick
Leave and Family Care Leave
The Department of Labor has
issued FAQs defining a health care provider for the purpose
of employees who may be exempted from paid sick leave or expanded
family and medical leave by their employer under the Families
First Coronavirus Response Act.
Employers with fewer than 500 employees and all public employers
are covered by this law. The act gave the department authority to
define health care providers and further gave employers
discretion for whether to provide these benefits to them. The
department adopted a very broad definition that includes anyone
employed at the following: a doctor’s office, hospital, health
care center, clinic, post-secondary educational institution
offering health care instruction, medical school, local health
department or agency, nursing facility, retirement facility,
nursing home, home health care provider, any facility that
performs laboratory or medical testing, pharmacy, or any similar
institution, employer, or entity. This includes any permanent or
temporary institution, facility, location, or site where medical
services are provided that are similar to such institutions.
Cal/OSHA Allows for Surgical Masks When Respirator
Supplies Are Insufficient
Cal/OSHA has
updated its guidance on COVID-19 for health care facilities
with respect to respirator use. It states 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. Hospitals will still receive
complaint letters, but a certification that they have a shortage
of N95 respirators, despite reasonable efforts to obtain
additional respirators and implementing strategies to maximize
existing respirator supplies, will serve as a response.
CMS Expands Medicare Advance Payment Program
The Centers for Medicare & Medicaid Services (CMS) yesterday
announced an expansion of the accelerated and advance
payments program for Medicare-participating heath care providers.
These payments provide emergency funding and address cash flow
issues based on historical payments when there is a disruption in
claims submission or processing. A fact sheet is available
here.
CDPH Allows CHA Tracking Tool to Replace Daily Reporting
of COVID-19 Patients
The California Department of Public Health (CDPH) has issued an
All Facilities Letter allowing hospitals that complete the
CHA COVID-19 tracking tool daily to stop reporting COVID-19
positive and suspected patients to CDPH and their local public
health officers.
Home Health and Hospice Waiver Request
CHA, in conjunction with the Washington State Hospital
Association, filed a
third waiver request with CMS, relating to home health and
hospice services.
March 27:
$50 Million for Hospitals to Flow Through State
Associations
The U.S. Department of Health and Human Services (HHS), Office of
the Assistant Secretary for Preparedness and Response (ASPR) is
making available $50 million to hospitals through the Hospital
Preparedness Program to help them during the COVID-19 public
health emergency. The funds are to be distributed through the
state hospital associations via a formula based on the COVID-19
risk population. Each state will get a specific allocation to
distribute; we don’t yet know what CHA’s allocation will be. CHA
will apply next week, and ASPR has promised to distribute the
funds by early April. Once received, CHA will distribute the
funds to hospitals as quickly as possible.
Updated COVID-19 FAQs on CHA Website
Recognizing hospitals’ need to get the most relevant COVID-19
information quickly and easily, CHA’s
Coronavirus Response website now features updates and
guidance in a Q&A format, organized by subject. Topics
include staffing, testing, licensing and certification, persons
under investigation, human resources, employee safety, supplies,
pharmacy, vulnerable populations, and federal and state funding.
The site also includes links to detailed information about
resource requests, Federal Emergency Management Agency
reimbursement, and more. In the coming days, look for a
comprehensive list of state and federal waivers, flexes, and
enforcement discretions.
OSHPD Suspension of Penalties for Late Data
Submissions
The Office of Statewide Health Planning and Development
has announced it will temporarily suspend penalty assessments
for late reporting of data from March 4 (when the Governor
declared a State of Emergency) through May 1. This suspension
period may be extended beyond May 1.
Accreditation Data Submission Optional
Given the changing environment due to COVID-19, The Joint
Commission has announced that data submission for accreditation
(ORYX) and certification (with standardized measures) will be
optional for Q4 of 2019 and Q1 and Q2 of 2020. ORYX contacts will
receive
notification this week; next week a formal announcement with
additional information will be available on the
website under the “Measurement” tab.
Guidance for Delivering Beneficiary Notices
The Centers for Medicare & Medicaid Services urges providers
treating patients with suspected or confirmed COVID-19 to be
diligent and safe while
issuing beneficiary notices to beneficiaries receiving
institutional care. Current delivery instructions provide
flexibilities for delivering notices to beneficiaries in
isolation.
