COVID-19 UPDATE #265

October 6, 2022

In a Dear Administrator letter dated October 5, 2022, providers were notified of the statewide 1135 waiver approved by CMS to extend the nurse care aide training and certification deadline to March 29, 2023, (180 Days) or until the end of the Public Health Emergency (PHE) (whichever date comes first) for Washington.  

With assistance from the Nursing Care Quality Assurance Commission (NCQAC), the Department of Health (DOH), Leading Age Washington and Washington Health Care Association (WHCA), the Department of Social and Health Services applied for a statewide 1135 waiver request due to widespread barriers identified for the nurse aide (NA) training and certification program in Washington state. 

It is important to understand that despite having more time to complete this requirement, facilities need to continue moving rapidly towards the goal of achieving certification for all NARs that exceed the 4-month requirement as the PHE may end before March 29, 2023. For questions, please email Molly McClintock, Nursing Home Policy Program Manager, or call her at (360) 742-6966.

On September 23, 2022, the Centers for Disease Control (CDC) and Prevention issued COVID management guidance for nursing home providers as well as residential facilities that provide activities of daily living (such as adult family homes and assisted living facilities). CMS has adopted the CDC standards for nursing homes, but the State of Washington has yet to do so for either nursing homes or assisted living centers. The WHCA team is working with our colleagues from LeadingAge Washington and the Adult Family Home Council of Washington to urge the Department of Health to adopt the CDC standards for all long term care settings including the nuanced community-based care settings of assisted living and adult family homes. We are concerned that over 37,000 Washington residents consider these settings home—and should be afforded the same rights as any individual living in the community.  

Our goal is to ensure that regulators understand the challenges providers are facing related to the sheer volume of regulatory guidance for varying state agencies. Notably, we have worked for the past 32 months to help providers manage a public health emergency that has profoundly impacted workers, residents, and families throughout Washington. Much of our focus with our members has been to provide support and clarity regarding the plethora of regulations, practices, and protocols implemented from a broad variety of regulatory agencies and entities including the Governor’s Office, the Department of Health, the Department of Social and Health Services, the Centers for Medicaid and Medicare Services, the Department of Labor and Industries, the Centers for Disease Control, and 35 local health jurisdictions. With monthly, weekly, and sometimes even daily guidance changes, the risk of regulatory sanction is the forefront for providers operating in the highly regulated care settings we represent. One of the greatest challenges for providers has been to assimilate and follow requirements that have been conflicting, duplicative and/or confusing. We are advocating for the adoption of the CDC guidelines as an opportunity to provide clarity and ensure compliance. 

In the coming weeks, the Department of Health is poised to determine whether to adopt CDC guidelines, or whether the State of Washington will maintain specific state standards. We will keep you apprised about the status of this request. 

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) is urging the Centers for Medicare & Medicaid Services to reissue a blanket waiver allowing America’s nursing homes to employ temporary nurse aides during the COVID-19 public health emergency and beyond. 

“Temporary nurse aides stepped up during the pandemic to serve our nation’s seniors in their hour of need, and now they are on pins and needles waiting to hear if they’ll have a job come Friday,” said Mark Parkinson, president and CEO of AHCA/NCAL. Read more. 

​​​The Centers for Medicare & Medicaid Services (CMS) released an update to QSO Memo QSO-22-25-CLIA​​ which rescinds enforcement discretion for the use of SARS-CoV-2 tests not FDA approved for use among asymptomatic individuals outside of the test’s instructions for use. 

At the start of the pandemic, some but not all of the SARS-CoV-2 Point-of-Care (POC) Antigen (Ag) tests were limited to use on individuals who are symptomatic. In December 2020, CMS released a memo saying it would use enforcement discretion to allow providers with CLIA Certificate of Waiver to use these tests outside of the FDA approved manufacturer’s use. CMS has now rescinded this memo as many POC Ag tests are now approved for both symptomatic patients and serial screening of asymptomatic patients making the waiver no longer necessary.  

AHCA/NCAL recommends that all LTC providers operating with a CLIA Certificate of Waiver using SARS-CoV-2 POC Ag tests check the manufacturer’s instructions for the tests they have on hand to ensure they are FDA approved for both symptomatic and asymptomatic individuals. If not, they must restrict the use of the tests to situations consist​ant with FDA approval. Providers should check the FDA list for allowed uses of existing antigen tests and use them consistent with the FDA and manufacturer’s approval. Providers that violate the manufacturer’s use may be subject to enforcement actions related to the facility’s CLIA Certificate of Waiver. View the full article here. For questions, email COVID19@ahca.org.

The U.S. Department of Labor (DOL) announced an $80 million funding opportunity through its Nursing Expansion Grant Program to support nurse training programs designed to expand the pipeline of nursing professionals. According to the U.S. Bureau of Labor Statistics, it is projected that more than 275,000 additional nurses are needed from 2020 to 2030, and that employment opportunities for nurses will grow at nine percent - faster than all other occupations from 2016 through 2026. 

More specifically, this funding is aimed at addressing bottlenecks in training the U.S. nursing workforce and expand and diversify the pipeline of qualified nursing professionals through two training tracks. The first track (Nurse Education Professional Track) will increase the number of clinical and vocational nursing instructors and educators by training new or upskilling experienced current or former nurses (including retired nurses) into advanced postsecondary credentialing necessary for nurses to become clinical and vocational nursing instructors and educators. The second track (Nursing Career Pathway Track) will train frontline health care professionals and paraprofessionals, including direct care workers, to advance along a career pathway and attain postsecondary credentials needed for middle- to high-skilled nursing occupations during the grant period of performance.  

The deadline to apply for the grant funding is January 6, 2023. For more information and eligibility criteria, click here. 

As we head into the fall and winter months, there will likely be an increase in the number of COVID-19 cases around the country. While vaccination continues to provide the best protection, COVID-19 therapies are widely available to help treat eligible people who do get sick and are at risk of developing severe disease. Antiviral treatments for patients at risk for COVID-19 reduces their risk of hospitalization and death.  

The antiviral Paxlovid (ritonavir-boosted nirmatrelvir) along with Veklury (remdesivir) are the preferred treatments for eligible adult and pediatric patients with positive COVID-19 test results and who are at risk for progression to severe COVID-19. COVID-19 therapeutics should be considered for any COVID-19 patient who meets the eligibility criteria.  

This information sheet summarizes current information about Paxlovid and offers resources about other COVID-19 therapeutics. In addition, a study was done to identify the efficacy of Paxlovid among elderly patients with co-morbidities. The study identified that Paxlovid significantly reduced COVID-19 hospitalizations and deaths. 

On October 4, 2022, the Tacoma-Pierce County Health Department sent a bulletin with several updates regarding boosters, COVID-19 Treatments, infection control and webinars being offered by the Department of Health and Residential Care Services. To view the full bulletin, click here.