State Health Order on Hospital Surge Released
The State Health Order, released by the California Department of Public Health (CDPH) Jan. 5 and amended Jan. 6, is in effect through at least Jan. 26 and unless rescinded, primarily does two things:
- In Section 1, delays Tier 1 (low acuity) and Tier 2 (intermediate acuity) elective surgical procedures (exempting children’s hospitals) for counties experiencing less than 10% ICU capacity in regions with 0% ICU capacity. This is a measure that many hospitals in highly affected areas have already undertaken to accommodate the massive influx of COVID-19 patients. However, the State Health Order only includes one set of criteria by which hospitals can determine which procedures to postpone, and that is the Tier 1, 2, and 3 framework of the Elective Surgical Acuity Scale. CHA is seeking clarifications from CDPH about other considerations hospitals can use in making these decisions, including clinical judgment and impact on hospital inpatient capacity.
- Allows the state to direct the transfer of patients, requiring hospitals to accept transfers from hospitals in crisis care “when capable and clinically appropriate.” While well-intended, CHA has concerns that shifting patients during a pandemic will not address the underlying capacity issues that are hitting in so many areas right now. The remaining Sections 2, 3, and 4 of the order are about patient transfers. These apply to all hospitals in California.
Currently, hospitals located within scope of the order for Section 1 (on elective surgical procedures, hospitals in crisis care) of the State Health Order are:
- In the San Joaquin Valley Region: Fresno, Kern, Kings, Madera, Merced, San Benito, San Joaquin, and Stanislaus counties
- In the Southern California Region: Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego counties and — as of Jan. 8 — Santa Barbara and Ventura counties (CDPH to issue press release).
To be within scope, a county must be in a region with 0% ICU capacity and be in a county with less than 10% ICU capacity. Region ICU data are posted here. CHA has asked CDPH to publicly post its calculations of ICU percent capacities by county so hospitals can plan and know when they will be affected.
State Issues Recommendations to Accelerate Safe Vaccine Administration Statewide
On Jan. 7, CDPH issued recommendations to maximize COVID-19 vaccine administration and reduce the potential for vaccine waste. According to the recommendations, “local health departments and providers should immediately administer COVID-19 vaccines to individuals in all tiers of Phase 1a.” The recommendations further encourage providers offering vaccines to consider partnering with other providers or organizations to provide vaccinations for individuals in the prioritized tiers.
The recommendations encourage that special efforts be made to administer the vaccine to vaccinators. CDPH also clarified that local health departments and providers may allocate doses on the assumption that immunization will be accepted by some, but not all, of those who are offered it, and then continue to offer vaccinations to all individuals in progressive priority tiers. Finally, if a county has maximized use of the vaccine to administer to individuals in Phase 1a, it should move to Phase 1b, Tier 1 while continuing to offer vaccines to those in higher priority groups.
DMHC Issues All Plan Letters in Response to Public Health Order
On Jan. 6, the Department of Managed Health Care (DMHC) released All Plan Letters (APL) 21-003 and 21-004 in response to the public health order issued and amended earlier this week by CDPH. This accompanies the State Health Order described above. APL 21-003 states that health plans may not prevent or delay the transfer of a plan enrollee pursuant to the order. The APL directs health plans to cover the medically necessary costs associated with the transfer and states that plans may not require prior authorization on a hospital’s transfer of plan enrollees under the order.
APL 21-004 is a reminder to plans of their continuing obligations to cover emergency services and care provided to enrollees and that such coverage includes reimbursement for appropriate transfers of unstable enrollees between hospitals in conformance with the requirements of the federal Emergency Medical Treatment and Labor Act. More details about both APLs are available on CHA’s website.
HHS Renews Public Health Emergency
On Jan. 7, the U.S. Department of Health and Human Services (HHS) formally renewed the COVID-19 public health emergency declaration, effective Jan. 21, for 90 days.
Revised Travel Advisory Clarifies Quarantine Requirements for Health Care Staff
CDPH has revised its travel advisory for individuals entering or returning to California from another state or country. The updated advisory clarifies that those who are needed to meet urgent critical health care staffing needs or to otherwise engage in emergency response do not need to quarantine. CHA had identified to CDPH that the travel advisory did not make this explicit, and given the staff coming in from other states and potentially countries wanted to make clear they do not need to quarantine.
CDPH, DHCS Issue Updates on Acute Hospital Care at Home
CDPH and the Department of Health Care Services (DHCS) have issued additional information and guidance for hospitals that are interested in participating in the Acute Hospital Care at Home program.
The Centers for Medicare & Medicaid Services (CMS) recently introduced a provider waiver for this program, expanding on its Hospital Without Walls waiver to provide regulatory flexibility for hospitals to treat patients in locations outside the hospital, including their homes.
CDPH has issued All Facilities Letter (AFL) 20-90, explaining that general acute care hospitals (GACH) seeking to provide acute hospital care at home services must also meet applicable GACH licensing requirements and obtain approval for appropriate program flexibilities from CDPH. DHCS has announced that Medi-Cal will reimburse participating hospitals for acute inpatient care in both fee-for-service and managed care for Medi-Cal beneficiaries. See CHA’s website for additional information.
AHA Tools Help Hospitals Plan, Communicate, Administer Vaccinations
The American Hospital Association (AHA) has developed several new resources on vaccine planning and administration for hospitals and health systems, as well as public-facing educational campaigns. These include:
- Advocacy: A letter that AHA sent to HHS asking for more federal leadership on vaccine rollout.
- New Ad Council Public Service Announcement: The Ad Council launched an AHA-supported COVID-19 Vaccine Education Effort, a multichannel campaign with four videos, several of which feature AHA Board Chair Melinda Estes, M.D. In addition to the Ad Council-developed videos, hospitals and health systems have access to a host of downloadable materials.
- New Toolkit: The Society for Healthcare Strategy and Market Development members developed a new communications toolkit to guide hospitals and health systems through the steps involved in planning, designing, and executing a vaccine communications plan and campaign.
- #MyWhy: A social media campaign that amplifies health care workers’ voices on the importance of getting vaccinated.
- AHA Vaccine Website: Developed in coordination with the Centers for Disease Control and Prevention (CDC), the site features a vaccine candidate scorecard, a vaccine primer, CDC’s communications and distribution resources, and an allocation framework.
CA Notify App Tracks COVID-19 Exposure
Last month, the state launched an app called CA Notify that is designed to quickly notify individuals when they’ve been in sustained contact (per CDC guidelines) with someone who tested positive for COVID-19. To assist hospitals and other partners in communicating about the new exposure notification tool, CDPH has developed this toolkit, which includes handouts in multiple languages, videos, and banners for social media platforms. Additionally, CHA hosted a webinar to explain the app and its benefits on Dec. 9; a recording of that webinar is also available.
Surge-Related Data Resources
- State Resources: Monitor the regional stay home order and ICU capacity by region or by county.
- CHA Resource: Hospitals can access county dashboards through the CHA COVID-19 Tracking Tool, which includes hospital-specific data on ICU capacity.
Next CDPH Call for Health Care Facilities: Jan. 12, 8-9 a.m. (PT)
Dial: (844) 721-7239
Summary of Jan. 5 CDPH Call
CDPH has provided a summary of its recent weekly call with health care facilities.