COVID-19 UPDATE #157
May 11, 2021
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INTERIM FINAL RULE ON COVID-19 VACCINE REQUIREMENTS FOR LTC AND ICFs-IID |
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Today the Centers for Medicare & Medicaid Services (CMS) published an Interim Final Rule on COVID-19 Vaccine Requirements. This rule applies to residents, clients, and staff of Long Term Care (LTC) facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID). CMS also published a QSO memo to state survey agencies on how to operationalize this new requirement.
The rule is scheduled to go into effect on May 21, 2021, ten days from its publication for inspection in the federal register.
This rule specifies that LTC facilities must develop and implement policies and procedures to:
- Educate all residents and staff about COVID-19 vaccines;
- Offer vaccination to all residents and staff; and
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Report to the CDC via NHSN certain data regarding vaccination status for residents and staff as well as use of any therapeutic treatments (e.g., monoclonal antibody). Note that this requires additional reporting via NHSN modules: reporting the Resident Therapeutics Pathway found on COVID-19 LTCF Module, as well as reporting via the Weekly HCP and Resident COVID-19 Vaccination Module.
Additionally, ICF-IID facilities must educate all clients and staff about COVID-19 vaccines and offer vaccination to all clients and staff. Reporting is not required for ICFs-IID; however, CMS strongly encourages voluntary reporting.
The comment period for this interim final rule closes July 12, 2021. CMS is also requesting feedback on the feasibility of implementing similar requirements in other long term care settings that accept Medicare or Medicaid payments, including assisted living.
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EYE PROTECTION REQUIREMENTS |
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WHCA staff has been fielding several questions about eye protection (goggles and/or face shields), specifically which employees must wear this type of PPE and when.
Eye protection must be worn by all workers who may come within six feet of residents, visitors, or other staff members whenever the community spread (infection rates in the county) exceed 25/100,000. For those counties over 25/100,000 cases, eye protection must be worn by staff regardless of outbreak status in the facility.
Currently in Washington (as of today), only two counties are below 25/100,000: Wahkiakum and Columbia. If you have questions about this issue, please contact Vicki McNealley or Elena Madrid. |
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DOH POSTS LTC FACILITY TESTING DOCUMENT |
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The Department of Health (DOH) has posted the LTC Facility Testing document on their website. Due to increased community transmission throughout Washington State, DOH continues to recommend that all healthcare personnel be included in routine testing, regardless of vaccination status. If you have questions, please email Elena Madrid or Vicki McNealley.
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BYD RESPIRATOR NIOSH INVESTIGATIONS |
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The Washington State Department of Health (DOH) is cooperating with the National Institute for Occupational Safety and Health (NIOSH) on an investigation of a quality issue with BYD N95 respirators.
DOH occupational health staff identified a recurrent issue in March 2021 with BYD N95s involving loose straps on the respirators (which should fit tightly). This quality issue has the potential to affect worker safety in health care and long term care settings, as well as in other sites, in our state. In order to be most effective, a respirator should form a good seal on the wearer’s face. A good seal is especially important when caring for patients with COVID-19 and when performing medical procedures that can create aerosols (fine mists of respiratory droplets) such as CPR or suctioning. If the investigation results in a recall, our state will need to actively participate in what would likely be a multi-agency effort.
Background:
- In November 2020, DOH started a project to provide fit-tested respirators to long term care and in-home care facilities through fit testing contractors. One of these contractors also notified DOH of the same quality issue, prompting internal testing, notification to facilities, and contact with NIOSH.
- The potential issue was identified in March 2021 and involves loose straps observed on some respirators. Respirator straps should be firmly fixed, not “adjustable.”
- Because the BYD respirators were most plentiful in our state warehouse, they went out in the highest number to fit-testing contractors, and thus became the most common model to which staffers were fit-tested during the project. DOH is working to determine the exact location of the respirators.
- The Department of Social and Health Services (DSHS) also sent out BYD respirators as part of a separate project. In addition to DOH and DSHS, the Department of Labor and Industries as well as the Department of Emergency Services have roles. DOH is working to define those roles.
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DOH is working with NIOSH to determine which respirators may have been affected by the quality issue. Depending on the investigation’s outcome, DOH will work with partners on a plan for what to do with millions of BYD respirators yet to be distributed in Washington. For now, the BYD respirators are being held back. That follows an internal BYD investigation, the results of which DOH has not seen.
