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Is Your Hospital Prepared?

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.

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Coronavirus Response
California Hospital Association (CHA)

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.

 

May 22:


May 22:

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:
 

  Nurses: May 21 at noon (PT)

Dial: (833) 614-0820

Passcode: 2874976

Audio webcast

Hospitals and Health Systems: May 21 at 2 p.m. (PT)

Dial: (833) 614-0820

Passcode: 9984433

Audio webcast

Lessons from the Front Lines: May 22 at 9:30 a.m. (PT)

Dial: (877) 251-0301

Passcode: 6086125

Audio webcast
 


May 18:

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:

Zoom: https://calhospital.zoom.us/j/94875209114
Meeting ID: 948 7520 9114
Listen only: (669) 900-9128 or (213) 338-8477


CDPH Updates Guidance on SNF Data Submissions

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.

Clarification on Health Care Exemption in Families First Coronavirus Response Act
The Department of Labor (DOL) recently responded to CHA’s request for clarification on the technical aspects of the health care exemption from the leave provisions in the Families First Coronavirus Response Act (FFCRA). There was some confusion over how a covered health care employer (those with fewer than 500 employees and public employers) could exempt some or all of its workforce from the expanded family and medical leave provisions and the newly created paid sick leave provisions. Based on the FAQs issued shortly after the law was passed, it was unclear whether a blanket exemption was permitted or whether it had to be on a “case-by-case” basis. The DOL has now clarified that, “Both the EPSLA and EFMLEA permit an employer to elect to exclude an employee from eligibility for paid leave under the Acts if the employee is a health care provider or emergency responder. Please see the regulations at 29 CFR 826.30© and Frequently Asked Questions numbers 56 and 57 for more information, including the definitions of “health care provider” and “emergency responder” for these purposes under the FFCRA. The Acts do not require specific individual notice to the employee(s) of the election to exclude.”

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:

  • ​May 14, 9 a.m.–noon (PT)
     
  • ​May 15, 2-5 p.m. (PT)
     
  • ​May 18, 9 a.m.–noon (PT)
     
  • ​May 19, ​​2-5 p.m. (PT)
     
  • ​May 20, 9 a.m.–noon (PT) ​
     
  • ​May 21, 2-5 p.m. (PT)​

Participants can register here.

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 has also issued a Toolkit on State Actions to Mitigate COVID-19 Prevalence in Nursing Homes, which provides a compilation of actions taken by state governments and others throughout the U.S. to help nursing homes meet the needs of residents since the onset of the COVID-19 pandemic.

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:
 

Nurses: May 14 at noon (PT)

Dial: (833) 614-0820
Passcode: 4279137
Audio webcast

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

Dialysis Organizations: May 6 at 2:30 p.m. (PT)
Dial: (833) 614-0820
Passcode: 8278522
Audio webcast
: (833) 614-0820  |  Passcode: 7844154
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.

Dial-In: (877) 251-0301  |  Access Code: 9545128
Audio webcast


April 29:

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.

For more information about the program and to register to participate, visit the HRSA COVID-19 Uninsured Program Portal.

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.

Dial: (833) 614-0820  |  Passcode: 7476619
Audio webcast

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.

Dial: (833) 614-0820  |  Passcode: 4268398
Audio webcast

 


April 28:

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.

For details about participating, see the information packet and infographic. For more information, call (833) 998-2381.

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.

Nursing Homes, 1:30–2 p.m.
Dial: (833) 614-0820  |  Passcode: 4680237
Audio webcast

Dialysis Organizations, 2:30–3 p.m.

Dial: (83c

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.

     Dial: (833) 614-0820  |  Passcode: 5787874

Audio webcast

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.

     Dial: (833) 614-0820  |  Passcode: 1854778

Audio webcast

Next CDPH Call: April 28, 8-9 a.m.

     Dial: (844) 721-7239  |  Passcode: 7993227

Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org.


April 24:

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. 

