COVID-19 UPDATE #259

September 2, 2022

Yesterday, the Advisory Committee on Immunization Practices (ACIP), with approval from the Centers for Disease Control and Prevention (CDC), recommended the updated Moderna and Pfizer-BioNTech bivalent COVID-19 boosters. These new “bivalent” vaccines are designed to fight the Omicron strains of COVID-19 more effectively. 

The bivalent COVID-19 vaccine will be administered as a single booster dose to those who previously completed a primary series of COVID-19 vaccine. Eligible individuals should wait at least two months after receiving their primary series or prior monovalent booster before receiving the bivalent booster. Individuals with a prior COVID-19 infection should wait three months from symptom onset or a positive test (if asymptomatic) before receiving the bivalent booster.  

The approval and recommendation to use the monovalent Pfizer-BioNTech COVID-19 boosters for persons aged 12 years and older and the monovalent Moderna COVID-19 booster for persons 18 and older are repealed and replaced with recommendations to use the updated bivalent vaccine. This means individuals do not need to choose which booster to receive as there is only one booster available; the bivalent is now the sole booster.  

The recommendations also confirmed that co-administration of the bivalent and influenza vaccine are allowed without contraindications. Therefore, providers should offer both influenza and COVID-19 vaccines during vaccine clinics if a person is eligible for both. 

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) has been meeting with the CDC and LTC pharmacy partners to ensure LTC remains a top priority for access to this booster. Facilities should contact their LTC pharmacies and schedule bivalent booster and influenza clinics for the coming months.  

Please contact COVID19@ahca.org with questions.

The bivalent booster is not yet available in our state. CMS has notified AHCA that SNF providers should continue to use the definition of “up to date” based on the monovalent vaccine recommendation until clarifying information is issued by CMS and/or CDC on the definition of “up to date” that incorporates the bivalent vaccine Facilities should not be using the lack of this booster as a criteria for screening or denying admission of potential residents.

In a Dear Administrator letter dated August 26, 2022, providers were informed the Department of Social and Health Services (DSHS) filed a CR-103P on August 11, 2022, adopting amendments to Chapters 388-76 (Adult Family Home Minimum Licensing Requirements), 388-78A (Assisted Living Facility Rules), 388-97 (Nursing Homes), and 388-107 (Licensing Requirements for Enhanced Services Facilities) WAC. These changes are in compliance with Engrossed Substitute House Bill (ESHB) 1120 (Chapter 203, Laws of 2021), a portion of which requires the department to write rules to re-establish inspection timelines that were suspended due to the COVID-19 pandemic.

The adopted rules are published in the Washington State Register under WSR 22-17-051. DSHS held a public hearing on July 26, 2022, and did not receive any comments on the proposed changes. The department did receive one question asking for clarification, which you can find on the Concise Explanatory Statement on Long Term Care Professional pages found here. The permanent rule change will be available no later than two weeks after the rule is published in the Washington State Register. If you have questions, please email Libby Wagner, Policy Program Manager, or call her at (360) 464-0484.

The Department of Health (DOH) has released a new tool, a Vaccine Booster Discussion Guide. It is a great resource to help staff with fall vaccine planning, preparations, and resident immunization discussions. 

The tool provides the discussion scenarios, and offers empathic responses and specific wording for staff to use in vaccine discussions to help address resident concerns. The tool also includes information for staff on many of the core reasons or beliefs as potential sources for individual vaccine concerns. The person-specific approach provides information from trusted messengers and a strong vaccine recommendation is proven to help move the needle on vaccine uptake. The tool can help staff better understand a resident’s situation using an equitable perspective. Protocols are offered for staff to help a recipient decide if vaccine is right for them in their specific situation.

Assisted living facilities, enhanced services facilities, and adult family homes that conduct medical testing (such as COVID-19 testing or blood glucose testing) or act on results of medical tests done in their facilities are required to have a Washington State Medical Test Site License (often referred to as a CLIA waiver).

To help assisted living facilities and homes understand this requirement, the Department of Health Laboratory Quality Assurance will answer pre-submitted questions during a call on September 22. To submit a question, please email hai-covid@doh.wa.gov and put "MTSW Q&A Call" in the subject line. Questions submitted by September 10 will be included in the Q&A. If you are not registered for the DOH weekly Q&A call (every Thursday from 11 AM – noon), you can register here.

The Centers for Medicare and Medicaid Services (CMS) has revised QSO-22-15-NH & NLTC & LSC: Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers to provide more information related to waivers of the Nurse Aide Training Competency and Evaluation requirements.  

CMS has created a formalized process to submit a request for a time-limited waiver via two options:  

1. ​​Individual Facility Waiver: When there are localized barriers to training/testing in a state or county not otherwise covered by a waiver, facilities may request a waiver by providing documentation of the barriers. The documentation must include information demonstrating that the aide(s) have attempted to become certified (e.g., enrollment in training or testing), but the NATCEP entity cannot accommodate the applicant(s) at this time.  
2. Statewide or County Waiver: When there are widespread barriers to training/ testing that are statewide or in a particular county within a state, the state agency may submit a request for the waiver for the affected jurisdiction. The state agency must provide documentation of the status of their NATCEP program and a plan for remedying the situation. 

Washington State has requested a statewide waiver and has yet to hear from CMS if the waiver has been granted.

CMS indicated a state or facility cannot attain or retain a waiver longer than the declaration of a public health emergency (PHE), and it will grant these waivers for a timeframe that is as short as possible, only while the declaration of a COVID-19 PHE is still in effect. If the PHE ends during or before the granted period of waiver for a facility or a state or a county, the waiver also ends.

AHCA/NCAL has a few legislative priorities that are gaining momentum due to the hard work of the association and its advocates. HR 7744, Building America’s Health Care Workforce, also known as the TNA Workforce Bill. Rep. Brett Guthrie (R-KY) introduced this bipartisan bill with cosponsors Rep. Madeleine Dean (D-PA) and Rep. David McKinley (R-WV) in May 2022. Currently, in nursing homes, the 1135 waiver on training and certification of nurse aides allows vital support to critical staffing needs for care of residents during the pandemic. Based on this waiver, in spring 2020, AHCA/NCAL created a TNA training course. The TNA waiver ended on June 6, 2022, and only four months are provided in statute for TNAs to become CNAs. This bill provides a responsible grace period of 24 months to continue the emergency waivers after the public health emergency ends, enabling all TNAs who wish to become CNAs. The grace period accommodates the time that is needed for training and testing capacities to meet demands. 

After targeted lobbying efforts, including meetings and facility tours with MOCs, this bill currently has 22 cosponsors, and a Senate version of the bill is expected to be introduced this fall. Read more.

The Tacoma Pierce County Health Department is sharing updates for long term care providers to assist in their efforts to continued response to the pandemic. The updates have information regarding testing, infection control, vaccines, and more.