Legislative and Budget Overview

As we all know, elections have consequences! Not too surprisingly, Governor Jay Inslee won his third term as the Governor of Washington state against the police chief from Republic, WA. The Democrats still control both the House and Senate. At latest vote count, the Senate will retain a 28-21 Democratic majority. Three Senators retired and were replaced by same party, two being former House of Representative members. There are 6 new members of the Senate. At the latest vote count here are 16 new House members, Democrat majority with 56/42.

Updated numbers by the Economic and Revenue Forecast Council released Wednesday show that projected revenue collections through mid-2023 are more than $900 million above what had been originally forecast. But the state’s revenue projection for that same timeframe remains nearly $2.4 billion below what it was before the pandemic hit. That potential shortfall has steadily been shrinking since June, when numbers showed that state revenues through mid-2023 were projected to be nearly $9 billion lower than previous projections had shown. In September, they were projected to be $4.6 billion lower.

The Governor’s budget will come out in early December based on these new revenue forecasts making it less likely that the state will opt to make deep cuts to in-home services. The House and the Senate will submit their budgets sometime in the middle of the session based on February revenue forecasts. No final decisions will happen until the final compromise budget comes out in April 2021.

WAHCA, HCAW and WSHPCO Meet with Spokane Legislators: I organized a Zoom meeting on November 6^th with key legislators from the Spokane area to discuss the Proposed Agency Decision Packages In-Home Services Budget Cuts for 2021-23 Budget. The meeting was successful in gaining their awareness around the negative impacts of these types of cuts and the increased costs that it would have on the state budget to eliminate hospice, home health rehab and reduce home care access and rates. Our speakers were:

• Jeff Wiberg -Family Resources Home Care spoke to the Home Care (DSHS/ALTSA): Provider Rate Cuts and Client Eligibility Cuts: 2.4 percent rate cuts across the board for Medicaid providers, including in-home providers, nursing homes, adult family homes, adult day health, private duty nursing, enhanced service facilities and assisted living facilities. (-$145.2M Total; -$66.6M GF-State) The client eligibility cuts would result in the loss of ALTSA services for over 12,000 people served in their own homes, community settings and nursing homes, and a reduction in DSHS and Area Agency on Aging (AAA) staff due to a smaller number of clients receiving services. (-$805.3M Total; -$385.6M GF-State; -69.6 FTE)
• Gretchen Anderson – Sunshine Home Health spoke to the cuts for Home Health (Health Care Authority
• Chris McFaul-Horizon Hospice spoke to the Hospice Benefit (Health Care Authority)
• Kurt Sigler, Maxim Health Care Spokane Operations Manager spoke about the impacts of a 2.4% budget cut on Private Duty Nursing

Potential Taxes under Consideration by the State Legislature: The Tax Structure Work Group, are holding listening sessions to allow legislators to hear from you on a variety of tax policies to help the Tax Structure Work Group craft alternative scenarios to share with the public in 2021. The only one that mentions healthcare specifically is the Retail Sales & Use Taxes, but the B & O tax may be a concern as well. We are watching this closely when the session starts…

Governor Proclamations & COVID-19 Waivers

A letter from Residential Care Services: Indoor visits are suspended for all LTC settings except for end-of-life care and essential support persons. End-of-life circumstances are generally defined as a sharp decline in health status. In these circumstances, only one person may visit, and that person must be designated by the long-term care resident or client, or their legal representative. The visitor restrictions apply to all four phases at this time. All other criteria to allow visitors, such as screening protocols and use of personal protective equipment (PPE), remain in effect for those visitations allowed under the new proclamation.

The latest COVID-19 Waivers have been extended until December 7^th.  We assume new ones will be posted soon thereafter hopefully until January 2021. We are hearing that the Democrats in the legislature will extend the waivers until the end of the emergency.

DSHS/ALTSA Covid Waiver Extensions: https://www.dshs.wa.gov/sites/default/files/ALTSA/rcs/documents/multiple/020-10-08-2.pdf

DOH Waivers: https://www.doh.wa.gov/Emergencies/COVID19/HealthcareProviders/RelaxingRegulatoryRequirements

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 December 7, 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.

 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 December 7, 2020, whichever occurs first. This means that a caregiver can work in a community-based setting past 200 days before obtaining a nursing assistant-certified or a certified home care aide 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 December 7, 2020, 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.

Barriers to the practice of health care provider volunteers: The requirement to verify that an NA has completed basic caregiver training and core delegation training before delegation, and the Washington state nursing care quality assurance commission community-based and in-home care setting delegation decision tree are waived.

Barriers to long-expired credential reissuance: The requirement to retake nursing assistant or nursing training and pass the competency examination prior to reissuance when a nursing assistant-certified credential has been expired for over three years is waived.

 The COVID-19 situation is rapidly evolving. You can monitor the following sources for updates:  

• Department of Health COVID-19 webpage: https://www.doh.wa.gov/Emergencies/Coronavirus
• Governor Inslee’s COVID-19 webpage: https://www.governor.wa.gov/issues/issues/covid-19-resources
• Washington State COVID-19 webpage: https://www.coronavirus.wa.gov
• Federal COVID-19 webpage: https://www.coronavirus.gov

Pearson Vue testing suspension information: https://home.pearsonvue.com/Standalone-pages/Coronavirus-update/United-States.aspx

Department of Health (DOH)

New Secretary of Health: (Seattle Times, Nov. 17, 2020) Gov. Jay Inslee announced Tuesday that Washington’s next secretary of health will be Dr. Umair Shah, the health director for Texas’s largest county. The new appointment comes as the state sees an increase in new COVID-19 infections and hospitalizations, and as Washingtonians brace for more cases, deaths and economic damage as the coronavirus surges. Shah — who replaces Secretary John Wiesman and will oversee the Washington Department of Health (DOH) — will begin his new job Dec. 21.

