COVID-19 UPDATE #222
January 20, 2022
DEAR ADMINISTRATOR LETTER ANNOUNCES EMERGENCY RULE UPDATE RELATED TO TRANSFER AND DISCHARGE OF NURSING HOME RESIDENTS
In a Dear Provider Letter dated January 18, 2022, skilled nursing providers are informed that shortly after filing an extension for emergency rules related to the transfer and discharge of nursing home residents originally implemented on September 3, 2021, the department received a request to clarify the circumstances under which the requirements can be waived. To provide this clarification, the department filed WSR 22-01- 072 on December 9, 2021, amending WACs 388-97-0140 and 388-97-0120 and superseding the emergency rules filed December 1, 2021 (WSR 21-24-069).

The new emergency rules continue to waive the requirement for nursing homes to suspend certain transfers and discharges pending the outcome of a resident appeal hearing. The emergency rules clarify that the suspension is limited to improving resident safety by allowing faster grouping of COVID-19 positive residents in one facility or grouping asymptomatic residents together.

This helps expedite infection control processes and maximizes the availability of nursing home beds. The following rules are amended as described until April 4, 2022:
  • WAC 388-97-0140(2)(d) – Facility-initiated transfer or discharge of a resident is allowed, when the facility cannot meet the resident’s urgent medical needs and for cohorting purposes related to the COVID-19 pandemic as allowed under any applicable Centers for Medicare and Medicaid Services (CMS) emergency waivers.
  • WAC 388-97-0120(ii) – Allows a transfer or discharge when an appeal request is received by the office of administrative hearings if the failure to discharge or transfer would endanger the health and safety of the resident or other individuals in the facility.
  • WAC 388-97-0120(2) – Allows the transfer or discharge pending the outcome of the hearing if the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. 

If providers have questions, they are encouraged to contact Molly McClintock, Nursing Home Policy Program manager via email or by calling (360) 742-6966.
CMS VACCINE MANDATE FOR SNF DEADLINE IS FAST APPROACHING | SURVEYOR TRAINING NOW AVAILABLE TO PROVIDERS
In late December, CMS released guidance QSO-22-07-ALL regarding health care staff COVID-19 vaccination. This CMS memo outlines the guidance and survey procedures for state agencies to assess facility compliance with the regulatory requirements.  It is vitally important that facilities read the memo in its entirety as well as the LTC attachment for additional information regarding deadlines, definitions and details.

CMS implementation will be phased in as follows: 
  • January 27, 2022, for the first dose, which includes: 
  • 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]). 
  • 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). 

CMS has now released training to surveyors on how CMS expects this requirement to be implemented, how surveyors will determine compliance, expanded guidance on scope/severity determination, and enforcement. This training is open for providers and it is imperative that facility staff understand this requirement. The training can be accessed on the CMS QSEP website and is titled “Surveying for the New Staff Vaccination Rule - Long Term Care (LTC).” The training is approximately 51 minutes and provides valuable information necessary to ensure understanding and compliance. The slides for the CMS Surveyor Training are available here.
DEAR ADMINISTRATOR LETTER EXPLAINS TEMPORARY DELAY OF SOME MEDICAID CARE ASSESSMENTS IN ASSISTED LIVING
In a Dear Administrator letter dated January 18, 2022, sent on behalf of the ALTSA Home and Community Services Division, assisted living providers are notified in light of the unprecedented emergency circumstances associated with the COVID-19 pandemic, and the surge in hospitalizations caused by it, the Aging and Long-Term Support Administration (ALTSA) will extend some Medicaid clients’ annual residential CARE reassessments for up to one year in order to add staff resources to assist with hospital discharges.

During the Public Health Emergency (PHE), CMS approved ALTSA for the flexibility to delay the need to conduct functional reassessments to determine Level of Care and Person-Centered Care Plans for beneficiaries needing 1915(c) and 1915(k) Long-Term Services and Supports (provided that the functional assessment otherwise complies with the regulatory requirements under 42 CFR 441.720) for one year. With the federal approval to exercise this flexibility, ALTSA will extend some residential CARE reassessments for up to one year.

ALTSA staff will continue to complete residential private to public assistance conversion assessments and significant change assessments. Annual reassessments will continue to be completed as time allows. Providers can contact their regularly assigned case manager, as they normally would, in the event a significant change assessment is required. The PHE, and by extension the flexibility to delay assessments, is currently in place until April 16, 2022.

If providers have questions, they are encouraged to reach out Natalie Lehl, Residential Policy Program Manager, via email or by calling (360) 725-2370.
DOH OFFERING WEBINAR ON VACCINE STORAGE, HANDLING, AND ADMINISTRATION
The Department of Health (DOH) invites providers to its first webinar of 2022 on Januarya27 from 12 - 1 PM. The webinar COVID-19 Vaccine Storage and Handling, and Vaccine Administration will be presented by the vaccine management team in the Office of Immunization and will cover:
  • Storage and transport requirements for each presentation of COVID-19 vaccine.
  • Identify best practices for maintaining the cold chain for COVID-19 vaccine.
  • Identify resources for COVID-19 vaccine storage and handling, and vaccine administration.

The webinar will be recorded and available for viewing after the live webinar. Continuing education credit will be available for nurses, medical assistants and pharmacists/ pharmacy techs. Register in advance for this webinar.
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.