COVID-19 UPDATE #153
April 12, 2021
CMS ANNOUNCES CHANGES TO 1135 WAIVERS
Last week, CMS issued a memo announcing it is ending four of the 1135 waivers issued in response to the COVID-19 Public Health Emergency (PHE). These changes are effective May 10, 2021. The four waivers that will be ending relate to prior notification of room and roommate change, prior notice of transfer/discharge, certain care planning requirements and MDS submission. 

CMS also provides clarification and recommendations for Nurse Aide Training and Competency Evaluation Programs (NATCEPs). Currently, CMS is keeping the current nurse aide waiver. 

Summary of Removed Waivers
CMS is making the following changes to blanket 1135 waivers, effective May 10, 2021. CMS’ rationale for removing these waivers is that facilities have developed processes for completing these requirements at this point. 
  • ​Resident roommates and grouping: ​
  • ​Ending: waiver of notification prior to Resident Room or Roommate Change at 42 CFR §483.10(e)(6). 
  • Keeping: related waivers at 42 CFR 483.10(e)(5) and (7) when change of rooms is done solely for purposes of cohorting due to COVID-19. 
  • Impact: You must provide notice before a room or roommate change except when the change is solely for COVID-19 cohorting. 
  • Resident transfer and discharge:
  • ​​​Ending: waiver of notification prior to Transfer and Discharge at 42 CFR §483.15(c)(4)(ii) 
  • ​Keeping: related waivers at 42 CFR 483.10(c)(5) as well as 483.15(c)(3), (c)(5)(i) and (iv) and (c)(9), and (d) that allow providers to transfer or discharge residents to another long term care facility solely for cohorting purposes without prior written notice. 
  • Note: It is important to read​ the details of these waivers to ensure you are applying them correctly and provide notice as soon as possible when transferring or discharging residents for cohorting purposes. 
  • Impact: You must provide written notice of transfer or discharge at least 30 days in advance, or as soon as practicable in certain situations, before the transfer or discharge. 
  • ​Care planning requirements: 
  • ​Ending: waiver of certain care planning requirements at §483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i) for residents transferred or discharged for cohorting purposes. 
  • Impact: You must complete baseline care plans within 48 hours of admission and comprehensive care plans within seven days of completion of the comprehensive assessment, according to current regulations. 
  • ​Minimum Data Set (MDS): 
  • ​Ending: waiver of timeframe requirements for completing and transmitting resident assessment information at 42 CFR §483.20. 
  • Keeping: waiver at 42 CFR §483.20(k) related to the Pre-Admission Screening and Annual Resident Review (PASARR).
  • Impact: You must complete and transmit MDS assessments according to current regulations.
The American Health Care Association has provided additional NATCEP information. You can read more about that here.
DSHS UPDATES ASSISTED LIVING INFECTION PREVENTION PATHWAY, ASSESSMENT
DSHS updated its recent Dear Provider Letter regarding restarting survey and included the most recent versions of facility-based infection prevention tools. It is suggested that to best prepare for DSHS full inspections and infection control visits, you use these tools to prepare your staff and evaluate your systems.
DEAR ADMINISTRATOR LETTERS PROVIDE INSIGHT ON EMERGENCY PREPAREDNESS RULES AND EMERGENCY RULES IN SNFs
In a Dear Administrator letter dated April 9, 2021, skilled nursing providers are informed in light of the COVID-19 public health emergency and the updated rules, with QSO-21- 15-ALL, CMS announced revisions to Appendix Z, and expanded the Interpretive Guidelines to incorporate lessons learned from the public health emergency and the new rules. The changes to Appendix Z are at the bottom of the QSO memo. As of the date of the Dear Administrator letter, CMS had not yet updated Appendix Z on their website. The revised guidance is primarily a result of burden reduction rules, and adjusts cycles of updates, and changes to the training and testing requirements. CMS also updated many other requirements listed in the QSO memo and the attached Appendix Z document. The updated rules and guidance are effective immediately. Providers are encouraged to email CMS if they have questions. They can email Lisa Herke or Debra Hoeman as well.

In a Dear Administrator letter dated April 9, 2021, skilled nursing providers are notified that emergency rules amending or suspending some nursing home requirements originally effective April 13, 2020, have been extended for a third time. The extension was effective April 6, 2021, and expires August 3, 2021.

