COVID-19 UPDATE #219
January 13, 2022
AL AND SNF FACILITIES CAN CONTINUE TO ORDER TESTING SUPPLIES FROM THE DOH
WHCA met with representatives from DOH yesterday and was able to confirm that all long term care facilities can continue to obtain COVID testing supplies from the Department of Health (DOH) warehouse ordering website. There is no cost for these supplies. Unfortunately, like everyone else, the DOH has had issues in the last few weeks with supply chains, unreliable deliveries, and an abundance of orders. As announced last week by Governor Inslee, the state has placed some very large orders and deliveries are anticipated staggered over the next few weeks. WHCA has been able to confirm that an allocation of those supplies has been made for LTC. DOH has also stepped up processing and delivery of orders by adding additional FedEx outgoing shipments from the warehouse, staff to process orders, and upgraded to priority overnight shipping. Due to the current backlog of orders across the state, they are still saying it is taking about 10 days from order placement to shipping. Facilities should continue to order supplies via the DOH website- Smart Sheets system so they are in the queue. The orders for supplies can be placed using Smart Sheets, If you have questions about supplies or ordering, you may email DOH-CBTS.
DEAR ADMINISTRATOR LETTER PROVIDES CDC AND DOH UPDATES
In a Dear Administrator letter dated January 10, 2022, all providers are notified of updates to Centers for Disease Control and Prevention (CDC) and Department of Health (DOH) guidance due to concerns about increased transmissibility of the SARS-CoV-2 Omicron variant. The letter summarizes the CDC and DOH updates and includes what the updates mean to providers, effective immediately. Providers should do the following immediately:
  • Check the Federal Food and Drug Administration site SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests to see if test materials in use by your Long-Term Care (LTC) setting can detect the Omicron variant.
  • Follow CDC Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 related to:
  • High risk exposure for HCP who was wearing a face mask in the presence of an infected person who was not wearing a mask; and
  • HCP Return-to-Work guidance for COVID-19 infection and exposure.
  • LTC settings will need to determine which work restriction mitigation strategy to implement based on their staffing shortage.
  • A facility may be in conventional staffing levels for environmental services, but contingency staffing for nursing.
  • Facilities should return to conventional staffing as soon as resources allow.
  • Any LTC setting at crisis staffing levels should follow the Critical Staffing Management in Long-Term Care Procedures outlined in the October 19, 2021, Provider Letters for each setting.
  • Consult DOH Interim Recommendations to Mitigate Health Care Worker Staffing Shortage During the COVID-19 Pandemic for further information.

The letter directs providers to reach out to Katherine Ander via email if they have questions.
DEAR ADMINISTRATOR LETTERS NOTIFY SNF PROVIDERS OF EMERGENCY RULES EXTENSIONS
Emergency Rules Extension Related to PASRR
In a Dear Administrator letter dated January 7, 2022, skilled nursing providers are notified the Department of Social and Health Services (DSHS) filed emergency rules on April 13, 2020, for some nursing home requirements, and those rules were consecutively extended with the last extension (WSR 21-18-065) expiring on December 24, 2021.

The department filed an extension of the emergency rules with an effective date of December 24, 2021 (WSR 22-01-166), due to expire on April 15, 2022. These rules are related to pre-admission screening and resident review (PASRR), and participation in resident and family groups.

The following rules were amended and temporarily repealed:
  • WAC 388-97-1915 and -1975: Emergency rules permit the level I PASRR screening, and if needed, the level II evaluation to occur up to 30 days after admission.
  • WAC 388-97-0920: Emergency rules are maintained, which is related to resident and family groups.

Emergency Rules Extension Related to Clinical Records
In a Dear Administrator letter dated January 7, 2022, skilled nursing providers are notified that the emergency rules filed May 15, 2020, by DSHS have been consecutively extended five times with the last extension expiring on December 15, 2021.

On December 8, 2021, the department filed a CR-103E (WSR 22-01-057), to extend the amended rule for a fifth time. The rule expires on April 7, 2022.

The amendment of WAC 388-97-0300 lengthens the time nursing homes have to provide the resident access to, or copies of, the requested clinical record from two to ten days. The amendment does not permit the nursing facility to deny the resident access to records.

Emergency Rules Extension Related to Physician Services
In a Dear Administrator letter dated January 7, 2022, skilled nursing providers are notified that an emergency rule filed April 29, 2020, has been consecutively extended four times with the last extension expiring on December 8, 2021.

