Coronavirus

About Coronavirus

As California’s hospitals continue their life-saving work during the COVID-19 pandemic, the hospital associations continue to advocate on behalf of hospitals and their patients, in addition to offering these tools and resources:

Coronavirus Response Newsletter

Provider Relief Fund Reporting Requirements AnnouncedThe U.S. Department of Health and Human Services has issued detailed reporting requirements for recipients of more than $10,000 in Provider Relief Funds for health care-related expenses or lost revenues attributable to COVID-19. The reporting requirements apply to all distributions except nursing home infection control, rural health clinic testing, and payments under […]

Coronavirus Response Newsletter

CDPH Describes Hospital Surge Monitoring Visits, Other Survey ActivityThe California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 20-69, which outlines the survey activities the department will conduct for both hospitals and skilled-nursing facilities. 

Coronavirus Response Newsletter

County Re-openings Begin This WeekCounty re-openings began this week, with new criteria for both loosening and tightening restrictions, based on what has been learned about how COVID-19 spreads. Effective Aug. 31, the state is using a four-tiered designation — widespread, substantial, moderate, and minimal — to determine the level of reopening indoor businesses within each […]

CMS Addresses Questions on Cost Reports and Provider Relief Fund Payments

The Centers for Medicare & Medicaid Services (CMS) has revised its COVID-19 frequently asked questions (FAQs) on Medicare fee-for-service billing to address questions related to the Coronavirus Aid, Relief, and Economic Security Act Provider Relief Fund and the Small Business Administration’s (SBA) Paycheck Protection Program payments.

COVID-19 Data Reporting to Become a Medicare Condition of Participation

The Centers for Medicare & Medicaid Services (CMS) has issued an interim final rule revising regulatory requirements related to the COVID-19 public health emergency. Among the provisions finalized, CMS establishes new requirements in the hospital and critical access hospital Conditions of Participation that require hospitals to report certain COVID-19-related data elements to the Department of Health and Human Services (HHS) on a daily basis.

FAQs: Face Coverings

How does the state’s face covering order impact hospital patients and visitors?

The face covering order requires Californians to wear face coverings when they are obtaining services from the health care sector in settings including, but not limited to, a hospital, pharmacy, medical clinic, laboratory, physician or dental office, veterinary clinic, or blood bank, unless directed otherwise by an employee or healthcare provider.

COVID-19 FAQs: Employee Safety

What are the requirements for taking the temperature of individuals, especially staff, entering the hospital?

The Centers for Medicare & Medicaid Services is revising the Focused Infection Control survey tool  to align with recent updates from the Centers for Disease Control and Prevention (CDC) related to screening and triage of those entering health care facilities. Hospitals should have a screening process to assess for signs/symptoms consistent with COVID-19 and for exposure to others with known or suspected COVID-19. CDC recommendations include but are not limited to screening questions with an assessment of illness, self-monitored pre-arrival temperature checks with reported absence of fever and symptoms, and facility-monitored temperature checks upon arrival.

CDC notes that, “although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals with SARS-CoV-2 infection, symptom screening remains an important strategy to identify those who could have COVID-19, so appropriate precautions can be implemented.” Hospitals are encouraged to review CDC’s updated infection prevention and control recommendations when developing or revising their screening policies and procedures. (1/21/21)

What personal protective equipment (PPE) should be provided to employees working in skilled-nursing facilities (SNFs)?

Cal/OSHA’s Aerosol Transmissible Disease Standard applies to SNFs and specifies what PPE is appropriate in a variety of circumstances. Cal/OSHA has developed specific guidance for SNFs and has indicated it intends to focus more attention on these workplaces. (4/22)

What are the rules around when a possibly exposed but asymptomatic health care worker can continue to work and when a symptomatic health care worker can return to work?

Health care workers who are asymptomatic but have been exposed to a known or suspected COVID-19 positive patient can continue to work during this period of emergency, subject to infection control precautions, according to the Governor’s Executive Order of March 15. The Centers for Disease Control and Prevention (CDC) has issued guidance based on the exposure risk. With respect to health care workers who have COVID-19 symptoms, whether they have been tested or not, CDC guidance provides two methods for determining when they can return to work. (4/9)

My hospital received a notice of complaint from the Division of Occupational Safety and Health alleging that my hospital is violating the Cal/OSHA Aerosol Transmissible Disease Standard due to my respirator conservation strategies. What are my options for respirator use and conservation given the continuing shortage? 

