Washington counties have seen a large increase in COVID-19 cases over the last few weeks. Positivity rates in many counties (including King, Pierce and Snohomish) are greater than 5%. We would like to bring your attention to the CMS Guidance, where skilled nursing facilities in a county with >5% positivity rates must routinely test all staff weekly. Additionally, Public Health officials are encouraging assisted living facilities to test staff weekly, or as frequently as possible.

You can review the CMS data tracker here. In addition, here is the most recent CMS county-by-county positivity spreadsheet.

At this time, the facilities with long term care residents and independent living residents are required to follow different parts of the Governor’s proclamation, depending upon the resident. Independent living facilities, and the residents in those facilities, are bound by the portion of the proclamation that closes fitness centers. LTC facilities and the residents in LTC facilities still follow Proclamation 20-66, (with the exception of the visitor provisions).

In a Dear Administrator letter to all providers dated November 18, Residential Care Services provides amendments to the Dear Administrator letter of November 17. It is amended to clarify the difference between visitation limitations related to end-of-life visits and essential support persons, and provide that window visits are allowed as an option for outdoor visitation. The letter also highlights that the visitor restrictions apply to all four phases at this time.

In addition, the letter provides clarity that residents have the right to leave the facility and this may result in them participating in holiday gatherings outside the facility or home. The provider should perform the risk assessment to identify the level of risk and implement any measures as indicated by the risk assessment upon the resident's return. The letter directs providers to reach out to their local RCS field manager or local health jurisdiction if they have questions.

It is important to understand the changes in revenue and expense between 2019 and 2020, the funds from outside sources, and the interaction between the multiple funding programs (PRF, PPP, Medicaid). The reporting system opens for providers on January 15, 2021, with a reporting deadline of February 15, 2021. For those providers that did not fully expend PRF funds prior to December 31, 2020, there is a final reporting deadline of July 31, 2021, for the period ending June 30, 2021. Additional information is available here. For questions regarding this information and available services, please contact Consolidated Billing Services, Inc., Bill Hartung, Director of Reimbursement at (509) 448-2067, extension 210, or Bill Ulrich, President/CEO at (509) 448-2067, extension 202.

On November 18, CMS released an alert regarding holiday visitation. During the holidays, facilities, residents, and visitors should continue to follow the guidelines for visitation and adhere to the core principles of infection prevention, such as remaining six feet or more apart, wearing a face covering at all times, and limiting the number of visitors in the nursing center at any one time. Families, residents, and providers need to work together to take precautions during the holidays to help reduce the risk of spread while supporting family and resident engagement as much as possible using these core infection prevention practices. 

CMS recommends against residents leaving the nursing center during the public health emergency because it increases the resident’s risk for exposure to COVID-19. The risk may be further increased by factors such as a resident’s health status, the spread of COVID-19 in the community (e.g., cases or positivity rate), or attendance at large gatherings. Read more.

AHCA/NCAL updated the 3-Day Stay and Benefit Period Waivers for Medicare Part A SNF PPS Fact Sheet here as well as the accompanying webinar here. Read more.

AHCA/NCAL will be hosting office hours on Monday, November 23, at 11 AM PST to provide a high-level overview of the COVID-19 monoclonal antibody and review what facilities need to know about this treatment. There will be a question and answer session at the end. Providers are encouraged to register for this training here. 

If a nursing home’s staff is unsure which training module best meets their needs, CMS is offering an online self-assessment tool here to help them identify their needs and suggest the appropriate training modules that best reflect those needs. A certificate of completion is offered for each completed training course. For anyone interested, the training is free to access on a public CMS website; instructions on how to create an account and take the training are available here. The list of nursing homes at which 50% or more of staff have completed CMS COVID-19 training is here.

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.