COVID-19 UPDATE #262

September 23, 2022

On September 8, Governor Jay Inslee announced the upcoming rescission of all remaining COVID-19 emergency proclamations and state of emergency by October 31.

Requirements for initial application and renewal of nurse licensure will continue in accordance with pre-pandemic requirements unless they are currently covered by the Nursing Care Quality Assurance Commission’s emergency rules or have been updated by permanent rule work. For a full list of rule changes, please see the nursing commission's infographic.

Orders that were in place under the Governor’s state of emergency will no longer be in effect on October 31, including:

• Uniform Emergency Volunteer Health Practitioners Act (70.15) - If you are currently licensed in another state and practicing in Washington State under the Washington State Registry of Emergency Volunteers (WAServ), when the state of emergency ends on October 31:
• You must have a Washington state license to continue working as a nurse in Washington state.
• If you do not have an active Washington State nursing license, or active temporary practice permit, listed on the Provider Credential Search, you will not be able to practice in Washington State.
• We encourage you to apply for your Washington State license as soon as possible to avoid a lapse in the ability to practice. For more information on how to apply for your Washington State nursing license, please visit our website at www.nursing.wa.gov.

• Nursing Technician (NTEC) Extension Date - During the state of emergency, the Nursing Commission was able to grant an additional 30-day extension of the NTEC credential after the initial 30-day post-graduation expiration date (totaling 60 days post-graduation). When the state of emergency ends on October 31:
• The Nursing Commission will no longer be able to grant an additional 30-day extension and the NTEC credential will expire 30 days after an individual graduates from a nursing program.
• Any NTEC credentials that have already received the 30-day extension will remain in effect until the new graduate sits for the National Council Licensure Examination (NCLEX) or the NTEC expires, whichever comes first.
• Emergency Interim Permits - During the state of emergency, the Nursing Commission was able to issue emergency interim permits (EIP) to qualified new graduates. Licensed practical nurses, (LPNs), registered nurses (RNs), and advanced registered nurse practitioners (ARNPs) were able to use an EIP to practice as a nurse in Washington State prior to passing the NCLEX or national examination. When the state of emergency ends on October 31:
• The Nursing Commission will no longer be issuing EIPs to new graduates. The EIPs issued prior to October 31 will remain active until the graduate sits for the national examination or the EIP expires, whichever comes first.

For more information, please email NCQAC.Rules@doh.wa.gov.

A Dear Administrator Letter dated September 21, 2022, advises due to the significant impact of the COVID-19 public health emergency (PHE), the Department of Social and Health Services (department) filed emergency rules (CR-103E) on April 13, 2020, for some nursing home requirements. The rules were amended and temporarily repealed in response to the lasting effects of COVID-19 on nursing homes, and to continue to align state nursing home rules with federal rules. The rules related to Preadmission Screening and Resident Review (PASRR) were consecutively extended with the last extension (WSR 22-09-014) that was effective May 7, 2022.

The department filed an emergency rule with WSR 22-19-023, effective September 14, 2022. The emergency rules related to PASRR that are temporarily amended or repealed include:

• 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.
• Are set to expire January 11, 2023.

Additionally, the department filed a CR-101 on August 5, 2020, to begin permanent rule making on WACs 388-97-1915, and WAC 388-97-1975. The CR-101 document is available on Aging and Long Term Support Administration’s (ALTSA) Information for Nursing Home Professionals web page, under “NH Rule Filings.” The department remains in discussion about adding language to the rules to explain the circumstances and times under which suspension of the rules was necessary due to COVID-19. If you have any questions, please contact Molly McClintock, Nursing Home Policy Program Manager, at (360) 742-6966 or molly.mcclintock@dshs.wa.gov.

In a Dear Administrator Letter dated September 22, 2022, DSHS reminds providers that 

on October 27, 2022, several proclamations issued in response to the COVID-19 pandemic state of emergency will be rescinded by the Governor. Facilities and staff should be planning how to meet the training requirements that were waived under these proclamations before they are no longer in effect.

The Department of Health (DOH) has adopted emergency rules to extend the timelines for individuals in an approved certified nursing assistants training program to complete certification based on their date of hire (WSR 22-19-027). Click here to find the dates by which registered nursing assistants must complete training, testing, and certification. Staff who complete nursing assistant certification according to the timeline in the emergency rules are exempt from completing home care aide certification (WAC 388-112A-0900).

DOH also set up mass examination sites to assist staff with completing nursing assistant certification and these mass examination sites are now open to staff in adult family homes, assisted living facilities, enhanced services facilities, and group homes. If you have staff who need to complete testing, direct them to the Credentia Website, create a profile, schedule their skills exam, and register to take the on-line computer based written exam.

If you have any questions or need assistance in scheduling the exam, please contact nac.exam@doh.wa.gov.  For more information on the nursing assistant mass skills testing, visit the WHCA Webpage https://www.whca.org/nac-testing/

Centers for Medicare & Medicaid Services (CMS), Center for Clinical Standards & Quality (CCSQ) and Clinical Standards Group (CSG) are hosting a virtual listening session with health care providers and suppliers on emergency preparedness, Tuesday, September 27, 2022, from 10-11:30 PM PT.

CMS is looking to gather information from individual health care staff on emergency preparedness. The input and lessons-learned from this session will be used to evaluate CMS regulations regarding emergency preparedness for certain health care providers. CMS is especially interested in hearing input on these questions:

1. How has the extended duration of the COVID-19 public health emergency affected the workforce at your facility/employer? How has your facility/employer addressed any staffing shortages? How has your facility/employer approached the delivery of patient/ resident care in light of staffing shortages?
2. What are some innovative approaches that your facility/employer has taken to address the impacts of emergency situations on health care staff?
3. What resources are available in your community to support health care workers during and after emergency events?
4. How often (if at all) do you participate in emergency preparedness exercises, and what do those exercises entail? How did the exercises prepare you to address actual emergency situations?
5. What can CMS do to ensure a more resilient healthcare workforce to withstand future emergencies?

