The newsroom includes access to CHA News, which provides timely information to members every Monday and Thursday and is at the core of CHA benefits. In addition, it is also home to resources such as toolkits and talking points designed to help member hospitals and health systems communicate with internal and external audiences on a range of current health care-related issues. Links to CHA media statements and press releases can also be found here.
A travel alert recently issued by the Centers for Disease Control and Prevention notifies providers of recent cases of surgical site infections in U.S. residents who underwent invasive medical procedures in Tijuana, Mexico.
Most cases were associated with bariatric surgery, and half of the impacted patients had surgery performed at the Grand View Hospital; this hospital has since been closed by the Mexican government. No cases have been reported in California to date. However, providers should be vigilant for the possibility of resistant infections in patients.
The Emergency Medical Services Authority (EMSA) is in the process of updating its Statewide Trauma System Triage and Transfer Resource Guide. The draft guide incorporates feedback from a previous comment period in 2017. Due to the time elapsed since then, EMSA has offered another comment period.
CHA will submit comments; members who wish to contribute should contact BJ Bartleson, CHA vice president, nursing and clinical services, by Feb. 8. Comments are due to EMSA by Feb. 17. For more information, visit the EMSA website.
Last week, CHA shared information about problems some providers have had in implementing a new state law requiring controlled substance security prescription forms to include a unique serial number. This week, the California Board of Pharmacy released updated frequently asked questions about the law’s requirements and enforcement.
CHA submitted the attached comment letter responding to the Centers for Medicare & Medicaid Services’ (CMS) proposed rule that would change managed care regulations for Medicaid and the Children’s Health Insurance Program (CHIP). While most of the rule’s proposals are technical adjustments or changes that have little impact on the Medi-Cal managed care program, some could impact the managed care portion of the Hospital Fee Program.
With that in mind, CHA urges CMS to:
- Consider multi-year approvals for directed payment programs structured like the Private Hospital Directed Payment Program.
- Provide greater flexibility with the network provider requirement as it relates to the directed payment programs.
- Build upon existing network adequacy standards instead of expanding flexibility unnecessarily.
As of Jan. 1, controlled substance security prescription forms must include a new, unique serial number in a format approved by the Department of Justice. However, the new requirement does not allow for a transition period during which providers would be allowed to use the previously approved form, and those who do not have access to the new forms have been forced to choose between denying care and risking action against their licenses.
The new law was enacted as part of a comprehensive bill package to address the opioid crisis.
To mitigate the issues prescribers are experiencing during the transition, the California Board of Pharmacy has recommended that no enforcement action be taken before July 1. In its letter outlining this recommendation, the board also provided several alternatives pharmacists may consider if the required form is not available. Further, Assemblymember Evan Low, the law’s author, has requested that the Department of Justice issue regulations delaying implementation of the requirement until issues can be resolved.
More information is available in a notice from the Medical Board of California and a joint statement from the medical board, pharmacy board and justice department. Hospitals that have questions should direct them to BJ Bartleson, CHA’s vice president, nursing and clinical services.
Prescribers are now required to offer naloxone hydrochloride, or another drug approved by the Food and Drug Administration, to patients who experience certain conditions related to opioid depression. The Medical Board of California has released frequently asked questions to assist providers in implementing the new requirements, which took effect Jan. 1.
In All Facilities Letter 18-57, the California Department of Public Health announces a new web-based data collection tool intended to assist providers that participate in the Palliative Care Pilot Program with annual reporting. Program participants must submit certain information using this tool by Jan. 1 of each program year. 2018 reports were due Jan. 1, 2019, but the online reporting portal will remain open through March 1.
Yesterday, Gov. Newsom released his first proposed state budget, totaling $209 billion for 2019-20. CHA was pleased to see health care as a primary focus of the budget. Other clear priorities are early childhood development, housing and paying down debt.
This year’s budget is an increase over last year’s, using some of the state’s estimated $21 billion surplus to lay the groundwork for future program expansion. At the same time, Newsom directed much of the surplus to paying off debts — including payments toward pensions — and reversing borrowing gimmicks used during the recession.
“The message we are advancing here is discipline, building a strong foundation on which everything else can be built,” Newsom said. His extensive knowledge of and interest in the budget were clear as he took questions from reporters at a nearly two-hour press conference.
