COVID-19 UPDATE #155
April 27, 2021
CMS AND CDC UPDATE GUIDANCE ON TESTING, VISITATION, AND ACTIVITIES IN RESPONSE TO COVID-19 VACCINATION
The Centers for Medicare and Medicaid (CMS) and the Centers for Disease Control and Prevention (CDC) updated guidance for long term facilities today in response to COVID-19 vaccination. The following key changes have now been made:
  • Residents and visitors may visit without distancing and source control masks if alone in the resident’s room and the resident and visitor are fully vaccinated. If the visitor is not vaccinated, they can visit with a fully vaccinated resident alone in the resident’s room without distancing while wearing well-fitting source control masks.
  • Communal dining and activities may occur without physical distancing if all residents are vaccinated.
  • Vaccinated health care personnel no longer need to undergo routine testing, but should continue to be tested after exposure, during an outbreak, or if experiencing symptoms.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) has provided a detailed summary of these updates. Members are invited to email AHCA at COVID19@ahca.org with any questions.
The new guidance can be found here:

WHCA is meeting with DSHS, DOH, and other stakeholders regarding revisions to the LTC Safe Start Plan. Until that plan is revised and approved by the Governor, assisted living and skilled nursing facilities need to continue to follow the current LTC Safe Start Plans:

If you have questions, you may email Elena Madrid or Vicki McNealley.
ASSISTANCE AVAILABLE FOR ASSISTED LIVING AND SKILLED NURSING FACILITIES TO OBTAIN VACCINATION RESOURCES
The Department of Health (DOH) has opened up a LTC Facilities (COVID-19 Vaccine Request survey for facilities to request assistance when they are unable to locate/obtain vaccination resources for residents. Skilled nursing and assisted living facilities should first contact and attempt to work with their long term care pharmacy to obtain the vaccine resources. If unable to obtain vaccine resources from your long term care pharmacy, facilities should reach out to their local health jurisdictions. After these steps have been exhausted, complete the DOH survey for assistance.
DEAR PROVIDER LETTER PROVIDES VISUAL AID FOR UNDERSTANDING LTC FACILITY VISITS UNDER SAFE START PLAN
A Dear Administrator letter dated April 23, 2021, informs providers that the Department of Social and Health Services has created a tool to help providers and families follow the visitation guidelines found in the Safe Start for Long Term Care Plans. This aid concisely explains what is and is not allowed during facility visits and includes answers to frequently asked questions. You can find this visual aid by following this direct link. Providers are encouraged to email RCSPolicy@dshs.wa.gov if they have questions.
DEAR ADMINISTRATOR LETTER PROVIDES INFORMATION TO AL PROVIDERS ON CR-103E RULE FILING
In a Dear Administrator letter dated April 23, 2021, assisted living providers are informed of the filing of a CR-103E (Emergency Rule) to extend emergency rules in Chapter 388-78A WAC of the Assisted Living Facility licensing rules. This fourth set of emergency rules also extend the suspension of the administrator training requirements and become effective April 15, 2020, with an expiration date of August 13, 2021, and is published in WSR 21-09-046.
DEAR ADMINISTRATOR LETTERS INFORM SNF PROVIDERS OF EXTENSIONS TO EMERGENCY RULES AND EMERGENCY WAIVERS
In a Dear Administrator letter dated April 23, 2021, skilled nursing providers are informed with QSO-21-17-NH, CMS announced updates or changes to some of their emergency blanket waivers. The letter explains changes to the following blanket waivers:
  • Emergency Blanket Waivers for Notifying Residents before Transfer or Discharge (42 CFR §483.15(c)(4)(ii)), or Room or Roommate Change (42 CFR §483.10(e)(6)).
  • Emergency Blanket Waiver for Care Planning Requirements (§483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i)).
  • Emergency Blanket Waiver of Minimum Data Set (MDS) Timeframe Requirements (42 CFR §483.20)
  • Preadmission Screening and Resident Review (PASRR) waivers
  • CMS is not ending the waiver at 42 CFR §483.20(k) related to the Pre-Admission Screening and Annual Resident Review (PASRR) at this time.
  • Training and Certification of Nurse Aides (42 CFR §483.35(d))
  • CMS is not ending the waiver of nurse aide training and certification requirements, or the waiver of the requirement that an individual cannot work in a nursing home as a nurse aide for more than four months without obtaining certification.

In another Dear Administrator letter dated April 23, 2021, skilled nursing providers are informed of a CR-103E filed to extend an emergency rule amending nursing home requirements related to physician services. Residential Care Services (RCS) filed an emergency rule (WSR 20-10-034) effective April 29, 2020, related to WAC 388-97-1260 and physician services. The rule was amended in response to the significant threat of COVID-19. The rule was extended on August 26, 2020, and extended again on December 24, 2020. On April 21, 2021, RCS filed a CR-103E (WSR 21-09-061) to extend the amended rule for a third time. The rule expires on August 17, 2021.

WAC 388-97-1260 was amended to permit the physician to delegate tasks to a registered nurse practitioner or a physician assistant, even if it is required to be performed by the physician in regulation and regardless of the frequency of the delegation. The amendment does not change the required frequency of physician/delegate visits, or the requirement for the physician to supervise the delegate. The delegate must only perform tasks within the scope of practice of their credential. The adoption of the emergency rule helps to align the state rule with rules the Centers for Medicare and Medicaid Services (CMS) have waived or amended in response to the COVID-19 pandemic. If you have any questions, please email Lisa Herke, Nursing Home Policy Program Manager, or call her at (509) 209- 3088.
COVID-19 FUNERAL ASSISTANCE AVAILABLE
The COVID-19 pandemic has brought overwhelming grief to many families. The Federal Emergency Management Agency mission is to help people before, during, and after disasters. FEMA is dedicated to help ease some of the financial stress and burden caused by the virus and is providing financial assistance for COVID-19 related funeral expenses incurred after January 20, 2020. For more information, check out the funeral assistance announcement or call FEMA's COVID-19 Helpline 1 (844) 684-6333.
EXPECTATIONS FOR PPE USAGE
The CDC outlines expectations for personal protective equipment (PPE) use in their interim infection prevention and control recommendations to prevent COVID-19 spread in nursing homes. Read more.
HHS EXTENDS COVID-19 PUBLIC HEALTH EMERGENCY
The Department of Health and Human Services (HHS) Secretary Xavier Becerra extended the ongoing COVID-19 PHE for an additional 90 days, effective April 21, 2021, which was the date that the current PHE was set to expire. Read more.
ADDITIONAL RESOURCES
WHCA continues to post resources and information as it becomes available on our website. If you have questions or need additional information, please call the WHCA office at (800) 562-6170.