AHA Advances 100 Million Mask Challenge
The American Hospital Association has taken on a critically
important initiative from
Providence, headquartered in Washington State with several
hospitals in California, to bring to national scale the
100 Million Mask Challenge. This initiative is designed to
facilitate new relationships between providers in need of
surgical masks and manufacturers with the capacity to produce
them. The AHA-led initiative will, over time, expand its
scope to meet the growing and ongoing challenges, and supports
hospitals’ first priority: to ensure the safety and well-being of
our caregivers on the front lines.
March 26:
CMS Issues Waivers for California Health Care
Facilities
In response to CHA’s request, the Centers for Medicare & Medicaid
Services (CMS) today
issued a waiver for all California health care facilities.
Included are 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 are included for
skilled-nursing facilities, home health, and hospice.
Senate Passes Sweeping Economic Relief
Package
Last night, the U.S. Senate passed the
Coronavirus Aid, Relief, and Economic Security (CARES) Act;
the House is scheduled to vote on it tomorrow. The President is
expected to sign the measure, which includes several measures of
particular importance to the hospital community.
See more details here.
CLIA Program Flexibilities
CMS has issued an
FAQ describing flexibilities under the Clinical Laboratory
Improvement Amendments program that are available during the
COVID-19 public emergency — including remote review and reporting
by pathologists, clarification of proficiency testing
requirements, and alternate specimen collection — and responding
to other questions about COVID-19 testing requirements.
CDPH Requests Waivers for Space, Staffing
Requirements
The California Department of Public Health has
requested statewide waivers from CMS, including flexibility
regarding use of space, staffing and program requirements. CHA
will inform members when CMS responds.
The Centers for Disease Control and Prevention
Updates
Updated COVID-19
testing priority guidance gives first priority to testing
hospitalized patients and symptomatic health care workers
Updated
testing guidelines to allow for self- or health care
worker-collected nasal or nasal turbinate swabs if
nasopharyngeal swab is not possible
Condition Code Approved for COVID-19
Services
The National Uniform Billing Committee (NUBC) has approved the
use of the “DR” condition code for services related to COVID-19 —
including services where the patient ultimately tests negative.
NUBC
provides guidance on how to ensure institutional claims
appropriately flag COVID-19 related care, as well as for coding
the testing services provided at off-campus facilities, such as
parking lots.
Announcement of Medical Resources That May Not Be
Hoarded
The federal Secretary of Health and Human Services
has announced that certain health and medical resources —
including ventilators, PPE, and similar items — are subject to
penalties if they accumulated beyond the reasonable demands of
business, personal, or home consumption, or for resale in excess
of prevailing market prices. Penalties for violation include a
fine of up to $10,000 or imprisonment for up to one year, or
both.
Dentists’ Clinical Skills Offered to
Hospitals
The California Dental Association has provided
a summary of the clinical skills dentists have been trained
in and can provide as hospitals, skilled-nursing facilities, and
clinics ramp-up for the surge in patients. Hospitals in need of
these skills are encouraged to contact CDA for assistance at
(800) 232-7645.
March 25:
Emergency Medi-Cal Provider Enrollment
The Department of Health Care Services (DHCS) released a
provider bulletin today, outlining the requirements and
procedures for emergency Medi-Cal provider enrollment. These
special exceptions were recently approved by the Centers for
Medicare & Medicaid Services, as a result of the DHCS request for
an 1135 waiver approved on
March 23.
Telehealth Allowable by Out-of-State
Physicians
The 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 telehealth
services.
Board of Pharmacy Updates
Inventory reconciliation: The Board of
Pharmacy (BoP) has waived a specific provision of pharmacy law
to change inventory reconciliation from every three months to
at least once every six months.
Mobile pharmacies: In response to Governor
Gavin Newsom’s declaration of a state of emergency, the BoP
will permit the employment of mobile pharmacies or clinics
that satisfy certain requirements to ensure continuity of
patient care during the COVID-19 public health crisis.
Other Resources, Information
For individuals with behavioral health needs:
The Substance Abuse and Mental Health Services Administration
is continuously
updating its website with guidance, resources, and
information to assist in the management of individuals with
behavioral health conditions posed by COVID-19. The website
contains information to assist individuals, providers,
communities, and states with both substance use disorder and
mental health needs.
