COVID-19 UPDATE #220
January 14, 2022
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BREAKING ALERT
GOVERNOR INSLEE MOVES TO HELP LONG TERM CARE
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On Thursday, January 13, Governor Jay Inslee announced several new emergency initiatives addressing our struggling health care system. Among the new initiatives, Inslee announced several measures to help nursing homes.
As WHCA members know, a big part of the strain on hospitals is due to problems discharging patients out of hospitals who no longer need acute care. To help long term care facilities, Inslee announced state officials will help with staffing in places such as nursing homes, by expanding the number of agency staff under contract to the state.
The state is looking to add 200 more contract staff that will be used to increase capacity in nursing homes. The goal is to move 240 hospital patients into long term care as quickly as possible. As recently as this morning, WHCA continued to remind the Governor’s Office and DSHS that the core issue in opening up capacity in nursing homes is addressing the long health jurisdictions’ predilection of closing facilities to new admissions longer than necessary based upon a building’s “outbreak status.” The local health jurisdictions' stubbornness on this issue is at the root of the current hospital overcrowding crisis.
The Governor announced the following actions to assist long term care:
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Expand agency direct care staffing and dedicate expansion staff to provide care in nursing homes to increase the capacity to admit patients from the hospital who no longer need hospital level of care. Detail on how facilities can access additional staffing will be distributed in an upcoming Dear Provider letter.
- Deploy additional staff to perform assessments, work with patients on transition planning and selection of qualified providers, and expedite financial eligibility.
- Contract with Area Agencies on Aging (AAAs) at high volume hospitals to perform care transitions for individuals not relying on Medicaid for the transition.
- This would free up hospital discharge planner time and assist individuals, regardless of payer source, to transition from hospitals, access community resources, and reduce readmissions in the community to create more capacity for short-term post-hospital stays.
- Engage more guardians and provide resources to expedite guardianship proceedings.
- This will accelerate the transition of individuals needing a guardianship from the hospitals to less restrictive settings, while at the same time protect the rights of individuals.
- Continue incentives for AFHs, ALFs and home care agencies that admit individuals who have transferred from acute hospitals to SNFs.
- Continue staffing strike teams to support long term care facilities who are taking admissions from acute hospitals and who need additional staff support to do so.
As additional information about the availability of more staffing for nursing homes is made available WHCA will provide additional updates.
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US SUPREME COURT ISSUES VACCINE MANDATE DECISIONS |
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The U.S. Supreme Court today issued opinions in the Centers for Medicare and Medicaid Services (CMS) and Occupational Safety and Health Administration (OSHA) vaccination requirement cases. Please note, for assisted living communities, Washington State mandates for staff vaccination still remain in effect and have not changed.
The bottom line is as follows:
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The preliminary injunctions against enforcement of the CMS interim final rule have been stayed, meaning that CMS can enforce its IFR nationwide; and
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The OSHA emergency temporary standards have been stayed, meaning they cannot be enforced.
What This Means for Skilled Nursing Providers
Nursing facilities and facilities that care for individuals with disabilities (ICF/IIDs) nationwide will be required to implement CMS’ rule. Assisted living providers are not included in the CMS IFR and are now not subject to a federal vaccine/testing requirement.
When are facilities required to be in compliance?
CMS implementation will be phased in as follows:
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January 27, 2022, for the first dose, which includes:
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Policies and procedures developed and implemented (template policies and procedures are available on the AHCA/NCAL COVID-19 website under 'Vaccines').
- 100 percent of staff having received one dose of vaccine, except those with or pending an exemption request and those having a temporary delay recommended by the CDC.
- A facility above 80 percent and has a plan to achieve a 100 percent staff vaccination rate within 60 days would not be subject to enforcement action (e.g., civil monetary penalties [CMPs]).
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February 28, 2022, for the second dose, which includes:
- Policies and procedures developed and implemented.
- 100 percent of staff having completed the vaccine series, except those with granted exemption request and those having a temporary delay recommended by the CDC.
- A facility above 90 percent and has a plan to achieve a 100 percent staff vaccination rate within 30 days would not be subject to enforcement action (e.g., CMPs).
- Facilities with less than 100 percent staff vaccination rates may be cited but will be exempted from enforcement actions (e.g., CMPs) if they meet the following criteria:
- January 27, 2022: Facility has more than 80 percent staff vaccination and a plan to achieve a 100 percent staff vaccination rate within 60 days.
- February 28, 2022: Facility has more than 90 percent vaccination rates and a plan to achieve a 100 percent staff vaccination rate within 30 days.
How will compliance be determined?
Compliance will be determined through the regular survey process, including through standard and complaint visits. Facilities are expected to track vaccination status, including booster status for each staff person and any exemptions, using a tracking tool of their choice. A facility's tracking mechanism should clearly identify each staff's role, assigned work area, and how they interact with residents. Survey teams will also ask for information on how unvaccinated staff are assigned and additional precautions taken to prevent transmission. CMS will provide a tool for facilities to use.
How will citations, including scope and severity, be determined?
Facilities found out of compliance (less than 100 percent of staff vaccinated, not including those with valid exemptions) will receive a citation with scope and severity based on staff vaccination rates, number of COVID-19 cases, policy and procedure implementation, and infection control practices.
On page 10-11 of the QSO memo, CMS provides detailed guidance on scope and severity and a scope and severity grid on page 14.
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HEALTHCARE STAFFING RESOURCE - WAserv |
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We encourage all long term care facilities who are seeking healthcare staffing resources to submit a request through the emergency volunteer health practitioner program system, WAserv. Since October 2021, WAserv has seen an increase in the number of registered practitioners, including NA’s, NA-C’s, and HCA’s. Facilities may benefit from submitting new requests, even if you have submitted a request in the past that was not filled.
Requesting volunteers begins with submitting a request to your local emergency management organization or local health jurisdiction. See the fact sheet for instructions and details. Tribal nations have the sovereign authority to set and follow their own processes for request, and may reach out directly to the state, local authorities, or local health care coalitions. Health care facilities who want to request approved volunteers, need to complete a health care facilities request form. Facilities requesting to activate specific volunteers should follow the guidance document, Health Care Facility Options for Requesting Health Care Providers. Please be aware that you will likely need to pay volunteers and will get the best response if you are able to cover lodging for them as well.
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CMS TO HOST OPEN DOOR FORUM FOR SNFs |
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On Thursday, January 27, the Centers for Medicare and Medicaid Services (CMS) will host an Open Door Forum from 11 AM - 12:00 noon PST. The agenda will include announcements and updates, PBJ discussion, public reporting updates on the January 2022 Refresh announcement, and MDS 3.0 QM User's Manual Version 15.0 announcement. There will also be open Q&A.
This Open Door Forum will be available via conference call only. To join the call, call (888) 455-1397 and use passcode 5109694.
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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.
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