Coronavirus Response Newsletter

Transition Continues to Blue Shield Vaccinator Network

As previously announced, the state of California has contracted with Blue Shield of California to create a statewide network of COVID-19 vaccine providers. A hospital, clinic, pharmacy, or other entity that wishes to administer COVID-19 vaccines after March 31 must sign an agreement with Blue Shield. The contract, which Blue Shield states is now final, requires vaccine providers to:

  • Vaccinate any resident of California, regardless of ability to pay and regardless of whether there is any previously existing patient relationship
  • Bill the patient’s insurer or applicable government program (not Blue Shield or the patient) for the vaccine administration fee, if any
  • Report vaccine administration data within 24 hours in the My Turn reporting tool and other technology platforms required by the state and the Centers for Disease Control and Prevention (such as VaccineFinder and CAIR2) or through an approved electronic health record (EHR) interface
  • Use My Turn to schedule vaccination appointments. Vaccinators can use the My Turn clinic scheduling feature or, for vaccine providers with an industry standard and certified EHR system (such as Epic or Cerner), by using an interface currently under development to connect these EHR scheduling modules to My Turn

After March 31, only entities contracting with Blue Shield will receive first dose allocations. Blue Shield hopes to have all contracts signed by March 22 but will sign on new vaccinators, if and where needed, on an ongoing basis. Providers interested in joining the network should contact Blue Shield at [email protected].

Both the state of California and Blue Shield have stated that all vaccinators will receive second doses, including those that choose not to become a part of the Blue Shield network. However, neither current vaccinators nor providers that sign a contract with Blue Shield are guaranteed any particular number of first doses. Blue Shield and the state will consider many factors when allocating doses to providers, such as health equity considerations, populations that are prioritized, local disease burden, and vaccinator performance.

To date, Blue Shield has focused on bringing larger hospitals and health systems into its network, as well as some hospitals and primary care clinics in Wave 1 and Wave 2 counties. Starting March 7, it will begin engaging with providers in Wave 3 counties. A list of these waves is available on page 11 of this slide deck. Blue Shield is also working with county health departments to identify other vaccinators with which Blue Shield will contract directly.

After March 31, counties will not receive vaccines to allocate to subcontractors; instead, vaccinators that formerly received doses from their county must sign a contract with Blue Shield if they wish to continue administering vaccines. Health departments must also join the Blue Shield network if they wish to remain vaccinators. To fill any gaps in its network, Blue Shield has contracted with Optum Serve to stand up mobile or pop-up sites.

Effective March 31, all appointment scheduling will be done through My Turn. Patients will register online with My Turn or by calling a Blue Shield call center. They will self-attest to any factors the state identifies to determine vaccine priority. These patient data will be fed into an algorithm developed by Blue Shield to determine who receives a vaccine appointment. At this time, the state intends that 70% of first doses will go to individuals age 65 and older, and the other 30% to individuals in the educational, childcare, emergency services, and food and agriculture sectors. Vaccinators will not be responsible for ensuring that the vaccine is allocated this way — the state will achieve this through the doses it allocates or the My Turn system.

The state and Blue Shield have provided information about the statewide vaccination network in a slide deck and a webinar recording.

CHA Sends Letter to State on Preparations in the Event of Another Surge

On Feb. 26, CHA sent a letter to Health and Human Services Secretary Mark Ghaly on surge preparations. The letter seeks to continue to partner, assess lessons learned, and resolve unfinished business that must be addressed in the event of another surge. Specifically, it makes five recommendations:

  1. Align the Governor’s state of emergency with the federal public health emergency (PHE). The U.S. Department of Health and Human Services (HHS) has stated the PHE will last through 2021 and that it will provide 60 days’ advance notice before ending it.
  2. Conform the timeframe for the space flexibilities established by the California Department of Public Health (CDPH) in All Facilities Letter 20-26.6 to the PHE, as well.
  3. Address when nursing supply is not enough to meet patient demand. The letter states a goal of reaching a shared understanding of the combination of strategies to be used if hospitals experience future staffing shortages.
  4. Obtain operational patient movement guidance from the Emergency Medical Services Authority (EMSA).  
  5. Work together to ensure that any future need to temporarily suspend non-essential services will not delay outpatient surgeries, which does not contribute to inpatient capacity.

CHA will work through these issues with leaders from the California Health and Human Services Agency and its departments, CDPH and EMSA.

HHS Directs Providers to Order Antibody Therapies from Distributor

HHS has announced that the monoclonal antibody therapy bamlanivimab and antibody cocktail casirivimab/imdevimab will no longer be allocated to health departments. Health care providers should order directly from AmerisourceBergen Corporation, the drugs’ sole distributor. The federal government will continue to monitor all direct orders — which remain free of charge to requesting sites — and retains the capacity to resume allocation of these and future therapies if needed. 

CDPH reports that California currently has a sufficient supply of monoclonal antibodies for all providers that request them. If more is needed, providers should contact their county’s Medical and Health Operational Area Coordinators, who can then facilitate re-allocation of existing supply. Medical directors or other authorized prescribers at skilled-nursing facilities (SNFs) and Programs of All-inclusive Care for the Elderly (PACE) which contract with specialty pharmacies receiving state allocations can order monoclonal product. For these providers, the pharmacy would prepare the product and send to the nursing facility or PACE program for infusion.

CDPH Updates Information on Regulatory Enforcement of SNFs

In All Facilities Letter (AFL) 20-32.2, CDPH provides updated information on regulatory enforcement of specified SNF requirements during the current public health emergency. Specifically, the AFL extends the waiver for change of service, space use, and increase in capacity until June 1 and rescinds all temporary COVID-19 staffing waivers, effective March 1. 

CMS Extends Limited Survey Activity

On Jan. 20, the Centers for Medicare & Medicaid Services posted a memo limiting federal survey activity by CDPH and other state survey agencies to immediate jeopardy allegations, with some exceptions. The original expiration date of Feb. 20 has been extended to March 22.

Pfizer Updates Vaccine Fact Sheets

On Feb.25, Pfizer updated its fact sheets for vaccine providers and recipients. The Provider Fact Sheet was revised to add an option for frozen storage and transportation at higher temperatures, as well as information about pregnancy risk and adverse effect experience. The Recipient Fact Sheet was revised to add the potential for severe as well as non-severe allergic reactions such as rash, itching, hives, or swelling of the face. Vaccinators must give vaccine recipients the updated Recipient Fact Sheet.

Next CDPH Office Hours: March 5

CDPH will hold a COVID-19 Vaccination Office Hours call for hospitals and other providers on March 5 from 9 to 10 a.m. (PT). To participate, visit this link.

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

Dial: (844) 721-7239  

Passcode: 7993227 

Recent Media Coverage

Below are recent news stories on vaccines, variants, and behavioral health:

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.