PACE organizations: The California PACE
Association – representing the state’s Programs of
All-inclusive Care for the Elderly (PACE) organizations – has
posted
an overview of what PACE programs are doing to respond to
COVID-19 and its impact on older adults, people with
disabilities and complex care needs, and their caregivers.
March 23:
Next California Department of Public Health (CDPH)
Call: March 24, 8-9 a.m. (PT)
FDA Releases Guidance to Mitigate Ventilator Supply
Disruption
The Food and Drug Administration today
released updated guidance to provide flexibility around and
expand the availability of ventilators and other respiratory
devices to treat patients during the public health emergency.
Major Disaster Declaration Provides Additional
Assistance
On Sunday, California secured a
declaration of a major disaster from the President. It will
provide additional assistance, including, but not limited to:
mass care and emergency assistance, crisis counseling, disaster
case management, disaster unemployment assistance, disaster legal
services, and Disaster Supplemental Nutrition Assistance.
Governor Defines Essential Critical Infrastructure
Workers
For the health care/public health sector, Gov. Newsom’s list of
essential critical infrastructure workers during the statewide
stay-at-home order includes those working in direct patient care
as well as all support functions.
FAQs are available with the Executive Order and definition of
essential critical infrastructure workers.
Executive Order Waives More Staffing
Ratios
To further increase health care capacity in clinics, adult day
health care, hospice, and mobile clinics, Gov. Newsom on Saturday
issued
an Executive Order that waives staffing ratios at those
facilities. Previously, the CDPH had issued a
statewide waiver, which suspends staffing ratios at hospitals
until June 30, 2020.
CHA Sends New Blanket Waiver Request to Centers for
Medicare & Medicaid Services (CMS)
CHA has submitted to CMS, on behalf of all hospitals and health
systems, a
second request for waivers that immediately suspend all
hospital and critical access hospital Conditions of
Participation, regulatory deadlines, and audit activity in
response to the unprecedented circumstances of the COVID-19
pandemic.
Locating Testing Swabs
The Health and Human Services Agency directs hospitals
experiencing shortages of testing swabs to these manufacturers:
Copan Diagnostics: 26055 Jefferson Avenue Murrieta, CA
(800) 216-4016
Covered California Extends Special
Enrollment
Covered California has
announced it will extend its special enrollment period
through June 30 to help people get coverage in light of COVID-19.
CMS Prioritizes Survey Activity
CMS will
prioritize survey activity by authorizing modification of
timetables and deadlines for the performance of certain required
activities, delaying revisit surveys, and exercising enforcement
discretion for three weeks. During the three-week timeframe, the
following types of surveys will be prioritized and conducted:
Complaint and facility surveys that are triaged at the
immediate jeopardy level
Targeted infection control surveys using a streamlined review
checklist to minimize the impact on provider activities, while
ensuring providers are implementing actions to protect the health
and safety of individuals to respond to the COVID-19 pandemic
Voluntary self-assessments of infection control plans
CMS will not conduct standard surveys for long-term care
facilities, hospitals, home health agencies, intermediate care
facilities for individuals with intellectual disabilities and
hospices. This includes the life safety code and emergency
preparedness elements as well as revisits that are not associated
with immediate jeopardy.
CMS has also announced that it:
Waived
the rule requiring a three-day qualifying stay for Medicare
Will
provide relief from timeframes for Minimum Data Set (MDS)
assessments and transmission, and delayed release of MDS 3.0
v1.18.1, which had been scheduled for Oct. 1, 2020.
Issued
FAQs on provider enrollment relief under 1135 waivers
OSHPD Suspends Reporting Penalties
The Office of Statewide Health Planning and Development has
notified CHA that it will temporarily suspend penalty assessments
for late data reporting and will notify impacted health
facilities by letter.
Board of Pharmacy Waivers
The Board of Pharmacy has issued new waivers allowing:
Sterile compounding pharmacies whose licenses expire on or
before May 1, 2020, to have their licenses renewed without being
subject to certain renewal requirements if the facility is in a
hospital or satellite location
Hospital pharmacies to obtain drugs and devices from out of
state for one month during the COVID-19 disaster
Support for Placement of People Experiencing
Homelessness
The Department of Social Services reminds health care providers
that 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.
Other New Guidance
For 340B hospitals: The Health Resources and
Services Administration has posted about the administration of
the 340B program, addressing 340B patient definition,
telehealth services, new 340B registrations particularly for
child-sites and contract pharmacies, group purchasing
organization prohibition for disproportionate share hospitals,
and 340B audits.