On Aug. 6, Cal/OSHA released updated guidance on COVID-19 for Health Care Facilities: Severe Respirator Supply Shortages, which modifies the earlier June 12 guidance in three significant ways:

It does not include the extended re-use strategy whereby an employee is provided five or seven N95s that are rotated in use under specified conditions.
While it allows hospitals to continue to disinfect N95s, it requires hospitals to store them for “future shortages.”
It does not include the option for hospitals to provide facemasks for routine care of COVID-19 patients or persons under investigation. (Read more)  (8/13)

On May 6, the Governor issued an Executive Order creating a rebuttable presumption in the workers’ compensation system for COVID-19 claims. That order expired on July 5. What does that mean for my hospital’s workers compensation program?

The Governor’s Executive Order N-62-20 implemented a presumption in the workers’ compensation system that expired on July 5. On September 17, the Governor signed Senate Bill  (SB) 1159, which creates several different presumptions based on job roles or worksites.

The law, which took effect immediately, adopts a COVID-19 specific presumption in the workers’ compensation system for employees that test positive for COVID-19. It is retroactive to July 6, 2020 and expires on January 1, 2023.  

The Division of Workers Compensation has issued FAQs, and CHA believes will be issuing emergency regulations as well. CHA has developed an on-demand educational video that reviews the law.

The law does four things:

Codifies the Governor’s Executive Order that created a presumption in the workers’ compensation system, from March 19 – July 5 for employees who were required to leave their home for work during the stay-at-home order
Creates a presumption in the workers’ compensation system for fire, police, and hospital employees
Creates a presumption in the workers’ compensation system for employees working in other workplaces that experience an “outbreak”
Requires the Commission on Health and Safety and Workers’ Compensation to evaluate the impact of these presumptions on the workers’ compensation system.   (9/22)

COVID-19 FAQs: Human Resources

CHA has compiled a comprehensive list of FAQs related to general employment, labor relations, and furlough and layoff issues; the American Hospital Association has prepared a summary of federal legislation employers should know about. Other commonly asked questions are below. ​

What are the requirements of AB 2537, the PPE stockpile bill? 

CHA has developed these frequently asked questions to assist hospitals with implementation. (12/29)

Are there any resources to assist hospitals in implementing AB 685, the law that requires employers to provide notice to employees about possible exposure to COVID-19 in the workplace?

CHA has two resources: a toolkit developed that includes a sample employee notice, and an on-demand educational video that provides an overview of the new law. (12/18)

Some hospital employees want to stay at a hotel, concerned about exposing their family members to the virus. Are there any resources for that?

Yes. These resources offer free or discounted rooms for exposed or COVID-19-positive health care workers: (12/11)

The Non-Congregate Sheltering for California Healthcare Workers Program provides hotel rooms to front-line health care workers who are exposed to or test positive for COVID-19 and do not have the ability to self-isolate or quarantine at home. The cost is covered by the federal or state government. 

For an employee to qualify for the program, the employing hospital must have a certification letter on file with the Office of Emergency Services (OES). The certification letter is referenced in the April 20 California Department of Public Health All Facilities Letter. If a hospital has not yet submitted a certification letter, it may do so at any time. Once that letter is on file, the hospital does not need to submit another one. The letter should be sent by email to the California Department of General Services at [email protected], in addition to sending to OES at [email protected] 
Effective January 12, 2021, the program is making a major change to the reservation process. To meet the criteria established by the Hotels for Healthcare Workers (HFHCW) program, all certified health care facilities are required to assign a designated point of contact to assist and oversee the reservation process; to serve as the approver for all lodging reservations, and to submit and/or approve all hotel reservation requests. As of January 12, the points of contact are the only individuals who can submit and approve reservation requests. The facility point of contact is expected to respond promptly, preferably within 24 hours, to approve or reject each hotel reservation request if contacted by CalTravelStore or Department of General Services staff. Failure to do so may result in delays and/or a lapse in the reservation.
Health care facilities can identify as many points of contact as they deem necessary. Additional details are here. Please submit the name, job title, email address and telephone number for your facility point(s) of contact to [email protected] no later than December 31, 2020, using the subject line “FACILITY POC for (enter facility name).” Health systems are encouraged to designate multiple individuals as points of contact.
While employees will still be able to call CalTravelStore to request a hotel reservation, the facility point of contact will be contacted by email and/or telephone to approve or reject each reservation request.
Finally, current hospital contracts expire at the end of 2020. The state is in the process of renewing contracts and has indicated that several hotels are electing not to renew the contract. If a hospital has a relationship with a hotel that is interested in participating in the statewide travel program, the hotel should contact Kelly Bouchard, statewide program manager, at [email protected] or (916) 376-399. The state’s sourcing team will follow up by sending to the hotel a Request for Proposal (RFP). Upon review and acceptance of the hotel’s proposal by the state, the hotel may participate in the program and will be reimbursed by the state according to the terms and conditions of the RFP.

