HomeMy WebLinkAbout03.28.20 Email from Shari McCracken - Fw_ CACE Update_ March 27, 2020
From:McCracken, Shari
To:Alpert, Bruce;Bennett, Robin;Clerk of the Board;Connelly, Bill;Cook, Holly;Lambert, Steve;Lucero, Debra;
McCracken, Shari;Ring, Brian;Ritter, Tami;Rodas, Amalia;Sweeney, Kathleen;Teeter, Doug
Subject:Fw: CACE Update: March 27, 2020
Date:Saturday, March 28, 2020 11:38:35 AM
FYI - a great summary of multiple matters from my Association, CACE.
Governor Newsom Issues Statewide Eviction Moratorium
Today, Governor Newsom issued Executive Order N-37-20, establishing a statewide
moratorium on evictions. This action comes after more than 40 legislators asked the
Governor to do so and after he attempted to lift barriers to allow local governments to more
easily approve local tenant protections in a previous Executive Order (N-28-20).
The order takes effect immediately and applies through May 31. Landlords may not evict
tenants and courts and sheriffs are prohibited from enforcing eviction notices. Tenants must
declare in writing, within seven days of their rent coming due, that they cannot pay all or
part of the amount because they had to miss work, lost their jobs or had their hours cut
because of the pandemic and provide documentation that supports their claim. Renters
must repay the full amount due in "a timely manner" and could still be evicted after the
moratorium lifts.
Comprehensive Summary of Federal CARES Act
The National Association of Counties has issued a helpful summary of the Coronavirus Aid,
Relief, and Economic Security (CARES) Act. In addition to an executive summary along
with a section-by-section synopsis of the Act, the document also contains links to previous
federal actions taken in response to the pandemic since early March.
Judicial Council Calls Emergency Meeting to Approve Additional Measures to
Maintain Essential Court Operations; Governor Signs Executive Order
The Judicial Council announced this afternoon that it will convene a special teleconference
meeting tomorrow – Saturday, March 28 – at 12 noon to consider and approve action to
give the additional branch additional tools to respond to and operate during the COVID-19
outbreak.
Courts remain open as “essential services” under the statewide shelter-in-place order, and
the Chief Justice has already taken a number of steps to facilitate local court operations
while complying with social distancing directives and assuring the health and safety of
judicial officers and court staff. As outlined in the meeting agenda and materials, the council
will consider a range of actions, including extending certain court deadlines and expanding
the use of technology for remote proceedings, among others. Details for joining the meeting
and providing public comment can be found here.
In related news, the Governor just issued Executive Order N-38-20, which suspends
statutory limitations on the Chief Justice’s authority that would otherwise impede her in
managing the business of the branch during the period of the pandemic.
LAO Offers Update on Paid Leave for Workers Impacted by COVID-19
The Legislative Analyst’s Office posted a new update this afternoon on the federal paid
workers provisions of the Families First Coronavirus Response Act, which becomes
effective on April 1, 2020. This update covers two forms of paid leave, outlines how they
interact with other state benefit programs, and identifies issues for the Legislature to
consider in the context of the overall COVID-19 response.
S PECIAL H EALTH C ARE U PDATE
Public and private hospitals and health systems, community clinics, and other health care
providers are experiencing significant challenges during the COVID emergency. The
following provides an overview of the issues and discusses some of the resources that may
be available to help address these challenges.
Fiscal Impacts – As health care providers delay and cancel elective and non-emergent
procedures, they are seeing a decline in revenues. Many of the revenue generating
activities at hospitals have come to a near halt as they prepare for surge capacity. Clinics
and health centers are seeing a drop in primary care visits. Dental practices (that may be
operated by community clinics or county health systems) are closed for non-emergency
visits. With visits down 25-50 percent at Federally Qualified Health Centers and Rural
Health Centers, the clinic’s payment system, which relies on face-to-face encounters, is
being impacted. Both the California Hospital Association and the California Primary Care
Association are working with their members on estimating the fiscal impacts and losses as
they work with their state and federal partners to demonstrate the need for additional
resources.
Federal activities aimed to assist health care providers include:
General
$100 billion for the Public Health and Social Services Emergency Fund to reimburse
providers for expenses or lost revenue due to COVID-19. The Public Health and Social
Services Emergency Fund cannot be used to reimburse expenses or losses that are
reimbursable from other funds. Public entities are included as eligible providers. The
Secretary of Health and Human Services will determine the reimbursement methodology
and process, which has not yet been detailed.
A one-year delay to Disproportionate Share Hospital (DSH) cuts, delaying the $4 billion
national cut scheduled for FY 19-20 until December 1, 2020.
Medicaid
The Families First Families First Coronavirus Response Act includes a 6.2 percent Federal
Medicaid Assistance Percentage (FMAP) increase, which will provide more Medicaid
funding to states. The increase is retroactive to January 1, 2020 and will terminate at the
end of the quarter when the national emergency status lifts. The payments will be
distributed first in grants for reimbursements from January 1, 2020 through March 31, 2020.
From April 1, 2020 through June 30, 2020, the funding will be based on the state’s budget
and checked against expenditure reports. California’s estimated share of the FMAP
increase is estimated to be $4.46 billion (source). Please note that there are calls for an
additional increase to the FMAP; for reference, during the Great Recession, the federal
government increased the FMAP by 10 percent. Look for this to be a topic of discussion if
there is a fourth stimulus package.
Medicare
A temporary suspension of the Medicare sequester payment reduction from May 1 through
December 31, 2020.
