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Moderna Vaccine Shipments to Begin Today
In a Dec. 18 webinar for hospitals and other vaccinators, the California Department of Public Health (CDPH) indicated that it anticipates having 40% of the first doses needed to vaccinate Phase 1-A populations for California by Dec. 28. These total 1.2 million doses and are for the 3 million individuals who meet Phase 1-A criteria (front-line health care workers and long-term care residents). The 1.2 million doses are arriving in four tranches:
- Pfizer first shipment (scheduled to have arrived by Dec. 16): 327,600
- Moderna first shipment (scheduled to arrive Dec. 21-27): 672,600
- Pfizer Centers for Disease Control and Prevention Long-Term Care Partnership: 45,825
- Pfizer second shipment: 187,200
The first shipment of Moderna vaccines is scheduled to arrive today through Dec. 27 at hospitals, local health departments, and other vaccinators. Hospitals with questions about how much they are being allocated should contact their local health department, unless they have been designated as a multi-county entity by CDPH (for health systems with hospitals in three or more counties that agreed to be designated), in which case they should contact CDPH.
Pfizer COVID-19 Vaccine Vials May Contain Additional Doses
As the initial doses of the Pfizer COVID-19 vaccine were administered last week, immunizers observed additional volume in the five-dose vials. In an update to Pfizer COVID-19 vaccine recipients on Dec. 17, CDPH reiterated guidance from the Food and Drug Administration (FDA) from Dec. 16 that, given the public health emergency, the FDA is advising that there is the potential to obtain a sixth or seventh dose from each of the vials. To determine whether an additional dose can be obtained from a vial, the following should be considered:
- The remaining liquid in a vial must make up a full dose.
- Multiple vials should not be pooled to create an additional dose, as the product is preservative free.
Requesting a Program Flex to Implement Surge Standards of Nursing Documentation
Many hospitals have asked how they can request a program flex for nursing documentation. To do this, the hospital must complete CDPH Form 5000A and submit it to CHCQdutyofficer@cdph.ca.gov and copy the local CDPH District Office. CHA has developed instructions and sample language to help hospitals complete the form. Note that if a hospital needs CDPH to approve the request within eight hours, it should put the word “URGENT” in the email subject line. CHA is additionally advocating with CDPH to allow such a flex statewide; in the absence of that, hospitals may wish to request individual program flexes now.
AFL Addresses Transfers to Low-Acuity Alternate Care Sites
On Dec. 16, CDPH released All Facilities Letter (AFL) 20-48.3 on transferring patients to low-acuity alternate care sites. The state is currently operating alternate care sites in Sacramento, Fairview (Orange County), and Porterville (Tulare County).
While the AFL defines the alternate care sites and the process for transfers, it does not provide the specific admission criteria for the three locations. As of Dec. 17, the Emergency Medical Services Authority in Orange County has circulated admission criteria for Fairview, which is also being used for the other locations. However, for admission information, hospitals should contact the local Medical Health Operational Area Coordinator.
DMHC All Plan Letter Directs Health Plans to Support Hospitals
CHA continues to advocate with the Department of Managed Health Care (DMHC) for assistance with hospitals’ response to the pandemic, providing information to the department about what hospitals need, and the challenges they are facing. On Dec. 16, DMHC released All Plan Letter (APL) 20-042, which directs health plans to remove administrative barriers on hospitals during the COVID-19 surge, including taking immediate steps to reduce or remove hurdles to the efficient admission, transfer, and/or discharge of health plan enrollees. By Dec. 29 and again by Jan. 12, 2021, health plans must report to DMHC the steps they are taking to support hospitals in removing barriers to providing efficient care during this unprecedented time.
In April, CHA urged DMHC to direct health plans to remove administrative barriers, support providers by offering advanced payment programs, and resolve unpaid claims. As a result, the department released an APL asking plans to describe the actions they have taken to support providers. In light of the most recent surge of COVID-19 individuals needing hospital care, CHA identified a number of steps that DMHC could take. While this APL does not incorporate these requests, the information it will gather is a step in the right direction.
CDPH Rescinds Requirement for Hospice Prior Authorization During Public Health Emergency
CDPH has issued AFL 20-47.1, which provides updated information about the temporary suspension of regulatory enforcement of hospice requirement during the public health emergency. The AFL rescinds prior authorization to begin operations based solely on submission of an application and clarifies that a hospice provider seeking initial licensure must receive approval before providing care.
CHA Provides Summary of CMS Acute Hospital Care at Home Program
On Nov. 25, the Centers for Medicare & Medicaid Services (CMS) introduced the Acute Hospital Care at Home Program, significantly expanding the existing Hospital Without Walls waiver. Program details are available in a summary prepared by CHA.
CHA is in communication with CDPH about state policies and procedures for the establishment and oversight of the Acute Hospital Care at Home Program. CDPH reports it is reviewing the program and will issue an AFL in the near future.