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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.

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 (CDPHi) — 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.


March 9:  

Next CDPH Call: March 10, 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.

Other Developments:

Hospitals urged to complete survey on surge capacity: CDPH has issued an All Facilities Letter (AFL) asking hospitals to immediately complete a statewide resources survey on surge capacity. The AFL also reminds hospitals to contact their Medical Heath Operational Area Coordination (MHOAC) with resource requests related to COVID-19.

Details on requesting licensed out-of-state health care personnel: Requests should be made to the Emergency Medical Services Authority (EMSA), and should include documentation that the health care provider is requesting additional practitioners; a roster of names with demographics and licenses; and attestations that the practitioners are licensed and in good standing. EMSA anticipates putting out a policy and template for requests this week.

See more


March 5:  

  • Next CDPH Call: March 10, 8-9 am: 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.

Other Developments:

  • CDC updates persons under investigation criteria: Today, the CDC expanded its criteria for who can be tested to a wider group of symptomatic patients based on clinical judgment.
     
  • Cal/OSHA posts interim guidance on use of N95 respirator supplies: Cal/OSHA has posted interim guidance and FAQs about the efficient use of N95 respirator supplies, allowing for the use of expired N95 respirators per NIOSH guidance, with some additional requirements.
     
  • State health and emergency officials ramp up response: As the spread of COVID-19 — the disease caused by novel coronavirus — continues worldwide, the state of California on March 2 announced a broad series of new actions designed to protect public health and safety. On March 3, the state announced it would release some of the 21 million expired N95 respirators currently held in reserves.
     
  • CDC posts community transmission guidance: Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States 
     
  • Options for screening outside the emergency department (ED): The Centers for Medicare & Medicaid Services issued a memo in 2009 (in the context of the H1N1 virus) about options under EMTALA for screening outside the ED. The memo concludes that EMTALA is not a barrier to hospitals setting up screening tents near their EDs or encouraging patients to go to off-site screening locations, as long as the off-site screening is voluntary. 
     
  • Recap of CDPH call with providers: CDPH hosted a call for health care providers on March 3, including state-specific status updates. See details here. CDPH will send call-in information through the California Health Alert Network.
     
  • CDC updates persons under investigation criteria: Today, the CDC expanded its criteria for who can be tested to a wider group of symptomatic patients based on clinical judgment.
     
  • Cal/OSHA posts interim guidance on use of N95 respirator supplies: Cal/OSHA has posted interim guidance and FAQs about the efficient use of N95 respirator supplies, allowing for the use of expired N95 respirators per NIOSH guidance, with some additional requirements.
     
  • State health and emergency officials ramp up response: As the spread of COVID-19 — the disease caused by novel coronavirus — continues worldwide, the state of California on March 2 announced a broad series of new actions designed to protect public health and safety. On March 3, the state announced it would release some of the 21 million expired N95 respirators currently held in reserves.
     
  • CDC posts community transmission guidance: Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States 
     
  • Options for screening outside the emergency department (ED): The Centers for Medicare & Medicaid Services issued a memo in 2009 (in the context of the H1N1 virus) about options under EMTALA for screening outside the ED. The memo concludes that EMTALA is not a barrier to hospitals setting up screening tents near their EDs or encouraging patients to go to off-site screening locations, as long as the off-site screening is voluntary. 
     
  • Recap of CDPH call with providers: CDPH hosted a call for health care providers on March 3, including state-specific status updates. See details here.

February 27:

The California Department of Public Health (CDPH) announced on Feb 26 that the Centers for Disease Control and Prevention hasconfirmed the first case of possible person-to-person transmission of novel coronavirus among the general public in the U.S. has been diagnosed in California. The individual is a resident of Solano County and is receiving medical care in Sacramento County. The individual had no known exposure to the virus through travel or close contact with a known infected individual.


February 26:  

CHA has coordinated with CDPH to host regular calls with hospitals and has created a web page as a repository for information. The next call is scheduled for March 3rd at 7:45 am. Call information will be sent by CDPH through the California Health Alert Network. Hospitals that would like to pose questions in advance and anonymously can send them to questionsforcdph@calhospital.org. 

CDC has issued an update discussing potential for community transmission, released a travel notice, published a checklist for hospitals to assess their preparedness for coronavirus and distributed strategies for optimizing N95 respirator supplies


For more information Go to CHA’s Coronavirus Watch webpage.

Commands