FAQs on testing: The FDA has
issued FAQs on diagnostic testing, including a 24-hour
hotline and list of commercial labs.
Asymptomatic staff in skilled-nursing facilities
(SNFs): CDPH has
revised its guidance from last week on SNF preparation for
COVID-19 to reflect an
Executive Order by the Governor stating that asymptomatic
health care workers may continue working during the period of
this COVID-19 emergency, provided those health care workers are
taking precautions to prevent transmission.
Adult day health centers: CDPH has issued
guidance for mitigating and preventing transmission of
COVID-19 in adult day health centers.
Process for sterilizing and reusing N95 masks:
Nebraska Medicine has published its
decontamination procedure for reusing N95 masks, involving
the delivery of ultraviolet germicidal irradiation to used N95
FFRs. The Centers for Disease Control and Prevention National
Institute for Occupational Safety and Health is currently
reviewing these methods.
March 21:
Hospitals Relieved of Most Regulatory Requirements
Through June 30
In response to the many issues related to COVID-19 response
that CHA has been working through with the California
Department of Public Health (CDPH) over the past few weeks, today
CDPH issued
an unprecedented statewide waiver of almost all
regulatory requirements for hospitals until June 30, 2020.
Hospitals are not required to submit individual requests for
program flexibility. There are a few exceptions:
Hospitals must continue to report adverse events and unusual
occurrences.
Hospitals must report substantial staffing or supply
shortages that jeopardize patient care.
Hospitals must act in the best interest of patients.
Hospitals must follow their disaster response plan.
Hospitals must follow infection control guidelines from CMS
and CDC.
Hospitals must comply with local public health department
directions.
This waiver does not apply to federal or state laws that are not
within the jurisdiction of CDPH. For information on federal
waivers click
here.
Governor’s Stay at Home Order Prioritizes Health Care
Resource
Gov. Newsom issued a
stay at home order to protect the health and well-being of
all Californians and to establish consistency across the state in
order to slow the spread of COVID-19. According to the order, the
healthcare delivery system shall prioritize services to serving
those who are the sickest and shall prioritize resources,
including personal protective equipment, for the providers
providing direct care to them.
DHCS Requests Second 1135 Waiver Request From
CMS
Yesterday, the Department of Health Care Services (DHCS)
submitted its second
1135 Waiver request to the Centers for Medicaid & Medicare
Services (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.
Board of Pharmacy Issues Staffing Ratio
Waiver
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 the
following 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. Under such
circumstances, the ratio may not increase. See other Board of
Pharmacy waivers
here.
Additional Guidance, Resources
Undocumented individuals urged to seek care:
The U.S. Customs and Immigration Services has urged everyone,
including undocumented individuals, with symptoms that resemble
COVID-19 to seek necessary medical treatment or preventive
services, noting that treatment or preventive services will not
negatively affect any future “public charge” analysis. The
public charge rule does not restrict access to testing,
screening, or treatment of communicable diseases, or vaccines
to prevent vaccine-preventable diseases.
Uninterrupted substance use disorder treatment through
telehealth: The Substance Abuse and Mental Health
Services Administration has
shared guidance to ensure that substance use disorder
treatment services are uninterrupted through the use of
telehealth technology and telephonic consultations. The
guidance clarifies that the prohibitions on use and disclosure
of patient identifying information would not apply in these
situations to the extent that, as determined by the provider, a
medical emergency exists.
State-level data on COVID-19 cases: The Kaiser
Family Foundation has released a new,
regularly updated tool for tracking coronavirus policy
actions, along with data on current cases and deaths and
state-level data on health coverage and provider capacity.
New FAQs on Medicaid/CHIP, catastrophic health plan
coverage: CMS yesterday updated its
FAQs for state Medicaid and Children’s Health Insurance
Program agencies, answering questions related to flexibilities
related to managed care, benefits, financing, Section 1115
demonstrations, and Section 1135 Waivers offered as part of the
Pesident’s declaration of a national emergency.
In response to the many issues related to COVID-19 response that
CHA has been working through with the California Department of
Public Health (CDPH) over the past few weeks, today CDPH
issued an unprecedented statewide waiver of almost all
regulatory requirements for hospitals until June 30, 2020.
