COVID-19 UPDATE #256
August 4, 2022
GOVERNOR INSLEE RESCINDS PROCLAMATIONS DIRECTLY AFFECTING ASSISTED LIVING AND SKILLED NURSING FACILITIES
On July 29, Governor Inslee announced that he is rescinding 12 proclamations that were issued during the COVID-19 pandemic state of emergency. This includes proclamations 20-65 and 20-66, which are the proclamations that have suspended many of the rules and laws regulating long term care facilities. These rules and laws will be reinstated effective October 27, 2022.

Residential Care Services has begun the work to reimplement the regulatory requirements in long term care settings. A letter from Aging and Long-Term Support Administration with further details outlining this work and providing resources for providers to navigate this transition will be sent out within the next few weeks. In addition, the Waiver Tracker will be updated as information changes. Please send any questions to RCSPolicy@dshs.wa.gov.
DEAR PROVIDER LETTER PROVIDES UPDATES ON SURVEYOR GUIDANCE IN SNFs
In a Dear Administrator letter dated August 3, 2022, skilled nursing facility providers were notified of revisions ot survyeor guidances for Phases 2 and 3, arbitration agreements, investigating compaints and facility-reported incidents, and the psychosocial outcome severtiy guide. The letter provides a summary of changes.

Revised Surveyor Guidance Summary:
  • Phase 2 Clarification and Technical Corrections: The Critical Element (CE) Pathways and the SOM have been updated to include significant revisions and additional guidance to enhance quality and oversight in the following areas:
  • Abuse and neglect o Admission, transfer, and discharge
  • Mental Health/Substance Use Disorder (SUD)
  • Payroll Based Journal/Nurse Staffing
  • Resident rights
  • Potential inaccurate diagnosis and/or assessment
  • Pharmacy Services
  • Phase 3 Updated Guidance and Requirements: CMS updated the guidance requiring all facilities to have an Infection Preventionist at least part time and based on the needs of the facility. In addition, CMS incorporated the review of COVID-19 requirements and F885, F886, F887, and F888 to the survey software.
  • Arbitration Requirements: Guidance prohibits facilities from requiring residents to sign binding arbitration agreements as a condition of admission to the facility, or as a requirement to continue to receive care at that facility.
  • Training Resources: Training on the changes with the regulations and guidance will be located on QSEP for providers and surveyors starting September 2022.
  • Complaint Investigations: CMS revised Chapter 5 of the SOM to clarify expectations communicating with complainants, reporting guidelines, timeframes for investigation, and removed the term “substantiate” from the SOM.
  • Psychosocial Outcome Severity Guide: CMS revised guidance to clarify the reasonable person concept and examples across the different severity levels.

If providers have questions, please email Molly McClintock, Nursing Home Policy Program Manager, or call her at (360) 742-6966.
DEAR PROVIDER LETTER EXPLAINS MEDICAL TESTING SITE WAIVER IN ASSISTED LIVING
A Dear Provider letter dated August 3, 2022, explains the federal and Washington State Medical Test Site Waiver (MTSW) licensure requirements for certain types of medical testing, including testing residents for COVID-19.

MTSW licensure is required when the ALF administers a medical test (such as a COVID-19 test or blood glucose test), or interprets the test result, or acts upon the test results. Examples of activities that require a MTSW license are when a facility:
  • Uses rapid COVID-19 tests for residents.
  • Tests blood glucose for a resident.
  • Dips test sticks in urine to test for ketones or other analytes.
  • Reports a test result to a medical facility who may adjust a resident’s diet or medication in response to a test result.

MTSW licensure is NOT required if a person performs and interprets their own medical test or shows their test result to someone else. For example, when:
  • A staff person takes a rapid COVID-19 test and interprets the result, then calls the facility to report they will or will not be coming to work.
  • A resident independently takes the medical test and acts upon the results themselves (such as by adjusting their own diet or medication or calling the medical facility).