Immediate Next Steps:
- While the NIOSH investigation is ongoing, DOH recommends that workers don’t use the BYD respirators that were produced pre-NIOSH approval.
- Those who were fit-tested for BYD respirators may need to be re-fit-tested.
- Please help share this information with response partners in your community.
DOH will keep us informed as new information becomes available. In the meantime, please email HAI-COVID@doh.wa.gov with any questions about this matter.
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CDC UPDATES NHSN TRAINING |
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The Centers for Disease Control and Prevention (CDC) is updating and simplifying the NHSN modules on weekly reporting of COVID-19 vaccination data for long term care facility residents and healthcare personnel. To review these updates to the NHSN Weekly COVID-19 Vaccination Modules for long term care facilities, NHSN will provide four broadcasts of the webinar.
Sessions are all held at 12:30 PM PST
• Tuesday, May 18, 2021
• Thursday, May 20, 2021
• Tuesday, May 25, 2021
• Thursday, May 27, 2021
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DEAR ADMINISTRATOR LETTER PROVIDES UPDATE TO SKILLED NURSING VISITATION GUIDANCE |
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- Core principles of COVID-19 infection prevention, which were updated to include new guidance on use of face coverings or masks, and social distancing at least six feet.
- Indoor visitation guidance.
- Close contact (including touch) recommendations for fully vaccinated residents.
- Communal dining and activities, including permitting fully vaccinated resident to dine and participate in activities without face coverings or social distancing if all participating residents are fully vaccinated. If unvaccinated residents are present, all resident should use face coverings when not eating and unvaccinated residents should physically distance from others.
Effective April 30, 2021, Washington State updated the Safe Start for Long Term Care (SNF) to align the plan with the CDC recommendations for communal dining and activities. Please continue to follow the Washington State Safe Start for Long-Term Care plan, and the directives of your local health jurisdiction if the local health jurisdiction has requirements additional to the Safe Start plan. |
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UPDATES TO SNF EMERGENCY REGULATORY WAIVERS ISSUED BY CMS IN REPONSE TO COVID-19 |
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In a memo from the Centers of Medicare and Medicaid Services (CMS) dated April 8, 2021, and updated on May 10, 2021, skilled nursing providers are informed of updates to the long term care emergency regulatory waivers. The memo notes the following:
- CMS is only ending the waivers at 42 CFR §483.10(e)(6) for providing written notice before a room/roommate change, and at 42 CFR §483.15(c)(4)(ii) for timing of notification of transfer or discharge. The related waivers, which continue to allow facilities to transfer or discharge, and change rooms for the sole purposes of cohorting, remain in effect.
- CMS is not ending the waiver at 42 CFR §483.20(k) related to the Pre-Admission Screening and Annual Resident Review (PASARR) at this time.
- The four Emergency Blanket Waivers at 42 CFR §483.10(e)(6), §483.15(c)(4)(ii), §483.20 and §483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i) will end effective May 10, 2021.
The American Health Care Association has provided a summary of the CMS memo. The summary is found here. |
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DEAR ADMINISTRATOR LETTER PROVIDES INFORMATION ON EXTENSION OF EMERGENCY RULES WITH REGARD TO CLINICAL RECORDS IN SKILLED NURSING FACILITIES |
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In a Dear Administrator letter dated May 5, 2021, skilled nursing providers are informed that on May 5, 2021, RCS filed a CR-103E ( WSR 21-10-073) to extend the amended rule with regard to clinical records in nursing homes for a third time. The rule expires on August 31, 2021. 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. |
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CMS COVID-19 STAKEHOLDER CALLS |
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The Centers for Medicare & Medicaid Services (CMS) holds frequent COVID-19-related calls for nursing home stakeholders. Important and updated information on topics ranging from visitation to the vaccine can be discussed on these calls, and questions participants have can be answered. You can access these calls on their website.
This page also holds all Partner Relations Group (PRG) podcasts, transcripts, and audio recordings. CMS makes Open Door Forums and other presentations available as audio podcasts. The podcasts are available free of charge. If you have any questions, please email PARTNERSHIP@cms.hhs.gov.
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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.
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