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To help the hospital gift shop community navigate through the unique challenges presented by COVID-19, i3 POS is hosting a free one-hour webinar this Thursday, April 16, at 8 a.m. (PT).

A panel of six retail industry leaders will address current concerns, including: 

What do I do with the Easter merchandise I was unable to sell?
What can I do to help keep my volunteers engaged?
Should I do something special when the shop is able to reopen?

This post has been archived and contains information that may be out of date.

How long does it take for COVID-19 symptoms to appear after exposure to the virus, and what symptoms should I look for?

The Centers for Disease Control and Prevention has updated its list of COVID-19 symptoms, broadening the range from mild to severe illness. In recent guidance, the California Department of Public Health identifies the symptoms in two categories: 1) symptoms — such as cough, shortness of breath, fever, chills, muscle pain, sore throat, and new loss of taste or smell, and 2) emergency warning signs — such as trouble breathing, persistent pain or pressure in the chest, new confusion, or bluish lips or face ­— that require medical attention immediately. (5/13)

I am interested in contributing my time and expertise within my hospital community. What volunteer opportunities are available?

Many California hospitals have suspended their volunteer programs. Until hospitals begin accepting new volunteers, here are some ways you can make a difference:

Sign up with California Volunteers: Governor Gavin Newsom launched the #CaliforniansForAll program to encourage Californians to help their communities during the pandemic.
Donate blood: Healthy individuals are encouraged to contact the American Red Cross to schedule an appointment.
Deliver meals: Meals on Wheels organizations throughout your community are seeking individuals to deliver food to vulnerable seniors.  
Donate to and/or volunteer at your local food bank (5/1)

I’m sick and think I might have coronavirus. What should I do?

Stay home, as most people who are mildly ill with COVID-19 can recover at home. Do not leave, except to get medical care. Be sure to get care if you have trouble breathing, have any other emergency warning signs, or if you think it is an emergency. If you need to call 911, notify the operator that you have or think you might have COVID-19.  As much as possible, stay in a specific room and away from other people and pets in your home. If possible, you should use a separate bathroom. If you need to be around other people or animals in or outside of the home, wear a cloth face covering. Cover your coughs and sneezes. Wash your hands often. And clean high-touch surfaces frequently. Follow care instructions from your health care provider. More information from the CDC. (7/20)

If I have symptoms of COVID-19, should I get tested?

The California Department of Public Health recommends first prioritizing testing of hospitalized individuals with signs or symptoms of COVID-19 infection followed by testing of other symptomatic individuals and higher risk asymptomatic individuals and then other asymptomatic individuals when certain conditions exist. (7/20)

I don’t have coronavirus, but I have another health care need. Who should I call?

If you are feeling sick with flu-like symptoms, please first call your doctor, a nurse hotline, or an urgent care center. If you need to go to the hospital, call ahead so they can prepare for your arrival. If you need to call 911, tell the 911 operator the exact symptoms you are experiencing so the ambulance provider can prepare to treat you safely.

Hospitals have implemented a variety of new safety measures to keep non-COVID and COVID patients from coming into contact. If you’re in need of care, especially for pre-existing or chronic conditions that need follow-up attention, please don’t hesitate to seek it in the appropriate care setting. Delaying care could put you at a higher risk for complications later on.

If possible, health care visits should be done remotely. Contact your health care provider to see what services they are providing through telehealth. More information on the Director of the California Department of Public Health’s stay home order.  (5/12)

What resources are available for family caregivers? 

The American Association of Retired Persons (AARP) has posted to its website a number of resources for family caregivers, including items dealing with COVID-19. AARP is also conducting weekly town hall on this topic.   

The Family Caregiver Alliance has posted several articles and resources to its website, including monthly livestream educational topics that have tips for caregivers about COVID-19, as well as podcasts and multilingual short video caregiving tips and infographics on Facebook, YouTube, and Twitter. (4/9)

What if I can’t work because I’m ill with COVID-19 or caring for a family member?

In California, if you’re unable to work due to having or being exposed to COVID-19 (certified by a medical professional), you can file a Disability Insurance claim. If you’re caring for an ill or quarantined family member with COVID-19 (certified by a medical professional) you can file a Paid Family Leave claim.

