COVID-19 UPDATE #46
June 18, 2020
LEGISLATIVE "FOUR CORNERS" EXTENDS WAIVERS FOR LTC
Late yesterday, in a letter to Governor Inslee, legislative leaders (the “four corners”) extended COVID-19 related emergency rule waivers until July 1, 2020. This is consistent with past actions that extended waivers for a two-week period. Since a gubernatorial emergency proclamation is only valid for 30 days, subsequent extensions must be approved by the majority and minority leaders in the State Legislature. Speaker of the House Laurie Jinkins (D-27), Representative J.T. Wilcox (R-2), Senator Mark Schoesler (R-9) and Senator Andy Billig (D-3) all must concur for a waiver to be extended.

For long term care providers, the waiver of the 120-day requirement for nursing assistants registered to become CNAs and restrictions on visitors are continued with this action. The waiver for long term care worker training and certification requirements for assisted living are also continued. Click here for the updated WHCA tracker.
CONTINUED COVID-19 TESTING IN ASSISTED LIVING COMMUNITIES
Point-prevalence COVID-19 testing for all residents and staff is winding down for assisted living facilities with memory care units. It is likely the Secretary of Health will order all assisted living communities to complete the same point-prevalence testing in the coming weeks. If you have not done so already, it is recommended you determine the prescribers who will be responsible for ordering the tests (for both residents and staff), and who will perform the testing in your community.

PRESCRIBER ORDERS
All tests must be ordered by a prescriber – MD, ARNP, or PA. Facilities that have already completed testing have used a wide array of methods to accomplish these written orders, including:
  • For residents, securing orders from their primary care providers
  • Hiring or contracting with a local or regional MD, ARNP, or PA
  • Contracting with an outside company who provides this service
  • Local clinics or hospital practitioners
  • Visiting medical providers (particularly if you have a current contract with this entity)

Because it may be likely that you will be expected to re-test at a later date, particularly in the event you have a positive case in your facility, it is recommended you consider an extended relationship with any or all prescribers to minimize future worry in obtaining necessary orders.

TESTING
Performing facility-wide testing of all residents and staff may prove difficult due to limited qualified staff. RNs, LPNs, and qualified delegated caregivers are all good options for completing facility-wide testing. If your facility does not have qualified staff to support this effort, you will want to notify DOH as soon as possible once the Secretary of Health orders the testing be done. Your local health jurisdiction is also a good option, as is a sister facility or neighboring long term care facility. There are a selected number of companies that may also be able to accomplish this order for a fee.

Because it may be likely that you will be expected, or prefer to, test in-house for any symptomatic or exposed resident or employee at a future date, you should consider how this can be managed with your current staffing model, or look to a local clinic or other setting that can perform these occasional tests as needed.

Some WHCA Associate Business members offer prescriber orders and/or lab services and may be able to assist in creating a plan for orders and testing as needed. Below are the WHCA Associate Business members that offer laboratory services specific to COVID-19 testing; contact information is provided.

COVID Response Partners, PLLC
David Ohlson, DO
Tel (206) 604-3633
 
Fidalab
Blake Crockett
Tel (360) 584-4998
 
Schryver Medical-Diagnostic Labs (Trident)
Shawn Barron
Tel (888) 418-9555
 
For assistance or additional information on this topic, please contact Vicki McNealley or Elena Madrid .
COVID-19 IMPACTS STATE BUDGET
On June 17, 2020, the Washington State Economic and Revenue Forecast Council announced a revenue shortfall is $8.9 billion over three years. Here is the link to the forecast analysis. The Council believes that the impact of lost economic activity due to the COVID-19 pandemic will extend for many years. The revenue forecast has been reduced by $4.5 billion in the current (2019 – 2021) biennium and by $4.4 billion for the next (2021-2023) biennium. There is speculation that the Legislature will likely convene in a special session in August to address the current revenue shortfall for this biennium. We will continue to keep you informed as things progress. If you have questions, please contact WHCA CEO Robin Dale .
FUTURE OF SNF FMAP PAYMENTS UNCLEAR
Nursing facilities in Washington are currently receiving a $29ppd Medicaid reimbursement rate add-on. The add-on is directly attributable to the enhanced FMAP funding that was approved in February. As soon as WHCA learned that enhanced FMAP funding would be available to states, WHCA, in consultation with Bill Ulrich, began urging the Department to determine how much of the overall enhanced FMAP funding was attributable to skilled nursing, and then argued that all of the funding should be made available to SNFs. WHCA was successful in convincing the Department to apply all enhanced funding that could be attributable to SNFs toward a rate add-on of $29ppd.