A 20 percent increase to the Medicare DRG code for discharged COVID-19 patients during
the coronavirus emergency.
An elimination of the requirement that Medicare patients must have been treated by a
Medicare provider in the past three years to qualify for expanded Medicare telehealth
coverage under the Section 1135 waiver authority.
An expansion of the Medicare Accelerated Payment Program during the COVID-19
emergency such that eligible hospitals could apply for lump sum or periodic interim
payments to cover a six-month period.
State and Local Governments
$150 billion for state, local, and tribal governments through the Coronavirus Relief Fund for
specific relevant expenditures. These funds will be distributed to states in proportion to their
population (with a minimum set aside of for smaller states/DC/territories/tribal
governments). The Governor said publicly that he estimates California will receive $10
billion. Up to 45% of state funds will be available to local governments, in proportion to its
population as a portion of the state’s population. It is unclear whether these funds will be
used to reimburse health care related expenses and revenue losses.
Surge Capacity and Response – The Governor announced this week that based on
updated modeling, California is projecting a need for 50,000 additional hospital beds. The
hospital system has committed to providing 30,000 beds through flexing existing beds and
facilities. The State is planning to acquire 20,000 additional beds — approximately 3,000 of
which are addressed through the state’s acquisition of Seton Medical Center (San Mateo),
St. Vincent’s (Los Angeles), and Community Medical Center Long Beach. The state is
looking at convention centers, fairgrounds, hotels and motels to address the remaining
17,000 beds.
The state has spent the following from SB 89 funds related to surge capacity and response:
$30 million to pay for the acquisition of the three hospitals referenced above.
$1.4 million to expand the state’s public health laboratory in Richmond.
$2 million to contract with American Medical Response to provide patient transportation.
Personal Protective Equipment (PPE) – All health care providers – hospitals and clinics –
are reporting difficulty in acquiring sufficient personal protective equipment (PPE). The
Governor announced plans to scope and procure additional protective gear, including 1
billion pairs of gloves, 595 million masks, and 200 million shields. California has engaged
several private sector partners, who are looking at manufacturing needed equipment, as
well as opening up supply chains from China. Service Employees International Union
United Healthcare West (SEIU-UHW) announced securing 39 million N95 masks this week,
as well. The national shortage of PPE was a topic of conversation between all 50 state
Governors and the Trump Administration this week. It is unclear whether the states will
form some sort of cooperative arrangement (such as group purchasing or procurement) in
response to the lack of federal intervention on PPE.
The state has spent $8.6 million from SB 89 funds to purchase new ventilators, IV fusion
pumps, and refurbished ventilators.
The second stimulus package includes liability protections on personal respiratory
protective devices.
Telehealth and Telephonic Care – The federal Section 1135 waiver approved by CMS
earlier this week did not include approval of a variety of provisions, including telephonic
care and flexibilities for telehealth services. The Department of Health Care Services
remains engaged on how to obtain federal approval, perhaps through a different vehicle,
and are encouraging health centers to move forward with telehealth and telephonic visits.
DHCS issued guidance on payment for telehealth and telephonic visits earlier this week.
Other Issues
Medicaid Federal Accountability Regulation (MFAR). The federal MFAR proposed
regulation, which would have significant impacts to state Medicaid programs and funding,
continues to be pending. Medicaid experts noted that the Centers for Medicaid and
Medicare Services (CMS) withdrew a proposed Medicaid eligibility rule this week. There
was an unsuccessful effort to include a moratorium on MFAR in the third stimulus package,
which would prohibit the Administration from implementing the proposed rule. The issue is
likely to be discussed in the context of a fourth stimulus package.
California’s 1115 Waiver. Public hospitals and counties are encouraging an extension of
California’s 1115 waiver that expires on December 31, 2020. Many of the reporting
deadlines and measurements will be difficult to meet as hospitals focus on COVID-19 and
surge capacity. There was also an unsuccessful effort to include a requirement that CMS
approve extensions of any state 1115 waivers that expire in 2020, if a state requests an
extension. This issue will continue to be discussed.
Graduate Medical Education State Plan Amendment (CA-17-009). While unrelated to
COVID, there was some good news about federal funding in the last week. DHCS received
th
approval on March 19 from CMS for California’s Graduate Medical Education (GME) State
Plan Amendment (SPA), retroactive to January 1, 2017. The SPA provides for $132 million
in 2017 and $185 million in 2018 in federal payments to support GME at designated public
hospitals. The funds will be allocated as follows:
% Distribution of Total
Hospital
Pool
UC Davis Medical Center7.3%
UC Irvine Medical Center4.3%
UCLA Medical Center5.4%
UC San Diego Medical Center4.7%
UC San Francisco Medical Center8.3%
Santa Monica UCLA Medical Center0.6%
LA County-USC Medical Center20%
LA County Harbor/UCLA Medical Center11.1%
LA County Rancho Los Amigos National
0.3%
Rehabilitation Center
LA County Olive View Medical Center5.0%
Alameda Health System – Highland Hospital4.1%
Arrowhead Regional Medical Center3.3%
Contra Costa Regional Medical Center1.9%
Kern Medical1.5%
Natividad Medical Center0.5%
Riverside University Health System Medical
2.2%
Center
San Joaquin General Hospital0.9%
San Mateo Medical Center0.4%
Santa Clara Valley Medical Center7.9%
Ventura County Medical Center0.7%
Zuckerberg San Francisco General Hospital9.6%