To learn more about what to do if you think you’re sick, tips for staying healthy and protecting your family, details on health insurance coverage of different types, and more, here are the COVID-19 websites for these entities:  (4/9)

State of California 
Centers for Disease Control and Prevention
California Department of Public Health
World Health Organization
California Department of Health Care Services
California Employment Development Department

What do I do if my hospital is running out of space in the morgue?

You can try to lease appropriate storage space, although it is in short supply in many parts of the state. You can also call your county coroner or medical examiner. The county coroner or medical examiner has the ability to request help from the California Governor’s Office of Emergency Services if necessary. (4/9)

Can funeral homes/mortuaries refuse to accept the bodies of those who died of COVID-19?

The existing state and federal guidance does not support funeral homes, mortuaries, or death care workers refusing to accept the bodies of those who died of COVID-19. Rather, the existing state and federal guidance provides that death care workers need only follow routine infection prevention and control precautions. Read more  (4/9)

How can I find out what sources of federal funding are available to my hospital during this time?

See CHA’s summary of the CARES Act Provider Relief Fund and overview of additional federal funding opportunities. (12/22) 

How can hospitals access the $175 in federal funding authorized under the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act?

The U.S. Department of Health and Human Services (HHS) has automatically distributed funding to hospitals via two rounds of general allocations – totaling $50 billion – and several targeted allocations. As of July, HHS has announced targeted allocations for hospitals in high-impact COVID-19 areas, safety-net hospitals, rural hospitals, rural health clinics, and other hospitals that serve rural communities, skilled-nursing facilities, and Medicaid and CHIP providers. As of September, approximately $50 billion of the $175 billion remains unallocated. Additional information on how the allocations were distributed is available in CHA’s summary of the Provider Relief Fund.  CHA continues to advocate for a balanced, fair, and inclusive distribution of the remaining Provider Relief Funds for hospitals that have been left out of previous distributions. (12/22)

What steps must hospitals take to attest to receipt of Provider Relief Funds, and what are the reporting requirements to document how the funds are spent?

Within 90 days of receiving a payment from the Provider Relief Fund, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The CARES Act Provider Relief Fund Payment Attestation Portal is open, and providers should review the terms and conditions for various distributions. According to the CARES Act, the funds may be used for building or construction of temporary structures; leasing of properties, medical supplies and equipment, personal protective equipment and testing supplies; increased workforce and training; emergency operation centers; retrofitting facilities; and surge capacity.

Recipients that received one or more payments exceeding $10,000 in the aggregate from the Provider Relief Fund will be required to submit reports to HHS on how the funds have been expended. On September 19, HHS published a notice providing additional details on reporting requirements. This notice includes the categories of data elements that recipients must submit for calendar years 2019 and 2020, and is a supporting document to its post-payment notice of reporting requirements published in August. HHS states that the reporting system will be available in early 2021.

HHS also states that if recipients do not expend PRF funds in full by the end of calendar year 2020, they will have an additional six months in which to use remaining amounts toward expenses attributable to COVID-19 but not reimbursed by other sources, or to apply toward lost revenues in an amount not to exceed the 2019 net gain. The reporting requirements apply for all distributions except the Nursing Home Infection Control and Rural Health Clinic Testing distributions, for which separate reporting requirements will be announced. The reporting requirements also do not apply to reimbursement from the Health Resources and Services Administration (HRSA) Uninsured Program, but HHS noted that additional reporting may be announced in the future for these payments.

Notably, CHA is aware that HHS’ September 19 notice includes revised definitions for determining “lost revenues” that may require many hospitals to return PRF funds at a significant loss. CHA is advocating with our national and state association colleagues to ensure that HHS reverts to previous guidance on defining lost revenues as detailed in a June 2020 FAQ. 

For more information, view HHS’ responses to frequently asked questions. (9/30)

Who can I contact if I have questions about my Provider Relief Fund payments?

HHS has established the CARES Act Provider Hotline at (866) 569-3522. (7/22)

Has HHS provided data on how much money each hospital has received?

