Clinical Care

About Clinical Care

California’s hospitals are dedicated to providing high-quality, safe, and person-centered health care. This wouldn’t be possible without the clinical services hospitals provide, which include emergency care, surgery, X-ray/radiology, laboratory services, and behavioral health care. The care that hospitals provide is shaped by their communities’ needs.

Federal, State Updates in Response to LA Fires

This page provides the latest information on federal and state actions regarding the Los Angeles fires. The resources and information about official actions can help your hospital respond to the fires and continue to treat patients.

If you have any questions, contact Trina Gonzalez, Vice President, Policy at tgonzalez@calhospital.org.

Federal

  • Blanket Waivers from CMS – Includes wavier of the SNF 3-day acute care stay requirement, other space/environment, medical staff, and telehealth waivers. Hospitals do not need to make requests to CMS to avail themselves to blanket waivers
  • Noridian Response to California Wildfire PHE – Includes instructions for use of mandatory disaster modifiers for Medicare claims impacted by PHE and provider enrollment relief
  • Public Health Emergency – Declaration to Aid California Health Care Response
  • Medicare waivers/flexibilities – CMS has established a portal for facilities to apply for 1135 waivers of certain Medicare Conditions of Participation and certification, as well as flexibilities that help ensure patient access to care during a disaster. A sample request would be a waiver of the skilled nursing facility three-day prior hospitalization requirements.
  • Waivers of Sanctions under the Physician Self-Referral Law during Emergencies
  • Limited Waiver of HIPAA Sanctions and Penalties During a Declared Emergency: 2025 Public Health Emergency for California in Response to Wildfires and Straight-Line Winds
  • State

  • Department of Health Care Services (DHCS) – DHCS has set up a site dedicated to the LA fires for Medi-Cal enrollees, plans, and providers. Facility flexibilities and other waivers from DHCS will be continuously updated on this site.
  • EMSA has released instructions on the approval process and procedures for health care facilities
  • DMHC Resource Guide – This includes language from the guidance DMHC sent last week and phone numbers and website links for the plans that are operating in the affected area.
  • Health Plans – All Plan Letter: Enrollees’ Continued Access to Health Care
  • Pharmacy – Waiver of standard practices, waiver of staffing ratio provisions, waiver related to remote processing, waiver related to the delivery of provisions
  • First Executive Order – CHA summary and guidance on governor’s first executive order
  • IV Solution Shortage Resources

    CHA has compiled the following federal, state, and local resources to assist hospitals in navigating the current IV solution shortage:

    State

  • California Board of Pharmacy | Temporary Provisions for Compounding Certain Parenteral Drug Products | October 16, 2024
  • California Department of Public Health | All-Facilities Letter 24-24: Intravenous (IV) Solution Shortage due to Hurricane Helene | October 9, 2024
  • Federal

  • U.S. Department of Health and Human Services | Fact Sheet: HHS Continues Taking Action to Increase Access and Supply of IV Fluids Following Hurricane Helene | October 18, 2024
  • Centers for Disease Control and Prevention | Health Advisory 518: Disruptions in Availability of Peritoneal Dialysis and Intravenous Solutions from Baxter International Facility in North Carolina | October 12, 2024
  • U.S. Department of Health and Human Services | Fact Sheet: Biden-Harris Administration Takes Action to Ensure Americans Can Access Medical Supplies Following Hurricanes Helene and Milton | October 11, 2024
  • U.S. Department of Health and Human Services | Letter to Health Care Leaders and Stakeholders on Impacts of Hurricane Helene from Secretary Becerra | October 9, 2024
  • American Hospital Association | Letter to Biden Administration Urging Action to Address IV Solution Supply Shortage | October 7, 2024
  • American Hospital Association | Special Bulletin: HHS, Baxter Announce Additional Mitigation Efforts to Increase Access, Supply of IV Fluids | October 18, 2024
  • American Hospital Association | Special Bulletin: Baxter Provides Updates on Efforts to Increase Access to and Supply of IV Solutions | October 24, 2024
  • American Hospital Association | Special Bulletin: Baxter Announces Expiration Dating Extensions for Certain Products Related to IV Solutions Disruption | October 28, 2024
  • Clinical Guidance