The program is authorized on a monthly basis, and authorization for the following month may not occur until the last day of the preceding month — making it difficult to determine how long the program will continue. If you have any questions about the program, contact Hospital Association of Southern California Regional Vice President Teri Hollingsworth.

2.  The American Hospital Association has provided this list of hotels, airlines, and food service companies that are offering discounts or complementary services for health care workers. Note, however, that not all hotels within a group are participating in the discount program.

Our staff needs help with childcare. What resources are available?

The California Childcare Resource and Referral Center California Child Care Resource & Referral Network has created a list of available resources and contacts. Additionally, all levels of government are working on childcare solutions for health care workers, with several available resources. Read more  (7/15)

On May 6, the Governor issued an Executive Order creating a rebuttable presumption in the workers’ compensation system for COVID-19 claims. That order expired on July 5. What does that mean for my hospital’s workers compensation program?

The Governor’s Executive Order N-62-20 implemented a presumption in the workers’ compensation system that expired on July 5. On September 17, the Governor signed Senate Bill  (SB) 1159, which creates several different presumptions based on job roles or worksites.

The law, which took effect immediately, adopts a COVID-19 specific presumption in the workers’ compensation system for employees that test positive for COVID-19. It is retroactive to July 6, 2020 and expires on January 1, 2023.  

The Division of Workers Compensation has issued FAQs, and CHA believes will be issuing emergency regulations as well. CHA has developed an on-demand educational video that reviews the law.

The law does four things:

Codifies the Governor’s Executive Order that created a presumption in the workers’ compensation system, from March 19 – July 5 for employees who were required to leave their home for work during the stay-at-home order
Creates a presumption in the workers’ compensation system for fire, police, and hospital employees
Creates a presumption in the workers’ compensation system for employees working in other workplaces that experience an “outbreak”
Requires the Commission on Health and Safety and Workers’ Compensation to evaluate the impact of these presumptions on the workers’ compensation system.   (9/22)

I am concerned about the emotional well-being of my staff. Are there resources beyond my Employee Assistance Program benefits?​

The Hospital Quality Institute’s “Care for the Caregiver” webinar is now available as an on-demand recording. The webinar includes practical and necessary tools to assist hospitals and their employees in creating a peer support model for adverse events such as the COVID-19 pandemic. Additionally, the training offers information on how to engage in empathic conversation with both patients and families. More information and the recording are available here.

Various associations representing California’s licensed mental health professionals have joined together to provide support to health professionals, first responders, and essential workers on the front lines fighting the COVID pandemic. On this website, health care workers can locate licensed providers who are offering services for free during the crisis.

In addition, behavioral health professionals in the Bay Area have created a pro bono project for Bay Area front-line health care workers. The COVID-19 Pro Bono Counseling Project is a project devoted to helping health care workers locate free convenient short-term psychotherapy during the COVID19 crisis. For more information, email [email protected] A short video on the program is also available. (7/14)

Are there any resources to help hospitals understand the Paycheck Protection Program in the CARES Act?

The American Hospital Association hosted a webinar to explain this new law, which provides forgivable loans when the funds are used for payroll and other allowable costs.

In March, the federal government passed the Families First Coronavirus Response Act, which contains two leave provisions. Does this law apply in California since we have our own leave laws and, if so, what am I required to provide?  

Yes, the act applies to California employers with fewer than 500 employees and all public employers. It went into effect on April 1.  However, the law contains an optional exemption for health care providers. The Department of Labor originally adopted emergency regulations that created a very broad definition of “health care provider” to include anyone who works in a hospital or other facility related to health care. However, on August 3, a federal judge concluded the department exceeded its authority in applying such a broad definition and invalidated that portion of the regulations.  Read more (9/16)

Has there been any change to the California meal and rest period rules?

Not specifically. However, with the waiver of the nurse-to-patient ratios in CDPH AFL 20-26, the ratios, including the “at all times” requirement is no longer in place, so hospitals have a bit more flexibility with regard to meal and rest period coverage. Hospitals with represented employees, however, should review their collective bargaining agreements to determine if they address this issue. (4/9)

Many counties have been issuing shelter-in-place orders over the past few weeks and on March 19, the Governor issued an Executive Order that required most people in California to shelter in place. Does this apply to hospital and other health care workers? Can I require them to come to work?

The Governor’s Executive Order allowed individuals needed to maintain continuity of operations of critical infrastructure to be able to travel to work. Health care is a critical infrastructure, but the Executive Order did not address whether some individuals were deemed essential to support health care while others may be non-essential. The following day, the Governor issued a list of “essential critical infrastructure workers.” In the health care sector, the definition of “essential” workers is broad. We understand that some hospital staff are being stopped by law enforcement on their way to work and that their hospital badge may not be sufficient to demonstrate that they are critical infrastructure staff.  CHA is working with the CalChamber to find a solution that will allow all essential critical infrastructure employees to travel easily to work.  (4/9)  

I understand some cities and counties are developing expanded sick leave ordinances. Do they apply to hospitals and health systems?

