Prepared by Leslie Emerick, Lobbyist
The year 2020 will be known as a turning point in so many ways. Such a challenging time for our nation…truly a time to look inward and ask how can we do better? Much like the rest of the state and country, Olympia is being rocked by protests against the death of George Floyd, the black man who died after being restrained by Minneapolis police. Protesters gather nightly at the state capital and make their case for changes in our criminal justice system. This on top of a pandemic with over 110,000 deaths and 40 million people unemployed nationwide could really shake up the legislative agenda for the 2021 Legislative Session.
We are facing huge budget deficits with projections of $7 billion dollars. Even with a $3 billion-dollar rainy day fund, this is significant. Around 75% of the state budget is protected such as K-12 education, which is protected under the WA State Constitution and some federally protected Medicaid programs such as skilled nursing facilities, so the budget cuts will be made in around 25% of the remaining budget.
The state legislature is torn between having a Special Session in June after the state’s revenue forecast comes out on June 17th, 2020 or to wait until more information comes in on federal funding. Congress is currently discussing whether to send the states funding to assist with the economic downturn. Only the Governor has the authority to initiate a Special Session and we are hearing from some state Senators that the session may be in August. New fiscal year spending begins on July 1, 2020. One issue is that cost-of-living allowances (COLAs) for state employees go into effect at that time and it will be difficult to pull them back. Agencies have been asked to project cuts up to 15% which can be devastating for some of the smaller state agencies. Hiring freezes have already taken effect and some new programs were already vetoed by the Governor.
Below is a link from the Office of Financial Management (OFM) State listing the cuts being proposed by state agencies. Some are pretty draconian, such as cutting some DSHS funding for home and community services such as home care and private duty nursing for medically fragile patients and hospice is on the list of potential cuts at Health Care Authority. https://ofm.wa.gov/budget/state-budgets/state-agency-fiscal-year-2021-savings-options
Reminder: These are preliminary and have not been put into effect yet. Only the state legislature has the authority to make these deep of cuts in the state budget.)
Dept of Health and Human Services (DSHS): https://ofm.wa.gov/sites/default/files/public/budget/statebudget/savings/300DSHS.pdf
Health Care Authority Medical Assistance Program: https://ofm.wa.gov/sites/default/files/public/budget/statebudget/savings/107HCA-HBE.pdf
Dept. of Health (DOH): https://ofm.wa.gov/sites/default/files/public/budget/statebudget/savings/303DOH.pdf
DSHS Issues: (Coronavirus: https://www.dshs.wa.gov/alert/covid-19-information)
Letter from Bill Moss, Assistant Secretary, Aging and Long-Term Care Services Administration (ALTSA) Stakeholder Message 06-05-2020.pdf
Subject: Preliminary ALTSA reduction proposals for State fiscal year 2021, June 5, 2020
The COVID-19 virus has had a significant impact on state revenues. On May 13, the Office of Financial Management (OFM) sent a directive to state agencies to propose preliminary options for reducing their General Fund-State (GF-S) expenditures from their current budgets by fifteen percent in state fiscal year 2021, which begins July 1. For the Aging and Long-Term Support Administration (ALTSA), that equates to over $220 million General Fund-State dollars and approximately $400 million in total dollars as nearly all of our expenditures are matched by federal Medicaid matching funds. These potential reductions are truly devastating and reflect an economic downturn expected to match or exceed that of the Great Recession. In completing the directive set forth by OFM, we followed a few key principles that align with our Mission, Vision and Values: Ensure that our clients with the greatest need continue to receive services; Continue our priority of safety and protection of vulnerable adults; Preserve our services to the greatest extent possible; Preserve our workforce by proposing furloughs and implementing hiring, travel and purchasing freezes to avoid complete job loss. As a reminder, this is just the beginning of this discussion and we welcome your feedback and ideas for measures required to meet the reduction target. The following are the reduction categories we are proposing with savings estimates for state fiscal year 2021: Client Eligibility: Elimination of the optional Medicaid Personal Care (MPC) state plan program. Increasing the level of functional need required to meet Nursing Facility Level of Care in Washington’s Medicaid state plan and waivers will decrease the number of Medicaid clients in home and community residential settings by approximately 20,500 people; nursing