Effective July 1, 2020, SNF Medicaid reimbursement rates will be rebased for the first time in two years. DSHS is currently working on projected rates, and those figures will be issued by the Department shortly. At this point we are unsure of the status of the $29ppd FMAP funding. We have urged the Department to continue the FMAP payments to SNFs as long as these funds are being provided by the federal government. The Department has been supportive of our request, but the decision lies with the Office of Financial Management (OFM). OFM has yet to make a decision whether to continue the $29ppd FMAP payments or to divert some or all of the funding elsewhere. If OFM fails to make a decision by the end of this week, projected SNF reimbursement rates will be issued without including the $29ppd FMAP funding. If OFM ultimately decides to continue some or all of the FMAP payments, rates will be adjusted and retroactive payments will be provided.

We continue to press the Department on maintaining the additional $29ppd of FMAP funding for the pendency of the COVID-19 State of Emergency. If you have questions, please direct them to WHCA CEO Robin Dale . Thanks to Bill Ulrich of Consolidated Billing Services for his help with drafting this article.
DEAR ADMINISTRATOR LETTERS ADDRESS REOPENING OF WASHINGTON STATE AND RESIDENT VISITS TO THE COMMUNITY
In Dear Administrator letters to assisted living and skilled nursing professionals dated June 16, 2020, the Department of Social and Health Services (DSHS) provides insight on the phased reopening under the Safe Start Washington plan. While counties progress through the Phases at different paces (some counties are in Phase 1, others in Phase 2, and a few have moved into Phase 3), facilities must be mindful of how each Phase components impact residents.

Purusant to the letters, “Under resident rights laws and rules, residents are able to participate in activities away from the home if desired or needed. A recent update to the four phase approach for the re-opening of Washington also allows for those in “high risk populations,” such as long term care residents, to engage in activities that are deemed permissible at each phase of the plan.”

 The letter continues to advise facilities that if a resident plans to leave the facility for any outing, there are several considerations to be made. The letters also outline suggested protocols and infection control procedures to implement for each setting. If you have questions about assisted living, please contact Jeanette Childress , Assisted Living Facility Program Policy Unit Manager. If you have questions about skilled nursing, please contact Lisa Herke , Nursing Home Program Policy Unit Manager.
DOH EXPLAINS COVID-19 NEGATIVE TEST RESULTS
The Department of Social and Health Services (DSHS) and the Department of Health (DOH) have collaboratively developed an information sheet describing for staff and residents what a negative COVID-19 test result means, what kind of test was administered, and resources for the resident or staff to get additional information about COVID-19 testing. Click here to access the document.
DHHS CARES ACT PROVIDER RELIEF FUND APPLICATON TUTORIAL WEBINARS FOR ASSISTED LIVING AND MEDICAID-ONLY NURSING CENTERS
The DHHS CARES Act Provider Relief Fund Medicaid Application Process, while a positive step, also has come with an array of questions and concerns. Unlike Tranches 1-3, the Medicaid Allocation requires an application requiring an array of data. Along with other provider groups, AHCA/NCAL submitted a lengthy list of questions about the Application process.

Today, DHHS announced two Medicaid Allocation Application tutorials.  The date options are below. Please note you must pre-register.

Medicaid Allocation Applications are due on July 20. Because pre-registration is required, we strongly suggest registering as soon as possible.
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.