RCS filed a CR-103E (WSR 21-24-038), effective December 8, 2021, to extend the amended rule for a fifth time. The rule expires on March 23, 2022.

WAC 388-97-1260 was amended to permit the physician to delegate tasks to a registered nurse practitioner or a physician assistant, even if it is required to be performed by the physician in regulation and regardless of the frequency of the delegation. The amendment does not change the required frequency of physician/delegate visits, or the requirement for the physician to supervise the delegate. The delegate must only perform tasks within the scope of practice of their credential.

Providers are directed to reach out to Molly McClintock, Nursing Home Policy Program Manager via email or by calling (360) 742-6966 if they have questions about any of these rules extensions.
DEAR ADMINISTRATOR LETTER NOTIFIES SNF PROVIDERS OF CMS CHANGES TO COVID-19 SURVEY ACTIVITIES AND INCREASED OVERSIGHT IN NURSING HOMES
In a Dear Administrator letter dated January 6, 2022, skilled nursing providers are notified on November 12, 2021, CMS released QSO-22-02-ALL, which announced changes made to COVID-19 survey activities and increased oversight in nursing homes.

Such changes include:
  • Focused Infection Control (FIC) surveys: Conduct annually and as concerns arise with managing COVID-19, or infection control practices.
  • Resuming standard recertification surveys:
  • DSHS will resume the normal schedule moving forward;
  • DSHS will prioritize surveys and compliance investigations according to potential risks; and
  • CMS will temporarily allow certain mandatory tasks to be discretionary or triggered based on offsite and/or onsite survey activities. The mandatory survey tasks that may be discretionary are:
  • Resident Council Meeting
  • Dining Observation Task
  • Medication Storage
  • Increasing oversight in nursing homes: CMS is concerned about how residents’ health and safety has been impacted during the COVID-19 public health emergency as state agencies have been unable to have the traditional level of visibility inside the nursing home. Such activities include surveying for:
  • Nurse competency;
  • Inappropriate use of antipsychotic medications; and
  • Other concerns (i.e., unplanned weight loss, loss of function/mobility, depression, abuse/neglect, pressure ulcers).

Providers are directed to reach out to Molly McClintock, Nursing Home Policy Program Manager via email or by calling (360) 742-6966 if they have questions.
NOW AVAILABLE: RESOURCE ON AVOIDING COMMON NHSN DATA REPORTING ERRORS IN SNFs
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) receives frequent questions regarding National Healthcare Safety Network (NHSN) reporting and common errors encountered by providers. To assist with these questions, AHCA/NCAL has developed a resource on common NHSN errors and how to avoid them. To reduce gaps in reporting, it is highly recommended to have at least two people with security access to the NHSN reporting pathways. 

AHCA/NCAL continues its advocacy efforts with the Centers for Medicare and Medicaid Services for reduction in reporting burden. Please contact NHSN@CDC.gov with any additional questions. 
CMS ADMINISTRATOR'S NATIONAL STAKEHOLDER CALL SET FOR JANUARY
On Tuesday, January 18, from 10 - 10:45 AM PST, the Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and her leadership team will provide updates​ on the CMS Strategic Vision, key 2021 accomplishments, and 2022 goals. Speakers on this call include ​CMS Administrator, Chiquita Brooks-LaSure, Principal Deputy Administrator and Chief Operating Officer, Jon Blum, and CMS Leadership Team.

The Administrator’s vision is for CMS to serve the public as a trusted partner and steward dedicated to advancing health equity, expanding coverage, and improving health outcomes as CMS engages the communities it serves throughout the policymaking and implementation process. CMS invites you to join this second national stakeholder call to learn more about how you can partner with CMS as the Administrator's vision is implemented. Register for the call. 
WA-PALTC TO HOST WEBINAR ON OMICRON
The Washington Society for Post-Acute and Long Term Care Medicine (WA-PALTC) will host a webinar titled Omicron: What is Our Game Plan Now? on Tuesday, January 18, 2022, at 6 PM. You are invited to join the discussion with experts about how to protect those in long term care and continue to operate facilities safely. Expert panel includes James Lewis, MD, MPH, Infectious Disease Specialist at King County DOH, Michael Myint, MD, MBA, Infectious Disease Specialist at Multicare, Ezra Stark, Medical Countermeasures Coordinator at DOH, and Sabine von Preyss-Friedman, MD, FACP, CMD, board president at WA-PALTC, who will also serve as moderator. Register here.
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.