home clients by approximately 680 people; and a corresponding reduction of a significant number of ALTSA staff and AAA full-time equivalent positions. ($129.8M GF-S; $282.3M total funds) Includes eliminating state funded non-citizens and Senior Drug Education programs, Medicaid funded Adult Day Health and Day Care services, reducing Adult Family Home Meaningful Day programs. ($15.5M GF-S; $2.7M) To assist clients in nursing homes to transition to their own residence with in-home care supports, ALTSA proposes paying for rental subsidies so that clients can afford to relocate to their own home. Even though the subsidy is state-only funding, the cost is still less than paying half of a nursing home rate, thus saving money. ($1.0M GF-S; $1.0M Total Funds) Savings is achieved by assuming an across–the-board three percent rate reduction for all ALTSA providers, including those who collectively bargain wages and benefits and capturing the additional 6.2 percent of Medicaid matching from July through September as savings. ($60.6M GF-S; $9.4M total funds) Including unpaid furlough days. ($15.0M GF-S; $25.8M total funds)
Monthly Public Webinar for the Consumer Directed Employer project:
In November 2019, DSHS signed a contract with Consumer Direct of Washington (CDWA). DSHS remains committed to initiating the transition to the CDE by the legislatively required date of June 30, 2021.The move to a CDE model will shift the IP employment-related activities to the CDEs and will help DSHS realize the goal of increasing the capacity of DSHS/AAA case management, customer service, and other social services staff to focus on core case management activities. New federal requirements were enacted in 2016 as part of the “21st Century Cures Act”. The Act requires states to implement an electronic visit verification (EVV) system for personal care services delivered in the home. The CDE will implement the EVV system for IPs. Home Care Agencies will implement separate EVV systems for Home Care Agency workers. You are invited to participate in a webinar on the Consumer Directed Employer project. This webinar is intended for members of the public who are interested in learning more about the Consumer Directed Employer project. To learn more: Visit the CDE webpage. Register online
LTSS Trust Commission is looking for a Consumer Representative to serve on Commission
The Long-Term Services and Supports (LTSS) Trust Commission is looking for a consumer representative to serve on the Commission. This group will make recommendations to the WA State Legislature and state agencies on the new LTSS Trust program as it is implemented in the coming years.
The Commission includes state legislators, representatives from three state agencies, and 10 Governor appointed members representing various stakeholders and advocates. One of the Governor appointed positions that still needs to be filled is a recipient of long-term services and supports or designee or representative of consumers under the program. The Commission will meet four to six times a year in Olympia and Commission members will be reimbursed for their travel expenses. Here is the link on Governor Inslee’s website if you know of someone interested: https://govforms.dynamics365portals.us/application-form/
Where it says, “Please choose the board or commission for which you would like to be considered:”, applicants should choose “Long-Term Services and Supports Trust Commission“. Please contact Crystal Williamson, [email protected] or call 360.725.3532 for more information.
COVID-19 Related Issues
First wave of supplies to ship as part of state’s plan for widespread testing in LTC facilities (This order may impact home care workers who assist in long term care and assisted living facilities.)
On May 29, DOH issued an order that requires widespread testing within long term care facilities. Residents and staff in nursing homes will be tested within approximately two weeks, with a completion goal date of June 12. All residents and staff in assisted living facilities with a memory care unit will be tested within four weeks, with a completion goal date of June 26.
Nursing home and other long-term care residents are at high risk for infection, serious illness and death from COVID-19, and testing, along with other infection prevention and control measures, is a critical tool to identify cases and stop transmission. Once test results are received, positive results should be reported following normal protocol, and be referred to local health jurisdictions for case investigation, contact tracing and isolation/quarantine support. If a resident tests positive, DOH recommends that the facility follow Centers for Disease Control and Prevention guidance on cohorting both residents and staff. Staff who are asymptomatic and test positive should not return to work for 10 days (from the test day). Federal guidance recommends a baseline universal test for all residents and staff before a facility progresses between any phases of reopening.
