Coronavirus Response Newsletter

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CDPH Issues AFLs on COVID-19 Staffing Flexibilities, State Cost-Sharing Program

In a positive development for hospitals, the California Department of Public Health (CDPH) has released two important All Facilities Letters (AFLs):

  • AFL 20-26.5 creates key administrative flexibilities, including on nursing documentation, for hospitals in regions with 0% ICU availability and in counties with 10% or less ICU capacity for the next 30 days. This will allow hospitals to focus on patients over paperwork. The AFL also standardizes future staffing ratio waivers to 60 days in length.
  • AFL 21-07 directs hospitals with temporary staffing waivers to maintain their efforts to return to required staffing levels. If hospitals seeking help with that effort choose to use a state staffing contract, they may now participate in the state’s cost-sharing program. 

State Ends Stay-At-Home Orders in All Regions

On Jan. 25, CDPH ended the regional stay-at-home orders for all regions statewide. Because case rates remain high across most of the state, the state’s hospital surge order remains in place to prevent hospitals from becoming overwhelmed. Lifting the regional orders allows all counties statewide to return to the rules and framework of the Blueprint for a Safer Economy and color-coded tiers that indicate which activities and businesses are open based on local case rates and test positivity. A majority of counties are in the strictest, or purple tier; counties can choose to impose stricter rules.

CDPH has stated that the recent administrative flexibilities in AFL 20-26.5 are still available to hospitals, even though it references the regional stay-at-home order that has been lifted, and that CDPH will be editing the AFL.

Governor Announces New Statewide Approach to Vaccinations

On Jan. 25, Gov. Newsom announced a unified statewide approach to vaccination administration and management intended to simplify and standardize the process. CHA issued a media statement affirming the state’s new approach and reiterating the need for a greater and more consistent vaccine supply from the federal government. Details of the state’s new approach include:

  • A single statewide standard for vaccine eligibility that will continue to vaccinate people 65 and over along with health care workers, and begin to prioritize emergency services, food and agricultural workers, and teachers and school staff
  • A unified statewide network to align the health care system, providers, and counties to ensure equitable and efficient vaccine distribution
  • A reallocation of vaccines from providers that have not used at least 65% of their available supply on hand for a week and have not submitted a plan to use it within four days of notice
  • statewide data platform that helps consumers sign up for and schedule vaccinations when it is their turn. The platform will also help certain providers automatically share data on vaccines received and administered to reduce data reporting lag time.

Additional information was released on Jan. 26 by the California Health and Human Services Agency and California Government Operations Agency.

CDPH Addresses Timely Vaccine Administration in Letter to Vaccine Providers, Local Health Officers

CDPH has notified local health officers and vaccine providers that CDPH and local health officers may recover unused COVID-19 vaccine from registered providers that have not used at least 65% of the vaccine in their possession for more than one week and have not submitted a plan to use it within four days of notice. The notice follows identification of a reporting gap in the volume of vaccine received in California and the number of vaccinations reported. The state plans to increase its California Immunization Registry workforce to help rectify the reporting issues and close the reporting gap. 

HHS Anticipates Public Health Emergency Will Last Through 2021

In a letter to governors dated Jan. 22, Acting Health and Human Services (HHS) Secretary Norris Cochran indicated the COVID-19 public health emergency will likely last through 2021. It was most recently renewed on Jan. 21, 2021, for an additional 90 days. For details about the financial support and regulatory flexibility to states and providers affected by the public health emergency, see the full CHA News article.

President Issues Executive Orders to Address Pandemic

On Jan. 20, President Biden issued two executive orders intended to address the COVID-19 pandemic — one that creates the role of a COVID-19 response coordinator to oversee the federal response to the COVID-19 pandemic, and one that requires face masks to be worn and physical distancing maintained in all federal buildings, on all federal lands, and by all federal employees (including members of the armed forces) and contractors.

