COVID-19 UPDATE #205
November 12, 2021
CMS ISSUES ADDITIONAL QSO GUIDANCE FOR SNFs
The Centers for Medicare and Medicaid Services (CMS) dropped two revised QSO memos today, November 12, 2021. The first memo, CMS QSO-20-39-NH addresses Nursing Home Visitation-COVID-19. The Department of Social and Health Services Residential Care Services and the Department of Health are currently reviewing this information in conjunction with the Washington State LTC Safe Start Plans. At this time, facilities need to continue to follow the LTC Safe Start Plans until further decisions are made by the Departments and Governor’s Office regarding any changes in relation to the CMS guidelines for skilled nursing facilities.

The second memo, CMS QSO-22-02-ALL, is regarding Changes to COVID-19 Survey Activities and Increased Oversight in nursing homes. The memo addresses steps that CMS is taking to assist state Survey Agencies (SAs) dealing with a backlog of complaint and recertification surveys. These steps include:
  • Revising the criteria for conducting COVID-19 Focused Infection Control (FIC) Surveys;
  • Guidance for resuming recertification surveys; and
  • Temporary guidance and minor flexibilities related to complaint investigations.

CMS is also announcing increased oversight in nursing homes to allow a more focused review of quality-of-life and quality-of-care concerns. As additional information or guidance becomes available regarding these “surprise” memos, WHCA will promptly communicate this to our members. If you have any questions, please contact Elena Madrid.
DEAR ADMINISTRATOR LETTERS CLARIFY HEALTH CARE PROVIDER SCREENING
In a Dear Administrator letter dated November 8, 2021, all providers are given clarification on screening health care providers - such as physicians, nurses, and physical or occupational therapists - entering facilities to provide resident care. In a letter dated November 18, 2020, all providers were informed of the need to screen health care providers. This November 8, 2021, letter clarifies that health care provider screening is different from the screening for other individuals entering the facility and should follow guidance from the Centers for Disease Control and Prevention (CDC). The guidance states:
  • A higher-risk exposure for health care providers means:
  • They had a prolonged close contact with a patient, visitor, or other health care provider with a confirmed COVID-19 infection and one of the following:
  • The health care provider was not wearing a respirator or face mask; or
  • The health care provider was not wearing eye protection when the person with a COVID-19 infection was not wearing a cloth mask or facemask; or
  • The health care provider was not wearing all recommended PPE while performing an aerosol-generating procedure.
  • In general, vaccinated health care providers who have had a higher-risk exposure but do not have symptoms of COVID-19 must not be restricted from entering the facility. This also applies to health care providers who have recovered from a COVID-19 infection in the prior 90 days.
  • Unvaccinated health care providers who have been given an accommodation to continue working must not be allowed to enter the facility for 14 days after their last higher-risk exposure.

If providers have questions, the letter indicates they can email the RCS Policy Unit.
NEW TEMPLATE POLICIES AND PROCEDURES AVAILABLE ON CMS STAFF VACCINE MANDATE | SNF
Last week, the Centers for Medicare and Medicaid Services (CMS) published an Interim Final Rule (IFR) requiring skilled nursing facilities, nursing facilities, and ICF-IIDs to establish a policy ensuring that all eligible staff be vaccinated for COVID-19 or request a medical or religious exemption. 

The implementation dates for this rule are as follows: 
  • Phase 1 – December 6, 2021: Staff must have received at least the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine.
  • Phase 2 – January 4, 2022: Staff must be fully vaccinated, except staff who have been granted exemptions, or those for whom COVID-19 vaccination must be temporarily delayed as recommended by the CDC due to clinical precautions and considerations. 

It is important that providers put policies and procedures in place NOW to come into compliance with these requirements. To assist members, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) has developed a template policies and procedures that members can personalize to meet their needs. Note that this document will be updated once CMS has released its interpretive guidance. 

AHCA/NCAL will host a webinar on how to implement religious and medical exemptions to the mandate on November 22 at 1 PM PST. Mark your calendars, and WHCA will provide login information when it is available.

CMS’s Staff Vaccine Mandate: Implementing Religious & Medical Exemptions 
Presented by Craig S. Roberts and Henry S. Shapiro, labor and employment attorneys with Jackson Lewis, P.C. 
Monday, November 22, 2021 | 1 PM PST
Watch for login information next week.
OSHA ETS FOR COVID-19 IN HEALTHCARE
WHCA received notification from the Department of Labor & Industries (LNI) Division of Occupational Safety and Health (DOSH) that they are working diligently to ensure their response to OSHA's Healthcare ETS is in close alignment with existing DOSH rules and policies, current Department of Health (DOH) guidance, and Governor proclamations, as well as being workable for the stakeholder community. The review process is taking a bit longer than initially anticipated, and they are projecting a release of the rule on or around December 1, 2021.
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.