Safe Start Washington – Phased Reopening County-by-County Governor Jay Inslee: In collaboration with the Washington State Department of Health, the Governor has established a data-driven approach to reopen Washington and modify physical distancing measures while minimizing the health impacts of COVID-19. Washington will move through the phased reopening county-by-county allowing for flexibility and local control to address COVID-19 activity geographically. This approach reduces the risk of COVID-19 to Washington’s most vulnerable populations and preserves capacity in our health care system, while safely opening up businesses and resuming gatherings, travel, shopping and recreation. The plan involves assessing COVID-19 activity along with health care system readiness, testing capacity and availability, case and contact investigations, and ability to protect high-risk populations. The plan allows counties and the secretary of Health to holistically review COVID-19 activity and the ability for the county to respond when determining if a county is ready to move into a new phase.
“Safe Start Washington” guidelines issued on May 29th https://www.governor.wa.gov/sites/default/files/SafeStartPhasedReopening.pdf
Use of face coverings required at work: Beginning June 8, all employees will be required to wear a cloth facial covering, except when working alone in an office, vehicle, or at a job site, or by any individual who is deaf or hard of hearing.
Washington Coronavirus Hazard Considerations for Employers (except COVID-19 care in hospitals & clinics) Face Coverings, Masks, and Respirator Choices https://www.lni.wa.gov/agency/_docs/wacoronavirushazardconsiderationsemployers.pdf
What Phase is your county in and what does that mean for your program’s practice? https://coronavirus.wa.gov/what-you-need-know/covid-19-county-variance-application-process
Chart of Washington’s Phased Approach: https://www.coronavirus.wa.gov/sites/default/files/2020-05/PhasedReopeningChart.pdf
Long-term care worker rules proclamation: The legislature has approved an extension for the governor’s proclamation suspending certification requirements in community-based settings (adult family homes, assisted living facilities, and home care agencies). The proclamation, which you can find here, is effective until the termination of the COVID-19 state of emergency or June 17, whichever occurs first. This means that a nursing assistant-registered can work in a community-based setting past 200 days before obtaining a nursing assistant-certified or a certified home care aide credential.
NAR four-month rule proclamation: The legislature has approved an extension for the governor’s proclamation suspending certification requirements in nursing homes. The proclamation, which you can find here, is effective until the termination of the COVID-19 state of emergency or June 17, 2020, whichever occurs first. This means that a nursing assistant-registered can work in a nursing home past 120 days before obtaining a nursing assistant-certified credential.
Healthcare worker licensing proclamation: The legislature has approved an extension for the governor’s proclamation removing certain barriers for licensure. The proclamation, which you can find here, is effective until the termination of the COVID-19 state of emergency or June 17, whichever occurs first. Below is a summary of what the waivers pertaining to nursing assistants do.
Barriers to continued and uninterrupted healthcare practice, including continuing education and other training requirements and license renewal deadlines: Licensed health profession rules requiring continuing education (CE), AIDS education, and training in suicide assessment, treatment, and management are waived. This includes the 8 hours of CE required to maintain the medication assistant endorsement and the requirement to demonstrate clinical skills to an instructor in a practice setting in nursing assistant training programs.
Department of Health
Nursing Care Quality Assurance Commission: Save the Date for the Long-Term Care and Nursing Education Virtual Summit: July 21, 2020, 9:00 a.m. – 3:00 p.m.
Who: Policymakers, nursing students, registered nurses, long-term care employers, and nurse education program stakeholders
What: A virtual summit to bring stakeholders together to develop strategies for student engagement and employment in long-term care settings.