The following rules are amended, suspended, or temporarily repealed:
  • Transfer and discharge rules: Amendment of WAC 388-97-0120 suspends the requirement to provide a bed-hold notice to a resident who leaves the facility.
  • Resident assessment: Amendment of WAC 388-97-1000 removes the timeline requirements from the required resident assessment.
  • Care planning: Amendment of WAC 388-97-1020 removes the requirement to develop a care plan within seven days of completion of the resident assessment.
  • PASRR: WACs 388-97-1915 and 388-97-1975 were amended to permit the level I screening, and if needed, the level II evaluation to occur up to 30 days after admission.
  • Resident groups: WAC 388-97-0920 ensures residents can participate in resident and family groups. The WAC was temporarily repealed. 

If providers have questions, they are encouraged to email Lisa Herke or call her at (509) 209-3088.
DEAR ADMINISTRATOR LETTER INFORMS ALL PROVIDERS OF REIMPLEMENTATION OF SURVEYS, INSPECTIONS, AND EVALUATIONS
In a Dear Administrator letter amended April 8, 2021, all providers are informed that Residential Care Services (RCS) is planning a gradual reimplementation of full surveys, inspection, and evaluations beginning in April. The process will be a hybrid using onsite and remote methods, and will combine the standard survey, inspection, or evaluation process with the focused infection prevention assessment process.

The letter explains the reimplementation will be gradual, starting with small numbers of facilities and homes each month. To prepare for reimplementation, providers are encouraged to conduct mock surveys, inspections, or evaluations using the Standard Operating Procedure and the infection prevention assessment pathway/tools. The letter provides the following links to the tools:

The letter also provides insight on how to minimize RCS staff time in a facility by providing remote access to electronic medical records and preparing adequate space for RCS staff to use during the onsite portion of the survey, inspection, or evaluation for example. The letter also explains that RCS staff are screened prior to conducting survey, inspection, or evaluation. Facility staff may also screen RCS staff upon entry. RCS will wear appropriate PPE and follow all CDC guidance for infection prevention. The letter also explains RCS staff lead will work with you on ways to minimize contact and limit exposure as much as possible during the survey, inspection, or evaluation process.

The letter also explains RCS staff must be given access as they are considered essential workers (see provider letter dated November 18, 2020). As essential workers, RCS staff are not considered visitors and do not sign a visitor attestation, nor are they included in the calculation of maximum capacity. Policies that impose time limits or restrict hours do not apply to the RCS staff conducting surveys, inspections, or evaluations as these may interfere with the process. Providers are encouraged to contact their RCS Field Manager if they have questions.
DOH ENCOURAGES SNFs TO ENTER VACCINATION DATA INTO NHSN
On Friday, April 9, 2021, the DOH released a letter to all skilled nursing facilities requesting they begin entering vaccination data into the NHSN portal. This data will be used to benchmark vaccination rates among skilled nursing facilities nationally and in Washington State, as well as to identify facilities that need resources for staff and resident vaccination. This data will help target vaccine resource improvement efforts and provide critical information to guide future COVID-19 planning and emergency response efforts. On a national level, this data will be evaluated by CDC and CMS to determine needs and the ability to alter current guidance related to facility infection control COVID practices such as activities, dining, masking, etc. It is anticipated that CMS will require this vaccination reporting via NHSN as mandatory for SNFs in the near future. It is paramount that facilities begin this reporting as soon as possible.
LOCAL SOURCES FOR RESIDENT VACCINATIONS
Have you heard about the new Department of Health (DOH) transition plan from Site Vaccine Clinics to meeting new resident vaccinations through local sources? Learn more by watching the webinar or read the plan document.
  1. Work with your existing LTC Pharmacy providers to see if they can provide in house vaccine delivery/services. Local storefront pharmacies may be willing to provide site visits/curbside service for those with mobility issues. Call and ask if possible and to make prior arrangements.
  2. Contact your local health jurisdictions to link with any available mobile vaccine teams that may be available to provide support.
  3. If none of these sources can provide, complete the DOH Survey to be contacted directly. DOH will work to provide available linkages and help address sourcing issues.
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.