COVID-19 UPDATE #271

November 3, 2022

Governor Inslee ended the state of emergency due to the COVID-19 pandemic on October 31. As a result, proclamations 20-36, 20-52, 20-65, and 20-66 were rescinded on October 27, 2022. This resulted in the Washington State vaccine requirement for health care workers ending. However, federal vaccination requirements remain in place for skilled nursing facilities who must continue to ensure that staff meet the vaccination requirements outlined in F888.  

With the overlay of the Washington state vaccine mandate requirements now gone, it is important that all SNFs revisit the federal requirements to ensure compliance and note the recent changes outlined by CMS in QSO Memo 23-02-ALL. Facility staff vaccination rates under 100% constitute noncompliance under the rule. The facility must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID-19. CMS states that staff are considered fully vaccinated if it has been two weeks or more since they completed a primary vaccination series for COVID-19. The completion of a primary vaccination series for COVID-19 is defined as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine. CMS goes on to state that regardless of clinical responsibility or resident contact, the policies and procedures must apply to the following facility staff, who provide any care, treatment, or other services for the facility and/or its residents: 

• Facility employees 
• Licensed practitioners
• Students, trainees, and volunteers and
• Individuals who provide care, treatment, or other services for the facility and/or its residents, under contract or by other arrangement

The policies and procedures do not apply to the following facility staff:

• Staff who exclusively provide telehealth or telemedicine services outside of the facility setting and who do not have any direct contact with residents and other staff and
• Staff who provide support services for the facility that are performed exclusively outside of the facility setting and who do not have any direct contact with residents and other staff 

The policies and procedures must include, at a minimum, the following components: 

• A process for ensuring all staff (except for those staff who have pending requests for, or who have been granted, exemptions to the vaccination requirements or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations) have received, at a minimum, a single-dose COVID-19 vaccine, or the first dose of the primary vaccination series for a multi [1]dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the facility and/or its residents

If you have questions, please contact Elena Madrid via email or call 1-800-562-6170 extension 105.

According to Department of Health (DOH), no matter which side of the mountains you reside, the trajectory of case rates closely resembles the same patterns for 65 and 80+ ages case rates. These last two categories of elderly folks have the highest rates of virus and are also the most vulnerable to it. Residents can’t be well protected if the virus is coming in through staff members and/or visitors because of what’s circulating in a community at any given time. As we know, there are current variants working to escape prior vaccine effectiveness, so getting vaccinated with the updated bi-valent will help all to be better protected.

This information demonstrates the necessity to continue efforts at increasing LTC staff demand for vaccines to ensure ongoing resident safety as we return to normal and learn to live with COVID-19 during the fall and winter seasons. Updated education can help provide talking points, and support LTC providers in making a strong recommendation for staff and residents to get boosted. Please let DOH know if there’s any way they can help.

Included below are some resources to consider for sharing with your staff, including a few quick 2-minute videos for stand-up meetings or shift start huddles, along with posters for break rooms and restrooms. DOH recommends, if possible, that something from the list be shared out with staff each week, and at least once each week over the next several weeks to help teams get educated and vaccinated. DOH will be sharing additional tools in the future for ease of use.  

1. FDA Video, 2 minutes, why do you need a bi-valent?
2. CDC Poster for break rooms or restrooms: CV-19 Tool Kit 
3. A new short video on “How does flu make you Sick”
4. Make a Strong Flu Vaccine Recommendation
5. Seniors vaccination Factsheet
6. Poster - "Take 3 Actions"
7. Brochure - "Take 3 Actions"

The department filed the following emergency rules with the Code Reviser's Office on October 24, 2022, and October 26, 2022. 

Chapter 388-06 WAC 120-Provisional Hire-Pending FBI Background Check Results which reinstates the fingerprinting requirement for providers that were suspended due to the public health emergency. To view this rule please click on WSR 22-22-025.

Due to the prolonged pandemic and associated difficulties accessing caregiver training and certification testing, DSHS adjusted the dates that caregiver training (including specialty training) and certification must be completed. The updated dates will be published in WAC 388-112A-0081. To view this amended rule please click on WSR 22-22-043.

In a Dear Provider letter dated October 31, 2022, CMS released revised QSO-20-38-NH, updating facility testing requirements for staff and residents. The letter addresses the CMS guidance for SNFs outlined in Revised QSO-20-38-NH. The letter addresses the following topics:

• Reporting Updates
• Updates to Testing of Staff and Residents with COVID-19 Signs and Symptoms
• Testing of Staff and Residents During an Outbreak Investigation
• Testing of New Admissions
• Resident Testing Refusals
• Other Testing Considerations

For any additional questions, email Molly McClintock, Nursing Home Policy Program Manager or call (360) 742-6966.

In a Dear Provider letter dated October 31, 2022, amended November 3, 2022, nursing home administrators are provided updated guidance for nursing home visitation. The letter addresses CMS guidance regarding the following:

• Visitors with a positive COVID-19 Test
• Visitors Exposed to Someone with COVID-19
• Indoor Visitation
• Indoor Visitation During an Outbreak Investigation
• Communal activities, Ding, and Resident Outings

The procedures are effective immediately and you may view them by clicking here. Skilled nursing facilities must follow the state of Washington DOH guidance dated October 31, 2022. Please view the letter for updated information effective immediately.

LTC facilities including SNFs must comply with the Secretary of Health Masking Order. This order applies to “every person” when indoors in a LTC facility. However, there are a number of exceptions and exemptions. Please see page 3 of the order for more details.

The DOH will host a COVID-19 Bivalent Booster Safety and Administration webinar on Tuesday, November 8, 2022, from 12 noon to 1 PM. The webinar will cover safety data related to COVID-19 bivalent vaccine booster recommendations and discuss the updated booster schedule for everyone 5 years and older. This webinar will be recorded, and continuing education will be available for nurses.

Learning objectives:

1. Discuss safety studies for COVID-19 bivalent vaccines
2. Describe updated COVID-19 bivalent vaccine schedule
3. Identify strategies to prevent and address COVID-19 bivalent vaccine administration errors

To register, click here.