Why: Washington’s population is rapidly aging, and one in three citizens will require long-term care services. Our state has a rich history of providing care to senior and disabled citizens in a variety of long-term care settings, including nursing homes, assisted living, adult family homes and supported living. However, these providers are finding it increasingly difficult to hire and retain nurses. While the long-term care setting provides an excellent career opportunity for nurses, long-term care is not often the setting of choice for student nurse clinical experiences or employment as graduate nurses. From direct patient care to managing and leading staff, nurses are the backbone of the long-term care workforce, and are essential to quality resident care. The demand for excellent nurse leaders and service providers will only grow in the coming decade. This summit is intended to bring nursing students, long-term care employers and nurse education programs together to:
Where: This meeting will be held by ZOOM. The agenda and link will be available as we get closer to the date of the event. For more information, please contact Paula Meyer at [email protected].
Long-Term Care Workforce Development Steering Committee: I have been regularly attending the workgroup meetings of the Curriculum and Committee for reviewing and assessing what would be in a core curriculum for all types of certified nursing assistants and have been participating in monthly workgroup meetings. The last meeting was on June 8th and there was a discussion about how to better include diversity issue in the trainings.
Palliative Care Roadmap: We are getting close to the final version of the “PC roadmap” with DOH staff and a smaller group of palliative care experts as to the direction and content for the report. Shawn D’Amelio, WAHCA Board President, has been at the table helping to craft the sections related to home care. Hard copies must be available for distribution no later than September 30, 2020. Here is the latest draft if you have any final suggestions!
Labor and Industries
Workforce Violence training bill goes into effect: By July 1, 2020, health care settings are required to provide training according to the workplace violence prevention plan to all applicable employees, volunteers, and contracted security personnel. The method and frequency of training may vary according to the information and strategies identified in the plan.
Beginning January 1, 2020, health care settings must develop and implement a workplace violence prevention plan every three years. Health care settings must also review data on workplace violence incidents and any emerging issues contributing to workplace violence annually and adjust the workplace violence prevention plan as needed based on that review.
House Bill 1931: Concerning workplace violence in health care settings, impacts in-home services agencies licensed under RCW 70.127. It requires workforce violence prevention planning and training for hospitals, including in-home services providers under RCW 70.127.
See the WA State Hospital Association article below: https://www.wsha.org/articles/new-requirements-for-workplace-violence-prevention-planning-and-training/
I made an inquiry as to whether the department can delay the July 1, 2020 implementation date due to the coronavirus pandemic. Here is the guidance I received from Labor and Industries re: workplace violence training requirement due July 1st, 2020
“I have been asked to provide you a response related to your question about training requirements in HB 1931 and whether or not we can delay the implementation date. Unfortunately, we do not have the capacity to alter dates related to legislatively mandated laws that are coming into effect, however under the currents circumstances related to the COVID19 pandemic we have issued DOSH Directive (DD) 1.60. This directive covers training and certification requirements and is not all inclusive. (DOSH 1.60: https://lni.wa.gov/dA/e64fe9ea26/DD160.pdf)
Due to the social distancing requirements during the COVID19 pandemic and the requirement to provide hands on training with role play this training would fall under the guidance of DD 1.60.
If you have any other comments or questions please let me know. Ryan Allen, CDE [email protected] Industrial Hygiene Technical Policy Manager, 360-902-5530”
Which mask for which task? The new Department of Labor & Industries (L&I) guidance document, “Which Mask for Which Task?,” describes various types of jobs based on the level of risk to workers, from negligible risk to extremely high. The publication spells out which face-covering, mask, or respirator is required for that task. Along with details about the appropriate protective face covering, the guidance also includes photos to help workers and employers identify the type of mask required.
“We know that choosing the correct face covering, mask or respirator can be confusing. It’s a new experience for most employers and people on the job,” said L&I Assistant Director Anne Soiza. “This guidance should help employers and workers understand the risk level for various tasks, and make the right choice to protect workers from the coronavirus. Employers needing assistance can call on our statewide consultants for help.”