COVID-19 UPDATE #266

October 11, 2022

The Centers for Medicare and Medicaid Services (CMS) has rescinded QSO-22-25-CLIA, which barred the use of SARS-CoV-2 tests outside the FDA test’s instructions for use. AHCA/NCAL highlighted the memo in a recent blog post. 

This comes after AHCA/NCAL strongly advocated this memo should be rescinded as it limited the use of the BinaxNOW COVID-19 Ag Card being sent by the U.S. Department of Health and Human Services (HHS) to symptomatic individuals. 

This means the BinaxNOW COVID-19 Ag Card being sent to long term care providers from the HHS program can continue to be used on both asymptomatic and symptomatic individuals.  

Specifically, CMS indicates that for the duration of the public health emergency, it will not cite facilities with a CLIA Certificate of Waiver when authorized SARS-CoV-2 molecular or antigen POC tests are performed on asymptomatic individuals outside of the test’s authorization. In addition, CMS will not cite nonwaived facilities when modified authorized, cleared or approved SARS-CoV-2 molecular or antigen POC tests are performed in such manner without establishing performance specifications. Read more.

The Department of Health filed the following emergency rules with the Washington State's Code Reviser Office.

WAC 246-840-930 and WAC 246-841-405 Amending specific training requirements for Nursing Assistant Registered (NARs) and Home Care Aides (HCAs). The Nursing Care Quality Assurance Commission (commission) is refiling these emergency rules to continue to allow a registered nurse delegator to delegate nursing tasks to a NAR or HCA based on requirements established by the Department of Social and Health Services (DSHS). NARs and HCAs must complete basic caregiver training as part of their licensure requirements. DSHS provides this training but was unable to do so during the coronavirus disease 2019 (COVID-19) pandemic and is currently experiencing significant delays due to the backlog. DSHS adopted permanent rules effective July 1, 2022, as WSR 22-12-081, which outline dates by which NARs and HCAs must complete basic caregiver training. These dates may extend through September 30, 2023, or within 120 days after the end of the COVID-19 training waivers established by the Governor, whichever is later. To align registered nurse delegator rules with nursing assistant rules, the commission is amending existing emergency rule language to reference DSHS's rules that describe when basic caregiver training must be completed based on hire or rehire date. The commission is also adding language that expands the documentation allowed for proof of training from a "certificate of completion" to "evidence as required by DSHS," as stated in DSHS's rule. This emergency rule will replace the existing emergency rule, filed as WSR 22-15-020, prior to the 120-day expiration because WAC 246-840-930(8)(c)-(d) were amended by a separate rulemaking (WSR 22-12-026) and this rule must be updated to reflect the new language that has changed; the effect of the emergency rule has not changed. Filed as WSR 22-19-006.

WAC 246-841-420, 246-841-470, 246-841-490, 246-841-500, 246-841-510 and 246-841-555. The Nursing Care Quality Assurance Commission (commission) is amending specific training requirements for Nursing Assistant Certified (NAC) and Nursing Assistant Registered (NAR) in response to the coronavirus disease 2019 (COVID-19) pandemic and the critical demand for healthcare professionals. These emergency rules allow additional pathways to complete necessary training to enter the workforce. Filed as WSR 22-19-007.

WAC 246-980-025 amendments and adopting a new rule section, WAC 246-980-012 for home care aides. Establishing alternate certification timeframes for long term care workers in an approved training program for nursing assistant-certified (NA-C) practitioners. These alternate timeframes were developed in collaboration with the Department of Social and Health Services and the Nursing Care Quality Assurance Commission. Due to impacts from the coronavirus disease 2019 (COVID-19) pandemic, long term care workers experience significant delays when completing training, testing, and certification as a nursing assistant-certified (NA-C). Often these delays prevent workers from meeting statutory or regulatory timeframes. By establishing alternate, extended timeframes for certification, the Department of Health (department) is enabling these workers to continue participating in the healthcare workforce as they pursue NA-C certification. Filed as WSR 22-19-027.

In a Dear Provider letter dated October 7, 2022, providers are informed that DSHS and the DOH have created the Epidemic Preparedness and Response Guidelines for licensed and certified long term care facilities and agencies in response to Engrossed Substitute House Bill (ESHB) 1218. 

These guidelines can be used as a tool to assist you in creating an epidemic preparedness plan unique to your facility. It is important to note these guidelines are not mandatory or regulatory. The guidelines do not supersede existing state licensing regulations or Conditions of Participation for federally funded programs. For questions, email Torre Wright, Epidemic Preparedness and Response Specialist or call (564) 200-3510.

Long Term Care facilities in Snohomish County are experiencing a disturbing uptick in COVID cases. Currently 13 facilities have a total of 203 associated COVID cases. That is an increase of 5 facilities in one week and an additional 121 cases from the previous week. 

• 5 SNFs with 151 cases (+3; +109)
• 4 ALFs with 44 cases (+0; +8)
• 4 AFHs with 8 cases (+2; +4)
• 0 other facility with 0 cases (no change)

Snohomish Health Officer, James Lewis, MD, MPH would like to remind LTC facilities that ideally should have treatment plans for residents for COVID (and other communicable diseases such as influenza). A resource developed by Dr. Lewis for King County can be found here. 

​​​Click here for the letter from Washington Health Care Association, LeadingAge Washington, and the Adult Family Home Council of Washington regarding the CDC guidelines for COVID management in long term care.

We are requesting Secretary Shah’s support for the adoption of these guidelines for Washington State in an effort to create clarity and alignment with regulatory expectations. We will continue to press this approach as the Department of Health considers this matter. If you have thoughts or examples related to this approach, please email Lauri St. Ours on the WHCA team.

Governor Jay Inslee has announced plans to lift the COVID-19 state of emergency October 31. Though the Washington State emergency orders are ending, coronavirus remains a workplace hazard and employers must take precautions to prevent the spread of the virus.

What does not end October 31 are the Health Emergency Labor Standards Act (HELSA) requirements that remain in effect as long as there is a public health emergency declared by the President of the United States. The current presidential emergency declaration is set to expire on March 1, 2023; however, President Biden may elect to continue it at that time.

HELSA requirements include:

• Frontline workers who contract COVID-19 are entitled to workers’ compensation wage replacement and medical benefits under a rebuttable presumption that exposure to disease occurred on the job. Under another state law, health care workers are entitled to these benefits, as well.
• Employers with 50 or more employees must continue to report COVID-19 outbreaks to L&I within 24 hours by calling 1-800-4-BESAFE (1-800-423-7233).
• Employers must notify employees of COVID-19 exposures at work.
• Non-health care employers must notify staff and others at the workplace of a potential exposure to COVID-19 within one business day.
• Health care facilities must notify staff and others at the workplace about high-risk exposures within 24 hours.
• Employers are prohibited from discriminating against high-risk employees for seeking accommodations for COVID-19.

For more information on HELSA, click here.