This session is the last in a multi-part series being held on emergency preparedness. While this third session is geared toward individual health care staff, other sessions sought information and feedback from state and local emergency response entities and health care providers and suppliers. Questions vary by session.

Prior to the listening session, you are encouraged to review the following rules as background:

• Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers
• Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction; Fire Safety Requirements for Certain Dialysis Facilities; Hospital and Critical Access Hospital (CAH) Changes To Promote Innovation, Flexibility, and Improvement in Patient Care

HOW TO JOIN: Please register here with your name, email, zip code, state, organization name and type, and whether you intend to provide verbal response during the session. Due to time constraints, capacity will be capped at 450 registrants and you are encouraged to registration as soon as possible.

Note: After registering, you will receive a confirmation email containing information about joining the session. Instructions for manually adding an invite to your calendar will be included. 

Providers who received Provider Relief Fund (PRF) payments exceeding $10,000, in the aggregate, between January 1, 2021, and June 30, 2021, are required to report in Reporting Period 3 (RP3). There will be no extension. You must submit a report on use of funds by September 30, 2022, at 11:59 p.m. ET.

On September 8, 2022, providers received a notification, based on their status in the reporting process, reminding them of their reporting requirement. The RP3 reminder email for providers registered but who have not yet reported may be viewed here. The RP3 reminder email for providers registered and in progress may be viewed here.  

Providers who experienced one or more extenuating circumstances that prevented them from submitting a completed PRF Report in Reporting Periods 1 and/or 2 (RP1 and RP2) by the deadline had the opportunity to submit a Request to Report Late Due to Extenuating Circumstance. The opportunities to submit late reports for RP1 and RP2 have passed. While it’s anticipated that the Extenuating Circumstances option will be offered for RP3, providers are highly encouraged to complete the report by the September 30 deadline. It is a request process that will open, and approved providers will be required to submit reports in a two-week window of time.

For more details about the Extenuating Circumstances process and what is considered in this category, please review the Request to Report Late Due to Extenuating Circumstances webpage. 

Upcoming reporting periods:

• ​Reporting Period 4 opens on January 1, 2023
• Reporting Period 5 opens on July 1, 2023

In a Dear Provider Letter dated September 20, 2022, RCS and Department of Health remind providers of the importance of protecting residents and staff from COVID-19, flu, and pneumonia.  

The flu and COVID-19 vaccines are your best protection against these illnesses. Since it is possible to have flu or other respiratory illnesses AND COVID-19 at the same time, the flu and COVID-19 vaccines will lower one's risk for these illnesses, help protect essential health care workers, and help save limited health care resources for those who need it most.

To minimize impact of COVID-19, flu, and pneumonia in your facility, RCS and DOH recommend the following:

• Encourage all residents and staff to stay up to date on their COVID-19 vaccination status, get the flu vaccine by the end of October, and encourage residents and staff to get the pneumococcal vaccine as needed.
• Wash hands and use alcohol-based hand sanitizer frequently.
• Wear a face mask.
• Call your local health jurisdiction whenever a resident tests positive for COVID-19 or flu, or if you see a sudden increase in acute respiratory illness (two or more ill residents within 72 hours).
• Report suspected outbreak of COVID-19, flu or any other communicable disease to the department.
• Review your facility's ability to implement infection prevention standards and meet the health care needs of residents with suspected or confirmed COVID-19 or flu.

For additional information, read the full letter here

AHCA/NCAL has provided a handout containing information on the Bivalent booster shots.  

• What is a Bivalent booster?
• Why should I get a Bivalent booster shot?
• Why should I get boosted if I might get COVID-19 anyway?
• When should I get a Bivalent booster shot?
• How can I get my booster shot?

Find answers to these questions by reviewing the handout.

The pandemic permanently changed the work environment and employee expectations. Natural infections like those caused by measles, polio, and smallpox produce lifetime protection. However, COVID-19 infections do not provide long-lived immunity, nor do our current vaccines. Herd immunity is not coming, and COVID-19 will remain a significant risk for individuals over 70, whether they are in senior care, living alone, or in multi-generational households.

Join world-renowned medical expert and immunologist Dr. Deborah Birx as she discusses Omicron-specific boosters, Evusheld, Paxlovid, and Monkeypox to help our communities move from surviving to thriving.

This webinar will:

• Describe ways you can preserve and protect your workforce with changes to return-to-work policies and testing
• Review the newest data on flu and COVID-19 vaccine effectiveness
• Share recommendations on how to use COVID-19 antibody therapies and antiviral treatments to improve outcomes for seniors in your community
• Discuss actionable steps you can take to prevent the spread of Monkeypox

To accommodate your schedule, please RSVP to the showing you wish to attend. The event will be 1 hour.

• Tuesday, September 27 at 9am PT
• Wednesday, September 28 at 10am PT
• Thursday, September 29 at 12pm PT

Please note: You will receive the event information 24 hours before the event date and time. For security purposes, a recording of the webinar will not be shared. However, a fact sheet will be available following all three events.

On September 16, 2022, the Tacoma-Pierce County Health Department emailed information and resources for long term care providers. Their email includes insight on the COVID-19 vaccine, emergency preparedness, infection control, fit testing, PPE, COVID-19 testing, Medical Test Site Waiver application for assisted living, and COVID-19 treatments. 

Click here to review resources available through Tacoma-Pierce County Health for providers in Tacoma and Pierce County.