On Jan. 21, the President issued additional executive orders and directives instructing various federal agencies to address the COVID-19 pandemic, including expanding testing and vaccination capacity, increasing personal protective equipment and other necessary materials to combat the pandemic, slowing the spread of COVID-19, and addressing inequitable outcomes. 

CMS Limits Hospital Survey Activity

The Centers for Medicare & Medicaid Services (CMS) has limited survey activity by accreditation organizations and state survey agencies (in California, CDPH). According to a Jan. 20 memo posted by CMS, hospital complaint surveys will be restricted to immediate jeopardy allegations, and recertification surveys will be suspended — with some exceptions to be announced in upcoming guidance. The restrictions on survey activity are in effect until Feb. 20, with potential for 30-day renewals. The memo also directs state survey agencies to contact CMS for information about additional flexibilities and assistance when their hospitals implement (or approach implementing) crisis standards of care.

Additional guidance on accreditation organizations is also forthcoming, which will describe a modified recertification survey process for a targeted sample of hospitals. CHA will provide additional information when available.

Behavioral Health Transfer and Discharge Resource for Hospital EDs

CHA has been working closely with the California Health and Human Services Agency, the Department of Health Care Services (DHCS), and the County Behavioral Health Directors Association (CBHDA) to find ways to assist and decompress hospital emergency departments (EDs) during the pandemic once an individual with a behavioral health condition is ready for discharge.  

CBHDA has reached out to its 58 county behavioral health director members to identify a primary/secondary contact for both mental health conditions and substance use disorders who can help facilitate ED discharges. The individuals in this spreadsheet can help coordinate ED transfers or referrals for any beneficiary who is uninsured or insured by Medi-Cal, and is a beneficiary of county behavioral health services. The spreadsheet includes the names, email addresses, phone numbers, and preferred method of communication for these county contacts.

Most — but not all — counties have identified individuals. As additional county contact information is gathered, the spreadsheet will be updated. Questions about this new resource can be directed to Sheree Lowe or BJ Bartleson.

DHCS Announces Flexibility on Medi-Cal IRF Requirements

DHCS has announced temporary regulatory flexibility for the amount of therapy required for Medi-Cal beneficiaries admitted for inpatient acute rehabilitation services, or 18 hours of therapy per week. During the public health emergency, inpatient rehabilitation facility days will be reviewed for consideration of authorization when therapy hours may not have met prior criteria. This flexibility is retroactive to March 18 and aligns with a Medicare waiver of the three hours per day guideline for the provision of an interdisciplinary program of intensive therapy services. More details are available in this CHA News article.

Recordings Available of CDPH Vaccination Calls; Next Call Jan. 29

CDPH has posted recordings and slides from its January office hours call and provider webinars on the Vaccination Program website. Links are also below:

CDPH continues to hold Friday office hours and webinars from 9 to 10 a.m. (PT), with the next one on Jan. 29. Visit this link to participate. CDPH distributes the link to enrolled COVID-19 vaccinators by email (from and posts them online to the Archived Communications portion of its Vaccination Program website.

Webinars Available to Assist Behavioral Health Providers

The Substance Abuse and Mental Health Services Administration provides regular training and technical assistance related to the COVID-19 impact on mental health and substance use disorders. Webinars and other provider resources address coping with the effects of widespread public health crises, improving services capability in response to COVID-19, specific guidance for clinicians, supporting communities as the COVID-19 crises evolve, and more.

Next CDPH Call for Health Care Facilities: Feb. 2, 8-9 a.m. (PT)  

Dial: (844) 721-7239  
Passcode: 7993227 

Summary of Jan. 19 CDPH Call

CDPH has provided a summary of its recent weekly call with health care facilities.

Media Highlights of Vaccine Coverage

See recent stories about California making changes to its vaccine eligibility framework and the latest on additional vaccine supply:

Surge-Related Data Resources

  • State Resources: Monitor ICU capacity by region or by county.
  • CHA Resources: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.