Key health-related investments in Newsom’s budget are:
Mental Health Leadership Position: Support for a statewide mental health leadership position that can bring to bear a breadth of resources and focus on a long-standing and pervasive health concern. In the coming weeks, the Governor will release more details about the new mental health czar position. In addition, he will appoint a new Brain Health Task Force.
Expanded Coverage: $260 million to expand full-scope Medi-Cal eligibility to all income-eligible young adults, ages 19-25, regardless of immigration status. Estimated to include 138,000 new enrollees.
Increased and Expanded Premium Subsidies: Increased and expanded subsidies to individuals and families insured through Covered California with incomes between 250 and 400 percent of the federal poverty level, with additional subsidies for people whose income falls between 400 and 600 percent of the federal poverty level.
Individual Mandate: Would require all Californians to obtain health coverage.
Medi-Cal Clinician Reimbursements: $3.2 billion, an increase of $900 million over last year, to extend the Proposition 56 tobacco tax fund supplemental provider payments to physicians, dentists, home health and other providers. This investment includes $360 million for a new program to encourage Medi-Cal managed care in-network physicians to meet goals in critical areas such as chronic disease management and behavioral health integration.
Whole Person Care Pilots: $100 million for the Whole Person Care Pilot program for supportive housing and the coordination of health, behavioral health and social services for people with mental illness.
Workforce Investments: $50 million for mental health workforce development and training programs, and $33 million in ongoing funding beginning in 2020-21 to continue the support of health care workforce programs that began in the 2017 budget.
Graduate Medical Education Funding: Approximately $40 million in funding from the Proposition 56 tobacco tax fund to University of California for graduate medical education. Administered by UC, this funding is to expand the number of residencies in California and is available to all accredited programs. In previous budgets, UC’s funding was decreased by the same amount, but that is not the case in this year’s budget.
Key health care reforms in the budget include:
Medi-Cal Prescription Drugs: As mentioned in the Executive Order the Governor released earlier in the week, the budget creates a single-purchaser system for prescription drugs by requiring the Department of Health Care Services (DHCS) to purchase and negotiate the pricing of all prescription drugs under Medi-Cal for all Medi-Cal beneficiaries. This will require Medi-Cal managed care pharmacy services to be transitioned to a fee-for-service benefit. CHA has requested more information about the proposal from DHCS to understand how it might affect the 340B drug program, and will actively engage with the Department and stakeholders on its development.
Surgeon General: Establishes a California Surgeon General to provide leadership in addressing root causes of serious health conditions, such as adverse childhood experiences and the social determinants of health.
In addition, the Governor proposes nearly $2 billion in spending on kindergarten and child care facilities, as well as home visits and parental aid. He also calls for a $500 earned income tax credit bonus for families with children younger than six, additional Cal Grant aid and paid family leave up to six months. He proposes a fund for safe drinking water, as well as major incentives designed to spur housing construction in California.
Newsom’s budget adds approximately $3 billion in permanent budget growth, but would require billions more in future spending to carry out much of his vision. Many of his proposals will take three or more years to accomplish.
Like his predecessor Jerry Brown, he believes the state may soon be “overdue for a correction” in today’s booming economy.
“We’re going to be sober and honest about how much we can do,” he commented.
In the next few weeks, the Governor will release more details on many of his budget proposals. Over the next several months, budget subcommittees will hold hearings on different aspects of the budget, and CHA will have an opportunity to weigh in on issues.
In mid-May the Governor will release a revised budget plan reflecting the most up-to-date revenue and expenditure information, as well as changes to budget proposals. The budget must to be finalized by June 15.
The Centers for Medicare & Medicaid Services (CMS) has issued a notice increasing fees for laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA) by 20 percent.
CMS says that the increase — the first in 20 years — is necessary to continue to pay for the general expenses of administering the CLIA program. While the fee increase was effective Dec. 28, 2018, CMS is seeking public comment on the methodology used to determine the new fees. Comments on the notice are due March 1. Additional information is available in a CMS fact sheet.
The House of Representatives on Wednesday passed legislation (H.R. 269) that includes the Pandemic and All-Hazards Preparedness and Advancing Innovation Act. The measure reauthorized the Hospital Preparedness Program (HPP) at an increased amount, including reserving a percentage of HPP funds for the purpose of developing regional health care emergency preparedness and response systems. CHA supports the measure and is hopeful that the Senate will act soon.