COVID-19 UPDATE #20
April 10, 2020
HHS RELEASES STIMULUS FUNDING
This morning HHS released $30 billion to hospitals, nursing homes and other Medicare providers. Providers will receive approximately 6.2% of their 2019 Medicare payments. Funds began hitting providers' bank accounts this morning. These funds are in the form of a grant, not a loan, meaning that the funding does not have to be repaid. Additional information can be found here . 
LEGISLATURE EXTENDS WAIVERS FOR LTC
Yesterday, the leadership from all four caucuses issued a letter extending laws and regulations waived by Governor Inslee by proclamation. Of note, visitation limitations for both skilled nursing and assisted living, and postponement of worker training, FBI background checks, and TB tests for assisted living facilities, remain in effect until May 9, 2020, or cancellation of the State of Emergency, whichever is sooner. Washington’s governor only has emergency authority to waive and suspend laws and regulations for 30 days, unless extended by the Legislature through concurrent resolution. Click here to review the Governor’s powers in a state of emergency. Since the Legislature is not in session, the waiver or suspension of statutory obligations or limitations may be extended in writing by the leadership of the Senate and the House of Representatives--the majority and minority leaders of the Senate and the speaker and the minority leader of the House of Representatives. Click here for the letter. Click here for the list of waived laws and regulations for skilled nursing and assisted living centers.
SKILLED NURSING FACILITY F-MAP UPDATE
As many of you know, the federal government has approved enhanced F-MAP funding of 6.2% for skilled nursing. For the SNF sector in Washington, this translates to $42 million for the current state fiscal year ending June 30, 2020. We have been awaiting clarification from CMS and DSHS whether the increased funding would be effective February 1 or March 1. This morning we received confirmation from DSHS that the funding would be retroactive to February 1, 2020. Payments for February 1, 2020, forward, until the state of emergency is no longer in effect, will take the form of a $29/ppd rate add on. February and March payments will be readjusted to reflect the enhance $29/ppd rate add on. Those adjustments will be paid to skilled nursing facilities in the form of a retroactive patient specific payment. Providers should receive retroactive payment for March on today’s remittance and we anticipate that providers will see the remaining additional adjustment next week or the following week, depending upon the Department’s ability to make mass adjustments in a timely manner. As soon as we have additional information, we will let you know. 
NEW PPE AND TESTING PROCESSES FOR ASSISTED LIVING AND SKILLED NURSING FACILITIES ANNOUNCED TODAY
Residential Care Services (RCS) announced in a Dear Administrator Letter released this morning that the processes for requesting and receiving personal protective equipment (PPE) has changed. 

The Department of Social and Health Services (DSHS) received direction on April 9, 2020, that revises how PPE will be requested and distributed to long term care facilities. The State’s mission is to: 
  • Get appropriate PPE to every long term care facility with a COVID-19 case. 
  • Get surgical masks to every long term care facility without a COVID-19 case so universal surgical masking can occur to prevent pre- and asymptomatic infection from staff to residents or clients. PPE requests will now be received and filled by your local Emergency Management Agency (EMA).

RCS provided a list of all long term care facilities by county to each EMA. The EMA will contact your facility directly to inquire about your PPE needs and will then arrange delivery and set up an ongoing ordering process. RCS stated that facilities should continue to use the DSHS online store as a backup for your emergency needs if your EMA cannot fulfill your request. This allows DSHS to cover the gap if your EMA cannot fulfill your PPE order or cannot respond in a timely manner. 

Included in the letter was also the announcement that the Unified Coordination Group Incident Commander had directed that every resident and staff member of a long term care facility be tested if that facility has a COVID-19 case. At this point, DSHS will be calling all long term care facilities in the next few days to gather the information needed to facilitate the COVID-19 testing. Assisted living and skilled nursing facilities will be asked the following information:
  1. Number of COVID positive or suspected residents 
  2. Resident census 
  3. Total number of licensed beds 
  4. Total number of employees 
  5. Staff trained to administer COVID test (Yes or No)

Please have this information up to date and readily available to expedite the process. As this is an evolving and newly-implemented expectation, changes may be made to the guidance in coming days as more information is obtained.
DSHS DEAR PROVIDER LETTER PROVIDES UPDATE TO STATE AND FEDERAL EMERGENCY WAIVERS 
On April 9, DSHS issued a Dear Provider Letter to update providers about a number of issues, including:

Click here for the current list of waived state regulations for nursing homes, assisted living and health care practitioners.  
ASSISTED LIVING MEDICAID UPDATE
Over two weeks ago, pursuant to federal legislation, CMS approved an additional 6.2% in federal funding for home and community based programs. Since then, WHCA has been pressing DSHS to release the funding to Medicaid Assisted Living facilities. This morning DSHS announced that the funding would be released sometime next week. DSHS is currently working out the details and timing of the rate increase. As soon as we have additional information we will let you know. 
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.