If the ALF is testing residents using a medical test, then a MTSW license is required. The facility must apply for a MTSW license through the Department of Health (DOH) to be compliant with state and federal regulations.
  • Facilities must mail the completed MTSW license application to the Olympia address listed on the application.
  • Facilities that have submitted a MTSW license application with fee payment may conduct testing activities while their MTSW license is pending. Once the application is processed, facilities will receive an email with their Medical Test Site and CLIA Number from DOH.
  • A facility who already has a MTSW license to perform COVID-19 testing must submit a Test Menu Change Form 505-088 to add to their license any other tests they are already conducting (such as blood glucose monitoring) to their existing MTSW license.
  • For more information on how to apply for a Washington state MTSW license, use this link.

There are reporting requirements related to COVID-19 testing. For information about reporting COVID-19 test results to DOH, use this link.

You can find educational materials on the DSHS ALF webpage. Additional information and resources, including information and registration details for the September 22 DOH COVID Long-Term Care Q&A call can be found in the Dear Administrator letter.

RCS encourages facilities to apply for the MTSW as soon as possible. There will be an education period for the next several months to allow facilities time to adjust to the requirements and get licensed. During this time CRS staff who identify an unlicensed Medical Test Site during inspection or investigation will provide education on how to obtain a Medical Test Site Waiver license. RCS staff will not write citations or make referrals to Department of Health until after June 30, 2023. If you have any questions about MTSW licensure, please contact the Department of Health Medical Test Site program at LQA@doh.wa.gov or 253-395-6746. 
REPORTING RELIEF: NHSN UPDATES THERAPEUTIC PATHWAY FOR SNFs
The National Healthcare Safety Network (NHSN) has updated the Therapeutics Pathway based on provider feedback on how to make enhancements to this module and provide some reporting relief.  

All NHSN users should have received an email detailing the modification, which includes a new check box labeled, “Did not administer any Therapeutics.” This allows users to select this option if the facility has NOT administered any of the listed therapeutics to residents during the reporting week and will auto populate the rest of the pathway.  

The American Health Care Association and National Center for Assisted Living (AHCA/ NCAL) successfully advocated for this modification, which was made to improve the reporting process for facilities who do not administer therapeutics, thus reducing the reporting burden.
RESEARCHERS SEEKING TO INTERVIEW NURSING HOME ADMINISTRATORS ON IMPACTS OF PDPM AND COVID-19
A research team from the University of Pittsburgh, University of Washington, and University of California Los Angeles has reached out to AHCA seeking its help in recruiting Nursing Home Administrators (NHAs) to interview. Volunteers will participate in a 45- to 60-minute telephone interview on the impacts of the SNF Patient Driven Payment Model (PDPM) and the COVID-19 pandemic and public health emergency on their facility. 

The information from these interviews will be confidential. More information is available in this brochure.

NHAs interested in participating may contact Amanda Shore at ams728@pitt.edu to schedule an interview. Participants will receive a $50 e-gift card for sharing their experiences about these challenging times.
URGENT INFORMATION ABOUT COVID WAIVERS FOR CERTIFICATE OF NEED, CONSTRUCTION REVIEW, AND FACILITY LICENSING
Early in the COVID-19 pandemic, Governor Inslee issued Proclamation 20-36 which waived certain certificate of need (CN), construction review (CR), and facility licensing requirements to allow health care facilities to rapidly adapt and expand to meet the demands for surge capacity.

The Governor has announced his intent to rescind Proclamation 20-36 on October 27, 2022. Facilities that utilized the waivers to address surge must either revert their operations or take immediate action to move toward compliance by October 27, 2022.
The Department of Health (DoH) will provide health care facilities a glide path to come into compliance, but you must act quickly to submit letters of intent and applications as described below.

What does this mean for licensed health care facilities?
If your health care facility took advantage of the waivers in Proclamation 20-36 and you plan to maintain these changes beyond October 27, 2022, you must comply with state law applicable to your license type. This could include obtaining a certificate of need, obtaining construction review approval, and/or updating your license.