  • Food & Drug Administration | Temporary Policies for Compounding Certain Parenteral Drug Products | October 11, 2024
  • Baxter | Recommendations for Management and Conservation Measures & List of Impacted Supplies
  • Vizient | Product Disruption Brief | October 10, 2024
  • Vizient | Adult/Pediatric IV Push Medication Reference | October 7, 2024
  • American Society of Health System Pharmacists | Fluid Shortages – Suggestions for Management and Conservation | October 4, 2024
  • Healthcare Ready | Situation Overview | October 3, 2024
  • Baxter | Product Allocation Letter | October 1, 2024
  • American Society of Health System Pharmacists | Guidelines on Managing Drug Product Shortages
  • Situational Updates

  • American Hospital Association | 8 of 10 Baxter manufacturing lines restarted | December 20, 2024
  • Baxter | Hurricane Helene Updates | Last updated December 19, 2024
  • American Hospital Association | Baxter restores additional IV solutions production lines | December 10, 2024
  • American Hospital Association | Shortage of Empty IV Bags Expected to Last Through March | December 4, 2024
  • American Hospital Association | Increased Allocations for Certain IV Products | December 2, 2024
  • Baxter | Expiration Dating Extension to 24 Months | November 8, 2024
  • Food & Drug Administration | Hurricane Helene: Baxter’s manufacturing recovery in North Carolina | Last updated November 8, 2024
  • American Hospital Association | Updates on IV Fluid Supplies After Helene Forces Closure of Baxter Manufacturing Plant | Last updated October, 28, 2024
  • Healthcare Ready | 2024 Baxter Plant Alert Hub | September 30, 2024
  • Healthcare Ready | 2024 Hurricane Helene Alert Hub | September 25, 2024
  • 2025 Emergency Services Forum

    Join us for the 2025 Emergency Services Forum, returning to beautiful Newport Beach! This conference is dedicated to the uniqueness of hospital ED management and its intersection with emergency services and the community. We’re finalizing an exceptional lineup of speakers and engaging topics. The 2024 Emergency Services Forum sold out – this is an event you and your colleagues don’t want to miss! 

    AHA Survey on 340B Rebate Model Closes Jan. 10

    What’s happening: The American Hospital Association (AHA) is asking hospitals to complete a survey by Jan. 10 to help it understand how a 340B rebate model would impact 340B member hospitals. 

    What else to know: Completing this 10-question survey will help AHA understand the financial, operational, and patient impacts that a rebate model — such as the one Johnson & Johnson sought to implement this year — would have on your hospital or health system.  

    Liver Transplant Saves Infant’s Life

    After being diagnosed with biliary atresia, infant Mia received a liver transplant from Children’s Hospital Los Angeles and is now back to achieving infant milestones like playing with toys and using her big voice.

    CMS Memos Clarify Policies for Providers, State Survey Agencies

    What’s happening: In four new memos, the Centers for Medicare & Medicaid Services (CMS) clarifies survey policies for critical access hospitals (CAHs), long-term care facilities (LTC), and laboratories.  

    What else you need to know: New and revised guidance addresses time-share and leased space arrangements in CAHs, immediate jeopardy in laboratories, and LTC policies.  

    DEA, HHS Extend Telehealth Prescribing Flexibilities

    What’s happening: The U.S. Drug Enforcement Administration (DEA) and federal Department of Health and Human Services (HHS) extended existing waiver flexibilities for prescribing controlled substances via telemedicine through Dec. 31, 2025. 

    What else to know: This is the third extension.  

    Baxter Announces Expiration Dating Extensions for Certain Products Related to IV Solutions Disruption

    As part of its efforts to mitigate the disruption to the supply of IV solutions after Hurricane Helene temporarily closed its North Cove, N.C., manufacturing plant, Baxter today said that it is now authorized by the Food and Drug Administration (FDA) to extend the use date of some products to provide a 24-month expiration from the manufacture date without relabeling the products. In a letter to customers today, Baxter said the extended expiration date is based on Baxter’s submission to the FDA including container closure integrity data, container functional performance data, and an analysis of product weight loss profiles for those certain product codes.

    CHA Releases Resource Web Page for Nationwide IV Fluid Shortage

    What’s happening: As hospitals and other health care providers nationally grapple with the shortage of IV fluids following the temporary closure of Baxter International’s manufacturing plant in Marion, N.C., CHA has compiled federal, state, and local resources to assist hospitals. 

    What else to know: Hurricane Helene hit the southeast in early October, causing widespread damage, including the temporary closure of Baxter’s plant — which, pre-Hurricane, manufactured 60% of the nation’s supply of IV solutions, producing 1.5 million bags per day.