Hospitals are not required to submit individual requests for
program flexibility. There are a few exceptions:
Hospitals must continue to report adverse events and unusual
occurrences.
Hospitals must report substantial staffing or supply
shortages that jeopardize patient care.
Hospitals must act in the best interest of patients.
Hospitals must follow their disaster response plan.
Hospitals must follow infection control guidelines from CMS
and CDC.
Hospitals must comply with local public health department
directions.
This waiver does not apply to federal laws or to state laws that
are not within the jurisdiction of CDPH. For information on
federal waivers click
here.
March 18:
Request Process for Out-of-State Medical
Providers
Today, the California Emergency Medical Services Authority (EMSA)
released a
process for requesting to authorizeout-of-state medical providers to function
within their scope of practice in California. Under this process,
hospitals and others must submit
this form to EMSA at covid19@emsa.ca.gov.
CHA Requests Assistance From
Congress
Today, CHA
sent a letter to the congressional delegation asking for
federal assistance to rapidly expand treatment capacity, augment
the supply chain in any and all ways possible, eliminate
disproportionate share hospital cuts, prevent the Medicaid Fiscal
Accountability Rule from taking effect, eliminate Medicare
sequestration cuts, and create a trigger for the enhanced Federal
Medical Assistance Percentages funding for COVID-19 hot spots.
Tele-Town Hall to Include Azar, Kaiser Permanente,
Providence St. Joseph Health
The U.S. Department of Health and Human Services (HHS) will host
a tele-town hall March 19 at 2:15 p.m. (PT) on best practices for
hospitals and health systems in preparing for COVID-19 and caring
for patients. HHS Secretary Alex Azar will host the forum, and
leaders from Kaiser Permanente and Providence St. Joseph Health
will share their experiences on COVID-19.
Register here.
YMCA Offers Emergency Child Care
Many YMCAs are making emergency child care available for people
working in essential operations, including hospital staff. For
more information, hospitals and their staff can
contact the CEO of their local YMCA.
Additional New Guidance
PPE supply: Today, the Centers for Disease
Control and Prevention
posted guidance on strategies for optimizing the supply of
three additional types of personal protective equipment: eye
protection, isolation gowns, and masks. As this is new
information, the California Department of Public Health (CDPH)
has not yet commented on how it will be applied in California.
Transferring deceased individuals: CDPH
issued guidance on transferring deceased persons suspected
or confirmed to have COVID-19.
Telehealth services under Medi-Cal managed
care: The Department of Health Care Services has
updated its guidance to Medi-Cal managed care plans,
offering members and providers the option to use telehealth
services when medically appropriate.
For Boards of Pharmacy:
U.S. Pharmacopeia (USP) has noted that, during the COVID-19
pandemic, it supports state boards of pharmacy and other
regulators using risk-based enforcement discretion related to
the implementation of
USP compounding standards and the compounding of
alcohol-based hand sanitizers for consumer use.
March 16:
Next CDPH Call: March 17, 8-9 a.m. (PT)
CHA Webinar: March 18, 11:30 a.m.-1 p.m.
(PT)
CHA will host a complimentary, members-only
webinar March 18 from 11:30 a.m. to 1 p.m. (PT). The webinar
will focus on untangling employee safety regulations and guidance
around coronavirus as community transmission increases.
New White House Guidance
Today’s
updated guidance from the White House urges people to stay
home and avoid groups larger than 10 for the next 15 days, avoid
eating at restaurants, not visit nursing homes or long-term care
facilities, and more.
Centers for Disease Control and Prevention
(CDC)
The CDC on March 15 issued a
recommendation that, for the next eight weeks, organizers
(whether groups or individuals) cancel or postpone in-person
events of 50 people or more throughout the U.S. The
recommendation does not apply to the day-to-day operation of
organizations such as schools, institutes of higher learning, or
businesses.
Department of Health Care Services (DHCS)
Updates
The DHCS
website now includes:
Federal guidance: The Centers for Medicare &
Medicaid Services has issued
revised guidance on protecting nursing home residents,
directing nursing homes to significantly restrict visitors and
nonessential personnel, and to restrict communal activities
inside nursing homes.
California Department of Aging (CDA): CDA has
posted several updates on its
home page, including links for area agencies on aging,
community-based adult services and more; as well as for older
adults and people with disabilities.
Other New Developments
The California Dental Association has issued
an announcement strongly recommending that dentists
practicing in California suspend nonessential and nonurgent
dental care for the next 14 days.