For those facilities requiring a Certificate of Need:
  1. By August 28, 2022, facilities must submit a Letter of Intent to the DoH conforming to WAC 246-310-080. Letters of Intent must describe the increase in capacity and/or new locations the facility wants to maintain and be accompanied by a patient transition plan should the DoH not approve the application. Send the Letter of Intent to COVIDwaiver@doh.wa.gov. 
  2. By October 27, 2022, facilities must submit a CN application and the appropriate fee to the DoH following existing CN application processes and requirements. Facilities must also submit applications to modify their facility license within this same timeframe, as appropriate. If your CN application is denied, you must execute your patient transition plan and revert your operations to your previously approved CN.

Exception: Health care facility types on a concurrent review cycle for CN applications (nursing homes, hospice care centers, and end stage renal disease facilities) will be required to submit a second Letter of Intent, CN application, and appropriate fee in compliance with the DoH's published schedule the next time the application cycle opens. Facilities must also submit applications to modify their facility license within this same timeframe, as appropriate. If your CN application is denied, you must execute your patient transition plan and revert your operations to your previously approved CN.
 
For those facilities requiring Construction Review:
  1. By August 28, 2022, facilities must submit a construction review application to COVIDwaiver@doh.wa.gov and appropriate fee. Applications must include a clear description of the scope of work (physical changes, additions, renovations) made to the facility.
  2. By October 27, 2022, facilities must submit formal engineering plans, functional programs, and associated documentation needed to evaluate compliance with the state licensing rules OR submit a technical assistance application to the DoH to confirm the scope of work and establish documentation requirements. Facilities must respond quickly and in good faith to correct non-compliant construction, eliminate hazards within the environment, and complete the review project.
  3. By January 25, 2023, and every 90 days after that until the project is fully approved, submit to the DoH quarterly progress reports that address project status, updates since the last report, and planned completion date.

Following the process above will not adversely affect a facility’s CN, CR, or license application. Failure to follow the steps outlined above will be considered non-compliance and the DoH may take appropriate enforcement action.

If you have any questions about what actions you should take now, technical assistance is available at COVIDwaiver@doh.wa.gov. The DoH will also host webinars about the glide path described above on the following dates:
  • Thursday, August 4 | 11:00 AM
  • Tuesday, August 9 | 10:00 AM
  • Thursday, August 11 | 2:00 PM
 
Zoom links will be distributed early next week, and we will share them when they are available.
LAST OF PHASE 4 PROVIDER RELIEF FUND PAYMENTS COMING TO A BANK ACCOUNT NEAR YOU
According to Argentum, one final round of Phase 4 Provider Relief Fund (PRF) payments could be coming as soon as this week, reports McKnight's Senior Living. This would mark the completion of all payment determinations. Argentum's Government Relations Director Dan Samson relayed the news during an Argentum Advocates membership call recently. Those providers that do not receive funds will have a 45-day period from the payment determination date to submit applications for reconsideration. Separately, as the Occupational Safety and Health Administration readies its roll-out of permanent healthcare employer requirements related to COVID-19 in September, Samson reiterated that Argentum opposes the rule and has petitioned for assisted living to be exempt because of its personal care delivery model and limited role in the delivery of healthcare.
FREE COVID-19 TESTING FOR STAFF AND RESIDENTS IN AL
Assisted living centers now have access to free COVID-19 testing for their staff and residents through December 31, 2022. The Centers for Disease Control and Prevention’s (CDC) Operation Expanded Testing (OpET) program expanded access to free testing nationwide to now include assisted living communities, which previously targeted schools, shelters, and correctional facilities.
 
Testing under OpET is available at no-cost to providers and can be used on staff or residents. You can receive up to a four-week supply at a time, and there is no cap on the number of tests that can be used in this program.  
 
How it Works: 
OpET coordinates with four regional coordination hubs to provide pooled PCR tests (i.e., laboratory-based Nucleic Acid Amplification Tests [NAAT]), with specimen collection supplies, shipping materials, laboratory testing, and results reporting. The provider must contribute staff to collect specimens.