HHS has provided data, including state-by-state breakdowns and hospital-specific distribution information, on many of its Provider Relief Fund distributions. (7/22)

Are these funds specifically for hospitals that have treated COVID-19 positive patients, or will all hospitals receive some funds?

The emergency funds are available to all Medicare or Medicaid enrolled providers and suppliers that provide diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. The emergency funds must compensate providers for health care-related expenses or lost revenue directly attributable to COVID-19 and not reimbursed from other sources. (4/12)

Did the CARES Act increase Medicare payments to hospitals? 

The CARES Act includes a number of provisions that will increase payments for hospitals caring for Medicare patients, including the elimination of the 2% sequestration cut from May 1 to December 31, 2020, a 20% add-on payment to the DRG rate for patients with COVID-19 at rural and urban IPPS hospitals, and expanded options for the Medicare accelerated payment program for children’s hospitals, cancer hospitals, and critical access hospitals. CMS has published guidance to hospitals on implementation of the 20% add-on payment. On May 11, CMS provided additional guidance on how this applies to payments made by Medicare Advantage plans. (7/22)

I’m worried that given the nationwide crisis, $175 billion will be insufficient. Are there plans for additional funding support for hospitals in the future? 

CHA will continue to work with congressional leadership and the delegation to address the growing needs of California’s health care delivery system. (4/12)

How can hospitals seek reimbursement for providing care to uninsured patients with COVID-19?

Health care providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after February 4, 2020, can request claims reimbursement through the COVID-19 Uninsured Program electronically and will be reimbursed generally at Medicare rates, subject to available funding. To participate, providers should register with the COVID-19 Uninsured Program Portal. Both CHA and HRSA have developed comprehensive FAQs on this topic. (7/23)

Are there other channels for hospitals to request funding to purchase PPE?

The Federal Emergency Management Agency Public Assistance Program is a grant program that may assist nonprofit hospitals and health systems in covering 75% of the cost of emergency protective measures. (4/12)

Can hospitals receive accelerated or advanced payments from Medicare to assist with cash flow while elective and other procedures are on hold?

The CARES Act authorized inpatient acute care, critical access, children’s, and cancer hospitals to request up to six months of accelerated payments, based on historical payment amounts. Other providers, including long-term care hospitals, inpatient rehabilitation facilities, and inpatient psychiatric facilities, can request up to three months of advanced payments. Hospitals should contact Noridian – California’s Medicare administrative contractor – to apply for these funds. However, on April 26, CMS announced it will suspend and reevaluate the Accelerated and Advanced Payment programs in light of the funding provided by the CARES Act and subsequent legislation. (4/29)

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)

What can be done if a supply shipment is delayed at a point of entry?

If a shipment of COVID-19 supplies, such as personal protective equipment (PPE) or test kits, is held up at a port of entry, please contact the Food and Drug Administration office covering your port of entry or email COVID19FDAImportInquiries@fda.hhs.gov with the entry number, port of entry, and other shipment details. More information is available here. (4/22)

I’m running low on PPE. Are there any recommendations for prioritizing its use or decontaminating and reusing them?

Yes, the CDC has issued detailed strategies for optimizing supplies of eye protection, isolation gowns, face masks, and N95 respirators.

In addition, the Food and Drug Administration (FDA) has issued emergency use authorization for various mask and respirator decontamination systems. In early June, the FDA reissued emergency use authorizations that revise policy on the types of N95 respirators that can be decontaminated for reuse. Per the CDC, use of respirators that have been decontaminated should be reserved as a crisis strategy. 

The California Department of Public Health (CDPH) has collaborated with Battelle Memorial Institute to deploy its FDA-authorized emergency use decontamination system in California. The Battelle method, a vaporous hydrogen peroxide system, received FDA authorization March 29, although as noted above, the respirators that may be used with this system may have changed. Participation in the program is free to hospitals. The federal government is paying for the cleaning and system, and the state is paying for the shipping costs to and from the decontamination sites.  For details about participating, see the information packet, infographic on the sign-up process, and sample service agreement. Signed service agreements and questions can be directed to Jon Cartlidge at cartlidgej@battelle.org.  (6/11)

Are there other channels for hospitals to request funding to purchase PPE?