There are a number of proposals across the state, and each has its own provisions related to health care workers. Current local ordinances include the cities of Los Angeles, San Jose, San Francisco, Oakland, Long Beach, Sacramento, San Mateo, Santa Rosa, and Emeryville, as well as Los Angeles County. (7/16)

Complying with all aspects of California Labor law is challenging during the best of times. Am I expected to comply right now as my hospital is faced with preparing and responding to the COVID-19 pandemic?

To date, the Governor’s Executive Orders have not relaxed any provisions of California Labor Code or the wage orders. CHA, along with CalChamber, appreciates the operational realities of complying with California’s hundreds of employment laws and are strategizing on ways to limit liability. We will keep hospitals posted about any developments. ​(4/9)

I may have to lay off staff. Does California’s Worker Adjustment and Retraining Notification (WARN) Act still apply?

Only parts of the California WARN Act apply.  On March 17, the Governor issued an Executive Order suspending many aspects of the California WARN Act. The executive order suspends, starting March 4, 2020, Labor Code Sections 1402(a), 1402, and 1403 for an employer that orders a mass layoff, relocation, or termination at a covered establishment. Certain conditions apply: Read more (4/9)

FAQs: Telehealth

Can a hospital provide telehealth services using out-of-state physicians who are not licensed in California?

Yes, during the COVID-19 emergency the state Emergency Medical Services Authority has set up a quick process for hospitals to be able to use health care practitioners licensed in other states. For details, go to https://emsa.ca.gov/covid19/ . (4/10)

Can hospitals bill Medicare for telehealth or other virtual services when provided to patients in their own homes?

CMS’s COVID-19 FAQs on Medicare Fee-for Service Billing provide responses to questions on when hospitals can bill Medicare for services provided to a patient in their home when the patient’s home has been made a provider based department of the hospital. (7/22)

Is there any federal guidance on how we can utilize telehealth services during this emergency?

Yes, the Centers for Medicare & Medicaid Services (CMS) has issued a fact sheet and frequently asked questions that provide guidance on how hospitals can use telehealth services under the Medicare program as a result of recently enacted legislation. In addition, CMS has prepared an FAQ on the use of telehealth by private health insurance plans. (4/10)

Where can I find information about telehealth services covered by health plans and insurers?

Both the Department of Managed Health Care and the Department of Insurance have issued guidance directing health plans and insurers to provide increased access to telehealth services during the COVID-19 emergency. (4/10)

Can hospitals use popular applications such as FaceTime, Skype, or Google Hangouts to provide telehealth services?

Yes, the federal Health and Human Services Office of Civil Rights has issued a notice of enforcement discretion announcing it will not impose penalties for noncompliance with HIPAA rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. However, public facing platforms such as Facebook Live, Twitch, TikTok, and similar video communication applications should not be used in the provision of telehealth by covered health care providers. (4/10)

Can providers from other states provide telehealth services to patients in California?

The federal government has waived requirements that physicians or other health care professionals hold licenses in the state in which they provide services for Medicare payment purposes — including for telehealth services — however, state law on licensure still applies. California’s Emergency Medical Services Authority has established a quick process for telehealth agencies and other entities, including hospitals, to obtain approval to use out-of-state personnel. (4/10) 

Can Medicare telehealth services only be provided to patients that have been seen within the past three years?

No, the Coronavirus Aid, Relief, and Economic Security (CARES) Act removed the restriction that telehealth services only be provided to established patients who have been seen by the clinician within the past three years. CMS had previously announced it would not enforce this requirement. (4/10)

Can providers in rural health clinics (RHCs) and federally qualified health clinics (FQHCs) provide Medicare telehealth services to patients outside of their clinics during this emergency?

Yes, the CARES Act removed “distant site” restrictions, allowing RHCs and FQHCs to receive Medicare payment for telehealth services delivered by a provider in their clinics to a patient outside of their clinic, including in their home. CMS guidance provides more information on payment and billing for telehealth services provided by RHCs and RQHCs. (4/20)

Can providers use telehealth to meet “face-to-face” encounter requirements?

For Medicare beneficiaries with end-stage renal disease who receive home dialysis, telehealth can be used for the monthly clinical assessment without first receiving the initial face-to-face clinical assessment and ongoing face-to-face assessments that would typically be required. In addition, telehealth visits with a physician or nurse practitioner can be used to satisfy face-to-face encounter requirements to recertify hospice care eligibility. (4/10)