How to Enroll:
To enroll your assisted living into OpET’s no-cost screening testing program:
  1. ​Identify your facility’s region and coordination hub.
  2. Visit your regional coordination hub’s website.
  3. ​Hub 1 – West: Alaska, Arizona, California, Guam, Hawaii, Idaho, Marshall Islands, Nevada, Northern Mariana Islands, Oregon, Palau, and Washington
  4. Hub 2 – Midwest: Colorado, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Montana, Nebraska, North Dakota, Ohio, South Dakota, Utah, Wisconsin, and Wyoming
  5. Hub 3 – Northeast: Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, U.S. Virgin Islands, Vermont, Virginia, Washington D.C., and West Virginia
  6. Hub 4 – South: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas
  7. ​Enroll your assisted living community. 
 
Visit the Operation Expanded Testing website to learn more.
SHORT-TERM JOB OPPORTUNITY: FACILITATORS FOR RESEARCH STUDY
The ENSPIRE study group seeks individuals with experience as a facilitator to work on a research study. The study is focused on employees who work in long term care centers. Teams of individuals with similar ethnic backgrounds, in particular Asian and Pacific Islander, Latinx, African American/Black, and white are being formed. ENSPIRE seeks facilitators who identify with these groups.

There are four to five hours of work per week for approximately five months. The pay is $60/hour. Each team will work together on Zoom to design ads that promote the COVID-19 booster. The teams will meet once a week for 11 weeks starting in September.

ENSPIRE is looking for individuals with leadership experience and experience in long term care. The person who is selected will be hired as a consultant for the time period of the project. A college degree is not needed, and the full job description is available here. Applications (in English) are due by August 15 and can be emailed to Tiffany Hoat.
NEW TELEHEALTH OPTION LAUNCHED TO EXPAND
COVID-19 TREATMENT ACCESS
To increase access to potentially life-saving medication to treat COVID-19, the Washington State Department of Health (DOH) and its partners have launched a new telehealth option for patients. The new option expands the Federal government’s Test to Treat initiative and gives people at risk of severe disease another way to quickly access free treatment for COVID-19.

Until now, telehealth for COVID-19 has only been available to insured patients who receive care through a health care provider that offers telehealth visits. This new program makes telehealth consultations for COVID-19 available to everyone, regardless of insurance status, with no out-of-pocket costs.

“At DOH, we value equity and innovation, and have embraced those values throughout our COVID-19 response,” said Umair A. Shah, MD, MPH, Secretary of Health. “Ensuring that we can equitably connect communities with therapeutics is pivotal so that we can continue our mission of reducing unnecessary death from this disease.”

DOH encourages people who test positive for COVID-19 to discuss treatment options with their primary health care provider. In situations where this might not be possible, free telehealth consultations are another option that can make it even easier to access treatments for COVID-19. People who test positive for COVID-19, including with a self-test, can consult with a health care provider using a smartphone or computer with a high-speed internet connection.

If appropriate, they can receive a free prescription for pick-up at the nearest pharmacy that has the oral antivirals or have their medication delivered. More than 1,000 sites are available across the state. This telehealth service is currently provided by DOH in collaboration with partners, including Birds Eye Medical and Color Health.   

There are two options to set up a telehealth appointment – either by visiting DOH’s new telehealth webpage or by calling the DOH COVID-19 call center. Those interested in signing up virtually can complete a brief intake form on DOH’s new telehealth webpage. If the information provided indicates treatment may be appropriate, the patient will be connected virtually with a health care provider for a consultation. Telehealth providers are available every day from 8 a.m. to 8 p.m.

Those interested can arrange an appointment by phone by calling the DOH COVID-19 call center at (800) 525–0127 and pressing #. The call center is available to arrange telehealth consultations from 8 a.m. to 8 p.m. on Mondays, and 8 a.m. to 6 p.m. on Tuesdays through Sundays and state holidays.

Telehealth appointments are currently available in 240 languages through translation services. People interested in receiving a telehealth appointment in a language other than English should arrange an appointment through the DOH COVID-19 call center. 

Visit the Washington State Department of Health’s website for more information on COVID-19 treatments and information for health care providers.
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.