COVID-19 UPDATE #280

January 12, 2023

Yesterday, the U.S. Health and Human Services (HHS) Secretary Xavier Becerra renewed the declaration that a public health emergency (PHE) exists. This is effective January 11, 2023, and will continue for 90 days pursuant to federal law. 

The PHE renewal through mid-April provides for the uninterrupted continuation of several flexibilities that have protected beneficiary access to important services in as safe and effective a manner as possible.

HHS will also continue to waive the three-day hospital stay rule that causes many seniors to be strapped with out-of-pocket costs in the thousands because they do not qualify for Medicare coverage. The American Health Care Association (AHCA) continues to advocate to eliminate this confusing and devastating policy barrier altogether. 

Questions? Please email COVID19@ahca.org.

With Washington’s COVID state of emergency now expired, uncredentialed caregivers hired on or after January 1, 2023, must complete their basic training (home care aide or nursing assistant) and specialty training within 120 days of starting work; these individuals must be certified as a home care aide or nursing assistant within 200 days of starting work. Uncredentialled caregivers hired on or after January 1, 2023, do not fall under the emergency nurse delegation regulations that allow for an uncredentialed staff person to apply for and obtain a nursing assistant registered (NAR) credential, complete nurse delegation classes, and perform delegated tasks without first completing the basic caregiver training. 

Uncredentialed caregivers hired just before and during the state of emergency (anytime between 8/17/2019 and 12/31/2022) who obtained a NAR and completed their delegation courses fall under the auspices of the public health emergency’s leniency and may continue performing delegated tasks without first completing their basic caregiver classes (home care aide or nursing assistant). The timeline for their basic caregiver and specialty training completion is organized into cohorts and dependent on their date of hire. The same goes for their certification timeline.  

The synopsis below outlines the training and certification cohort timelines for care staff hired during the state of emergency and now. 

Anyone hired on or after 1/1/2023 and expected to perform delegated tasks will need to have the following per standard nurse delegation requirements:

• NAR (if not already certified as a NAC or HCA) and
• Completion of basic caregiver training (home care aide or nursing assistant) and
• Nurse delegation core training (9 hours) and, if going to administer insulin
• Nurse delegation focus on diabetes training (3 hours)

Questions about assisted living regulations? Please email Vicki McNealley or call 1-800-562-6170 extension 107.

To remain in compliance with the Nurse Aide 1135 waiver, Washington State is required to provide CMS monthly reports. 

As a part of the report process the state needs to compile information from each CMS certified nursing home on a monthly basis. If you completed this survey last month, please complete this survey again. The state is required to compile this information and send it to CMS on a monthly basis.

Please assist in this process by completing the 3 question survey. If we are unable to provide the requested information to CMS, Washington State may lose this critically important 1135 waiver and the ability to allow NARs to continue working in a nursing home beyond four months while they complete the certification process.

King County is now considered to be in high community transmission by CDC case data. A few other counties in Washington are also in high community transmission. There are a few aspects of the HCF/LTCF guidance that take community transmission into account outlined below. Public Health Seattle/King County wants all long term care facilities to be aware of this and they will be letting facilities know this as they call in to report cases. Facilities need to be reviewing this data regularly and adapting infection prevention and control practices as appropriate.  

With high level of community transmission, long term care facilities should immediately implement the following changes:

1. Test all new admissions.
2. HCP must wear eye protection with all patient interactions.
3. Wear N95 for all aerosol generating procedures.

Questions? Please email Claire Brostrom-Smith, Program Manager, Healthcare-Associated Infections-Communicable Disease Epidemiology & Immunization Section of Public Health Seattle/King County or call her at (206) 477-7753.

In a Dear Provider letter dated January 10, 2023, providers are reminded of the importance of protecting residents, clients, and staff from COVID-19, influenza, and pneumonia this season. You can minimize the impact of these illnesses by encouraging all residents, clients, and staff to stay up to date on their COVID-19 vaccinations, get the flu vaccine, and get the pneumococcal vaccine as needed. Questions? Please email RCSPolicy@dshs.wa.gov.

Stay informed about quality online trainings from CDC, other federal agencies, and federally funded partners with CDC Learning Connection. Sign up to receive monthly newsletters that include CDC learning opportunities and free continuing education (CE) units by taking courses such as the COVID-19 Update: Clinical Guidance and Patient Education for Bivalent COVID-19 Vaccines, Onboarding New Employees, Polio Vaccinations, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and more.

F884 remains the most frequently cited F-tag for SNFs in Washington. Facilities must continue to comply with the CMS NHSN reporting requirements outlined in the F-tag. Repeat citations can result in CMS enforcement remedies.

The Department of Health (DOH) shared a new flyer describing their services and technical support for SNFs reporting to the National Healthcare Safety Network (NHSN), to include information regarding a monthly NHSN user group call. This is a monthly forum for NHSN SNFs to share and collaborate, improve reporting accuracy, and increase user knowledge. Calls are scheduled on the second Thursday of each month, from 11 AM to noon, with the next call on Thursday, February 9. Register here.

The Centers for Medicare and Medicaid (CMS) has published a three-part audio series​ on COVID-19 vaccines and therapeutics. In these short audio clips, Dr. Lee Fleisher, CMS Chief Medical Officer, talks to experts from the Centers for Disease Control and Prevention and the Food and Drug Administration about how COVID-19 vaccines and therapeutics support better resident outcomes. Read more.

Skilled Nursing Facilities and assisted living facility providers in Washington State and across the U.S. can now access free COVID-19 test kits through an expanded partnership between the HHS and LeadingAge. This applies to WHCA members, too! More information is available in the January 9 McKnight’s article regarding the free test kit program. According to the article, facilities can receive as many as 90,000 test kits shipped to one address. Submit your requests.

COVID-19 Plan Tools, information, and action steps are available on a COVID-19 Plan template. This information can be shared with healthcare providers or part of a resident- centered plan of care. A CDC template is also available to assist with care planning. More information is available on the CDC website here.

WHCA continues to post resources and information on our website as they become available. If you have questions or need additional information, please call the WHCA office at (800) 562-6170.