The Federal Emergency Management Agency Public Assistance Program is a grant program that may assist nonprofit hospitals and health systems in covering 75% of the cost of emergency protective measures. (4/12)

We’ve heard a lot about various companies and organizations offering to donate supplies. Who can we contact to potentially access those donations?

The best way is to request them through the Medical and Health Operational Area (MHOAC) Coordinator Program. See CHA’s Resource Request page for instructions on requesting supplies through MHOAC. (4/9)

Can I request pharmaceuticals or other supplies from the Strategic National Stockpile?

Yes. Hospitals need only attempt to first secure resources on their own and then, if unable to secure what they need, contact their county MHOAC Program for any resource (PPE, equipment and supplies, personnel, pharmaceuticals, acute care transfer, beds, transportation, etc.). They do not need to choose how the MHOAC can fulfill that request, such as through the Strategic National Stockpile. See CHA’s Resource Request page for instructions on how to request items through the MHOAC Program. (4/9)

One of our suppliers has suddenly tripled its prices. Is that legal?

Price gouging is illegal, and the California Attorney General is conducting surveillance on potential price gouging in the marketplace for medical supplies and other goods and services being sold to hospitals, health care providers, and others. If you have information or leads that you would like to share, please contact the California Department of Justice at oag.ca.gov/report.

In addition, the U.S. Department of Justice and the U.S. Department of Health and Human Services are aggressively pursuing cases to prevent the hoarding or price gouging of medical supplies and drugs essential to combat COVID-19, as well as other fraud related to the pandemic. If you have been the target or victim of price gouging, or are aware of the hoarding of essential medical supplies or drugs necessary to fight the virus, please report it to the National Center for Disaster Fraud Hotline at (866) 720-5721 or via email at disaster@leo.gov. For more information, visit www.justice.gov/coronavirus. (4/12)

What are the requirements for testing skilled-nursing facility (SNF) residents?  

SNFs are required to include a plan for resident and staff testing as one of the elements in a facility-specific COVID-19 mitigation plan. CDPH has issued recommendations for ongoing baseline, surveillance, and response-driven testing for SNFs to prevent spread of infection. (7/22)

At my acute care hospital, we have several Medicare patients who need continued care at a skilled nursing level, but there are no local SNFs willing to admit patients, due to the public health emergency. Is there a way we can continue to provide the necessary care and get reimbursed? 

Yes. On May 20, The Centers for Medicare & Medicaid Services issued a blanket waiver to allow acute care hospitals, excluding inpatient psychiatric hospitals and long-term care hospitals, to establish swing beds to provide skilled nursing care for hospitalized patients who don’t need continued acute care but cannot transition to a SNF during the COVID-19 public health emergency. Hospitals establishing swing bed SNF services will receive reimbursement via the SNF prospective payment system. Noridian, the Medicare administrative contractor for most California hospitals, has provided additional provider education and outreach on this matter.  (5/28)

Our hospital has a patient who no longer needs acute care. We gave her the “Important Message from Medicare,” and she has not appealed the discharge decision. However, she refuses to consent to the skilled-nursing facility placement we secured. What can we do?

During the COVID-19 pandemic, many statutes and regulations regarding discharge planning and consent for transfer have been waived. Read more

What personal protective equipment (PPE) should be provided to employees working in 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. 

Do SNFs have to report cases to COVID-19?

Yes, SNFs are required to report communicable diseases, health care-associated infections, and potential outbreaks to state and local health departments. CDPH has released All Facilities Letter 20-43 requesting that SNFs provide, via an online survey, a daily report of staffing levels, the number of COVID-19 residents — including confirmed positive and suspected residents — equipment availability, and other facility needs.  Additionally, beginning July 20, SNFs are required to submit the results of required COVID-19 surveillance or response driven testing data to the CDPH on a weekly basis.  (7/22)

What should I do if I become aware of an unsafe situation in a skilled-nursing facility? 

Contact the District Office for the CDPH Licensing and Certification Program. Contact information for district offices is located here. (4/20)  

What is the impact of recent CMS waivers on discharge planning and patient determination of their post-acute care destination?