For details about participating, see the information packet, infographic on the sign-up process, and sample service agreement. Signed service agreements and questions can be directed to Jon Cartlidge at cartlidgej@battelle.org

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.

Dial: (833) 614-0820  |  Access Passcode: 5899488

Audio Webcast

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.

  • Nursing Homes, 1:30 – 2 p.m. 
    Dial: (833) 614-0820
    Passcode: 2672118
    Webcast
     
  • Dialysis Organizations, 2:30 – 3 p.m. 
    Dial: (833) 614-0820
    Passcode: 1796168
    Webcast

April 20:

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

Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org.
 


April 17:

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.

AFLs Address Staffing Ratios, Acute Psychiatric Hospitals, Stockpile Supplies

  • 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:

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

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.


Next CDPH Call: April 14, 8-9 a.m. (PT)

Dial: (844) 721-7239  |  Passcode: 7993227

Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org.
 


April 10:

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.

Questions about this funding can be directed to Ryan Witz at rwitz@calhospital.org or Anne O’Rourke at aorourke@calhospital.org.

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.

More details can be found in the AHA Special Bulletin.
 


April 7:

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.

Crisis Standards of Care Resources
The American Hospital Association has published a summary document, “Caring with Limited Resources during the COVID-19 Crisis: A Compilation of Resources for Your Team.” This document includes ethical guidance, clinical resources, capacity planning tools, information on communication and palliative care, and more.

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.

Optimizing PPE and Equipment
The Centers for Disease Control and Prevention’s Strategies to Optimize the Supply of PPE and Equipment are displayed in an easy-to-read table format in this summary document by the New Jersey Hospital Association.

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

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)

Dial: (844) 721-7239 |  Passcode: 7993227

Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org.

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:

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 behavioral health FAQs: DHCS has updated its FAQs for narcotic treatment programs to reflect recent federal guidance, including the ability to prescribe new patients buprenorphine through telemedicine in lieu of an in-person visit; flexibility to apply for blanket waivers to allow 14-28 days of take-homes and home delivery of methadone; and clarification that the U.S. Department of Health and Human Services Office for Civil Rights will use enforcement discretion regarding HIPAA violations when providers use telehealth in good faith. DHCS has also updated its FAQs for driving under the influence programs.
  • 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.
  • Telehealth toolkits: CMS released telehealth toolkits to assist general practitioners and end-stage renal disease providers in providing telehealth services under the COVID-19 emergency waivers.

March 20: 

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:

  1. Hospitals must continue to report adverse events and unusual occurrences.
  2. Hospitals must report substantial staffing or supply shortages that jeopardize patient care.
  3. Hospitals must act in the best interest of patients.
  4. Hospitals must follow their disaster response plan.
  5. Hospitals must follow infection control guidelines from CMS and CDC.
  6. 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 authorize out-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

Employer-Sponsored Child Care Statewide Waiver
The Department of Social Services has provided a statewide waiver for operation of child care facilities, including temporary employer-sponsored child care.

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:

Guidance for Nursing Homes and Older Adults

  • 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.

See more


March 12:  

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.

Today, the Governor issued a new Executive Order. Of note:

  • 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.

Interim CDC guidance on infection prevention and control: The Centers for Disease Control and Prevention (CDC) has updated its Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. It does not expressly move to droplet precautions but states that airborne isolation rooms should be reserved for patients undergoing aerosol-generating procedures.

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.

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Ventilator Sharing Protocols
Shared by Mount Sinai Health System

Note: Mount Sinai Health System Emergency Ventilator Sharing Protocol is a working protocol and is subject to revision.

Version Date: April 11, 2020

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Emergency Legal Preparedness: COVID-19
The Network for Public Health Law

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

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Strategic National Stockpile Ventilator Training Program
Centers for Disease Control (CDC)

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.

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COVID Drive-Thru Testing: Considerations and Lessons Learned
ASPR TRACIE

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.

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Listen, Protect and Connect Psychological First Aid System
FEMA

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.

Commands