A
JAMA-published paper details Italy’s early experience with
critical care utilization during the COVID-19 outbreak.
CHA how-to guide on requesting licensing program
flexibility: CHA has prepared
an overview for requesting program flexibility from CDPH,
including links to the CDPH forms for requests to suspend both
state licensing regulations and statutes.
Next CDPH Call: March 17, 8-9 a.m. CDPH
will send call-in information through the California Health Alert
Network. CHA will also share the information, once available,
through Coronavirus Watch. Hospitals that would like to
pose questions in advance and anonymously can send them to
questionsforcdph@calhospital.org.
Commandeering power for quarantine, isolation, and
treatment sites (#8 in the Executive Order): Gives the
state the power to commandeer hotels (and other places of
temporary residence), medical facilities, and other facilities
to quarantine, isolate, or treat individuals with COVID-19 or
who have had a high-risk exposure to COVID-19.
Unemployment insurance could be available sooner (#2
and #3 in the Executive Order): Allows the Employment
Development Department to waive the one-week waiting period for
unemployment insurance. CHA requested this for any health care
workers who have at-home isolation in advance of the original
Executive Order last week that declared a State of Emergency.
Scope of practice for paramedics can be augmented
(#4): Allows the Emergency Medical Services Authority
(EMSA) director to “implement additions to local optional
scopes of practice for paramedics without first consulting with
a committee of local EMS medical directors named by the EMS
Medical Directors Association of California.”
Suspends state law on who can conduct testing in public
health labs and licensed labs. (#9)
CDPH guidance for long-term care facilities:
CDPH has issued an
All Facilities Letter for long-term care facilities.
CDPH recommendations for older adults, other compromised
individuals: CDPH has issued a
press release with recommendations for older adults, people
with compromised immune systems, and those with serious chronic
medical conditions. Recommendations include staying home as much
as possible.
State guidance on gatherings, social distancing:
On March 11, CDPH released
recommendations for canceling or postponing, during the month
of March, large gatherings of 250 or more people, small
gatherings where people are not six feet apart, and limiting
gatherings to no more than 10 people for those who are most
at-risk for COVID-19 (i.e., older adults).
The World Health Organization (WHO) pandemic
designation: The WHO Director-General made remarks
today about why the organization made the decision to
designate COVID-19 as a pandemic.
CDPH updating numbers regularly: These are
online
here, including a
map of the counties where community transmission is
occurring, currently: Yolo, Sacramento, Solano, San Francisco,
San Mateo, Santa Clara, and Riverside.
Centers for Medicare & Medicaid Services (CMS)
guidance: CMS has released
updated guidance for nursing home providers,
guidance aligning with the CDC’s recommendations on the use
of N95 respirators, and
EMTALA guidance.
This Primer provides key information on the public health
emergency response to the COVID-19. The primer will provide
information & objective guidance (not legal advice) on emerging
issues of law and policy and serve as a quick briefing on core
legal preparedness and response issues
Pandemic events present multiple challenges to the health care
environment and the ability of the respiratory therapist to
provide mechanical ventilation to all persons in need.
The Center for Disease Control and Prevention’s (CDC) Strategic
National Stockpile (SNS) is a repository of ventilators that
would be used to supplement the supply currently in use by the
nation’s acute care facilities. These ventilators can be
requested and allocated to areas of need in the event of a
pandemic.
ASPR TRACIE compiled and synthesized information from the Centers
for Disease Control and Prevention (CDC), local and state health
departments, and other open sources.
This response highlights resources for healthcare system
emergency preparedness planners to use while preparing for and
responding to infectious disease outbreaks with drive-through
clinic models.
Considerations and lessons learned from these materials are also
gathered and provided as points for consideration. ASPR TRACIE
reached out to members of its Subject Matter Expert Cadre for
information and will update this document with additional
operational resources and guidance documents as they become
available.
The Listen, Protect and Connect psychological first aid system
designed for families, neighbors, co-workers and first
responders. One version is an “all ages” family-to-family,
neighbor-to-neighbor version and two are specifically for
supporting children. One for parents and one just for teachers
and schools to use.
This approach suggests ways we all can support each other’s
resilience and coping before, during and after emergencies. The
approach builds on strengths and practices that families and
community already use and offer additional ideas and tools to
call upon in times of disaster.