CMS has waived certain aspects of the discharge planning process, most notably the requirement that hospitals provide a patient in need of post-acute care services a complete list of certified providers in their area, and the requirement to use and share data on quality and resource use measures. (4/20)

Is there a waiver for the inpatient rehabilitation facility “3-hour rule?”    

Yes. During the COVID-19 public health emergency, the Coronavirus Aid, Relief, and Economic Security Act waives the provision generally required for payment — that patients of an inpatient rehabilitation facility receive at least 15 hours of therapy per week. 

Can patients with COVID-19 be discharged to SNFs?

Yes, as long the appropriate level of transmission-based precautions can be maintained. The Centers for Disease Control and Prevention (CDC) has provided interim guidance on discontinuing transmission-based precautions and disposition of patients with COVID-19 in health care settings. If a patient is being discharged to a SNF and transmission-based precautions are still required, they should go to a facility that is able to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19 residents.

CDPH has also issued interim guidance for transfer and continuity of care of residents with suspected or confirmed COVID-19 infection, including admission of COVID-19-positive residents following hospitalization who still need transmission-based precautions. Unless otherwise directed, hospital personnel must consult with their local health department when discharging a COVID-19-positive patient from the hospital to a SNF.  (7/22)

Can patients under investigation (PUIs) be discharged to a SNF?

No. CDPH guidance states that PUIs with test results pending should not be transferred to SNFs until the results are available. Investigated patients with negative test results may be transferred from hospitals to SNFs following usual procedures.

Can SNFs require testing for all admissions from the hospital?

Recent CDPH  guidance recommends that all SNF residents be tested prior to admission or readmission. If the transferring hospital does not test the patient, the SNF must test and quarantine upon admission. While CDPH guidance states that hospitals are not required to perform COVID-19 testing on patients solely for discharge considerations, acute care hospitals may choose to, in order to facilitate care coordination and SNF admission. (6/11)

Should SNFs send residents to the hospital emergency department for testing?

No. If clinically stable, residents with suspected or confirmed COVID-19 should remain at the SNF with appropriate infection prevention and control measures. According to CDPH, residents with suspected or confirmed COVID-19 should be transferred to hospital emergency departments only when clinically indicated.

Can SNFs require that a new admission receive negative tests prior to admission?    

No.  Test results on asymptomatic individuals for the purposes of SNF discharge do not necessarily have to be available at the time of SNF transfer, since all newly admitted residents will be placed in the SNFs quarantine/observation area for 14 days since the date of their last potential exposure.  For SARS-CoV-2 positive individuals, facilities should use the symptoms or time-based strategy for discontinuing isolation and transition-based precautions.  Additional information can be found in AFL 20-87.

Multiple SNFs in my regions are closed to admissions, so I am unable to find a placement for my patients who need a SNF

CDPH has asked that hospitals of SNFs that encounter difficulty in transitioning new or returning resident from an acute care hospital to a SNF based on a COVID-19-related admission hold contact their local health department or the healthcare associated infections program of CDPH for review of the admission and decision and suggestions for next steps.   Additional information can be found in AFL 20-87. 

Has CMS expanded the availability of respiratory-related devices and oxygen services during this public health emergency?

Yes, in CMS’ recent interim final rule, the agency removed coverage restrictions that limited access to respiratory-related devices and oxygen services to Medicare beneficiaries with certain clinical characteristics. During the public health emergency, Medicare will cover equipment such as non-invasive ventilators multi-function ventilators, respiratory assist devices, continuous positive airway pressure devices – as well as oxygen services – for any medical reason as determined by a clinician.  (4/7)

What federal waivers are available for inpatient rehabilitation facilities, skilled-nursing facilities, home health agencies and hospices, and long-term care hospitals?

Federal legislative and regulatory action has included several important provisions affecting inpatient rehabilitation facilities, home health agencies and hospices, SNFs, and long-term care hospitals. As the crisis continues and additional areas emerge, additional waivers may be forthcoming. To read more about each type of facility, see: (4/7)

 Inpatient Rehabilitation Facilities     
Home Health Agencies
Hospice     
Skilled-Nursing Facilities 
Long-Term Care Hospitals