COVID-19 UPDATE #239
April 8, 2022
UPDATE TO COVID-19 EMERGENCY DECLARATION BLANKET WAIVERS FOR SNFs
CMS has issued a QSO memo entitled Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers (QSO-22-15-NH & NLTC & LSC)​, which provides an update to COVID-19 emergency declaration blanket waivers for nursing homes and intermediate care facilities for individuals with intellectual disabilities and allows 30 or 60 days for reimplementation of several areas that have been under blanket waivers.
CMS will end specified waivers in two groups: 

  • ​60 days from issuance of this memorandum - Monday, June 6, 2022 
  • Physical Environment
  • Life Safety Code (LSC) and Health Care Facilities Code (HCFC) ITM
  • Outside Windows and Doors
  • Life Safety Code-Fire Drills & Temporary Construction
  • Paid Feeding Assistants for LTC facilities
  • In-Service Training for LTC facilities
  • Training and Certification of Nurse Aides for SNF/NFs 

  • ​30 days from issuance of this memorandum - Saturday, May 7, 2022 ​
  • Resident Groups 
  • Physician Delegation of Tasks in SNFs
  • Physician Visits
  • Physician Visits in Skilled Nursing Facilities/Nursing Facilities
  • Quality Assurance and Performance Improvement (QAPI)
  • Detailed Information Sharing for Discharge Planning for Long-Term Care (LTC) Facilities
  • Clinical Records 
 
Residential Care Services (RCS) will be working with the state Department of Health and CMS over the next few days to clarify the changed waiver requirements and will release a provider letter as soon as they have clear details. In the meantime, if you have questions, please email them to RCSPolicy@dshs.wa.gov.
EMERGENCY RULE ADOPTION
WAC 296-62-600 and 296-62-601 | Public Health Emergency Reporting and Notification Requirements for Infectious and Contagious Diseases, and Public Health Emergency Voluntary Personal Protective Equipment Usage

The Division of Occupational Safety & Health (DOSH) of the Washington State Department of Labor & Industries (L&I) is renewing its emergency rules regarding related reporting and notification requirements for infectious and contagious disease and permitted voluntary use of personal protective equipment during a public health emergency. These requirements are under RCW 49.17.062 and RCW 49.17.064, 2021’s Health Emergency Labor Standards Act (HELSA), and RCW 49.17.485. This emergency rule supersedes WSR 22-01-047 filed on December 7, 2021.

The emergency rule includes requirements for when there is a public health emergency for an infectious or contagious disease and as such, the requirements are applicable to COVID-19.

Under the emergency rule:

  • Employers with more than 50 covered employees at a workplace or worksite are required to report infectious or contagious disease outbreaks of 10 or more employees to L&I;
  • Definitions for Covered Employee, Public Health Emergency, Worksite or Workplace and Test-confirmed are included;
  • Employees are not required to disclose any medical condition or diagnosis to their employer;
  • Employers, except for certain healthcare employers, are required to notify employees in writing of potential exposures within one business day; and
  • Employees and contractors must be permitted to voluntarily use personal protective equipment.

In addition to the previous rule, this emergency rule adds requirements for healthcare employers to provide written notification to employees of high risk exposures within 24 hours. A high risk exposure is one where the healthcare worker is exposed to COVID-19 at work without the appropriate personal protective equipment being worn.

L&I filed a Preproposal Statement of Inquiry (CR-101) on May 13, 2021, WSR 21-11-051, regarding permanent amendments to existing permanent rules to address hazards from COVID-19 or other outbreaks of infectious or contagious diseases. Some parts of the emergency rule will be considered for permanent rulemaking.

To view the updated rule, visit the L&I website.
BI-WEEKLY COVID-19 FACILITY STATUS UPDATES DISCONTINUED
Residential Care Services has announced that providers will no longer be requested to complete the bi-weekly COVID-19 Facility Survey, effective immediately. A Gov.delivery message was also sent on April 7, 2022.

  • Background: On April 20, 2020, in a Dear Provider/Administrator letter the department requested ongoing COVID-19 facility status updates. Providers were asked to visit the DSHS/ALTSA website twice weekly, on Monday and Thursday by midnight, to update the COVID-19 status of residents and clients, staff numbers, census, and COVID-19 test kit training needs. This reporting tool was used to capture Washington State COVID-19 facility status and CDC National Healthcare Safety Network (NHSN) information for facilities that preferred to streamline data reporting or did not yet have NHSN user accounts.
  • Effective Immediately: The COVID-19 Facility Survey is no longer requested. The Facility Survey reporting link will no longer be active or accessible on 04/30/2022. Facilities who have used this site to report NHSN data are encouraged to enter data directly into NHSN or establish active NHSN user accounts for direct reporting.
  • Facilities Must Continue Complaint Resolution Unit (CRU) Reporting for COVID-19 or other communicable disease outbreaks. Facilities are requested to report all resident and staff COVID-19 cases to the CRU.
 
RCS thanks you for your diligence in reporting and managing disease outbreak throughout this worldwide pandemic. They are adapting reporting and response requirements in response to the evolving pandemic conditions.
NEXT STEPS FOR SNFs USING 1135 WAIVER FOR NURSE AIDE TRAINING AND CERTIFICATION
The release of CMS QSO-22-15-NH & NLTC & LSC has caused concern and confusion as to what it means for the ability of nursing homes to employ Temporary Nurse Aides (TNAs). AHCA understands members' concerns and challenges, as the TNA role has been invaluable to the care of residents throughout the pandemic and TNAs serve as key support to the other staff in nursing homes.

The American Health Care Association (AHCA) is seeking some clarifications from CMS, and in the meantime, has outlined key takeaways and next steps facilities can take to prepare for the upcoming end of the 1135 waiver.

Please note: Yesterday’s announcement about waiver end dates does not impact the 3-Day Stay or the Spell of Illness waivers. Those waivers remain in force nationwide for all hospitals, communities, and SNFs. AHCA will continue to advocate for innovative approaches to resident care and services and seek new ways for enhancing the workforce to support members in providing quality care to residents. Please email questions to COVID19@ahca.org.
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.