California Department of Public Health Issues All Facilities Letter Waiving Compliance with Hospital Regulatory Requirements Until June 30, 2020

On March 15, California Governor Gavin Newsom issued an executive order in response to the COVID-19 outbreak that, among other things, requires the Department of Public Health to focus its resources on the most serious health and safety issues at licensed facilities. To implement this, the California Department of Public Health (CDPH) issued All Facilities Letter 20-26 on March 20, notifying hospitals of a temporary waiver of licensing requirements and a suspension of regulatory enforcement. Because the licensing requirements have been waived, facilities do not have to submit program flexibility requests in order to operate outside of regulatory requirements.

Hospitals Still Must Comply with Certain Requirements, As Detailed in the All Facilities Letter  

There are several important exceptions to this waiver. As quoted from the All Facilities Letter:

1. Hospitals shall continue to comply with adverse event and unusual occurrence reporting requirements specified in [Health & Safety Code] section 1279.1 and Title 22 California Code of Regulations section 70737(a).
2. Hospitals shall report any substantial staffing or supply shortages that jeopardize patient care or disrupt operations.
3. Hospitals shall continue to provide necessary care in accordance with patient needs and make all reasonable efforts to act in the best interest of patients.
4. Hospitals shall follow their disaster response plan.
5. Hospitals shall follow infection control guidelines from the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) related to COVID-19.
6. Hospitals shall comply with directives from their local public health department.
7. CDPH will continue to investigate and conduct enforcement activities for allegations of the most serious violations impacting health and safety, pursuant to Executive Order N-27-20 (PDF).

CDPH Provides Additional Guidance; Appears To Allow New Hospitals/New Beds Without Approval

CDPH also encourages facilities to “implement contingency plans to address staff absenteeism and the rapid influx of patients.” For hospitals seeking initial licensure or to change beds or services to their license, CDPH asks hospitals to submit an application online, but notes that “[t]his shall not require approval before the hospital may provide care, although CDPH will reach out to provide technical assistance to ensure patient safety and the quality of care.” This suggests that hospitals can start providing care or shift beds without CDPH approval. Finally, CDPH directs hospitals to contact their local district office if they have any questions about the All Facilities Letter. 

Hospitals Should Keep An Eye on Future CDPH Guidance and Seek Counsel As Needed

With the evolving nature of the COVID-19 crisis, additional CDPH guidance is likely. California hospitals should keep an eye out for additional updates from CDPH, as well as from federal agencies and accreditation organizations. Additionally, in light of the All Facilities Letter’s sweeping nature, some hospitals may be evaluating unorthodox solutions to their COVID-19 challenges. In such instances, hospitals should consult legal counsel to ensure continued compliance with legal requirements that are still in effect, and consider contacting their local district office to discuss.