In a news conference announcing the appointment, Inslee said hospitalizations of infected people are increasing on both sides of the Cascade Mountains. Meanwhile, state health officials Tuesday reported a new daily record of 2,589 confirmed COVID-19 cases, and 23 new deaths.

But Inslee praised Shah, who has since 2013 served as executive director for Harris County Public Health, the county that encompasses Houston. There, he managed a public-health staff of 700 that serves the county’s 4.7 million residents, according to Inslee’s office.

Letter to DOH Regarding Vaccines for Home Care Workers from HCAOA/WAHCA:

The Home Care Association of America Washington State Chapter represents hundreds of agencies that bring care into the homes of thousands of our state’s older citizens and people with disabilities every day. Throughout the pandemic, home care aides have provided one-to-one care in individuals’ homes to keep them safe and prevent the spread of the coronavirus. Home care is critically important as we face record numbers of cases and hospitalizations heading into the holiday season. Home care is the answer to keeping our most vulnerable safe from this disease and our frontline workers are essential as Washington battles COVID-19.

As you continue to fine-tune our state’s plan for the distribution of a COVID-19 vaccine, we urge you to include home care aides as health care workers to receive this vaccine first. If we are to contain the spread of the virus, home care workers play an essential role in the fight against the coronavirus and should be among the first to receive the vaccine.

Home care agencies monitor the conditions of our frontline workers every day and are in an excellent position to monitor the well-being of our clients, who are at home, yet are vulnerable to the virus. We continue to provide our frontline workers with PPE, testing when appropriate and offer ongoing training on infectious disease control.

Update on vaccine candidates from DOH: This week we heard encouraging news about a second COVID-19 vaccine candidate. We are excited that there are potentially two very effective vaccines close to being ready for approval.

Both pharmaceutical companies developing these vaccines are indicating strong vaccine effectiveness among participants in Phase 3 clinical trials. One of the companies has announced they will apply for Emergency Use Authorization through the U.S. Food and Drug Administration (FDA).  As these vaccines go through the approval process, we will learn more about how well they work. They will also be vetted for safety.

Provider enrollment: Health care providers began enrolling earlier this month to be COVID-19 vaccine administrators. As of November 16, 375 providers have turned in applications. Most applications are still in progress, but we have fully approved six sites. We want to encourage clinics, pharmacies and health care offices across the state to apply to be vaccine administration sites. If you are a health care provider and want to enroll, learn how and get enrollment materials at www.covidvaccinewa.org.

Vaccine planning: Estimates on the amount of doses we will receive have varied. We do not have new information from the federal government about our allocation or timing for receiving vaccine. We also do not have information on how often we will continue to get additional doses. To see Washington’s interim plan that addresses who might get the vaccine in what phases, go to www.covidvaccinewa.org.

Palliative Care Roadmap Completed and Available!! I have some good news, Pat Justis has located funds for a third printing of the PC Roadmap!  One of her Program Managers has an underspent budget and would like to fund this, so we just have to spend it before 3/31/2021. Pat believes that our second printing of 5,000 will be expended by then.

We are excited that this new booklet is now available to order. And best of all, the booklet is free with no shipping charges!! It’s posted on DOH Rural Health webpage. (https://www.doh.wa.gov/Portals/1/Documents/Pubs/609013.pdf) and offers permission for others to post it to their own web sites.  For ordering: https://prtonline.myprintdesk.net/DSF/  and register.

Nursing Care Quality Assurance Commission (NCQAC)

Emergency Volunteer Health Care Workers Needed: The NCQAC has been experiencing a backlog of licenses for nurses and are working to rectify it. DOH is continuing to look for medical practitioners and caregivers who are willing to support health care and long-term care facilities in the event of a surge this fall related to COVID-19. Those volunteers could be health practitioners licensed in another state who can practice in Washington if their other licenses are in good standing and they register with us. Or, they could be health practitioners licensed in Washington who want to volunteer to help meet demands in an emergency. Right now, we are urgently looking for Certified Nursing Assistants, Licensed Practical Nurses, and Health Care Assistants. Interested volunteers can visit our website at www.doh.wa.gov/emergencyvolunteer to learn more about our emergency volunteer program or email [email protected] with specific questions.

NCQAC Draft Advisory Opinion for Telehealth Nursing Services: This may be of importance due to the amount of telemedicine that home health and hospice agencies have been providing, especially during the pandemic. NCQAC concludes that the appropriately prepared and competent advanced registered nurse practitioner (ARNP), registered nurse (RN), licensed practical nurse (LPN), nursing technician (NT), and nursing assistant (NA), may perform telehealth delivery of nursing care services in settings appropriate for telehealth care within their legal and individual scope of practice. This document touches on a number of areas including nurse delegation, documentation and standard of care.  Please let me know if you have any comments or concerns that you would like to let staff at NCQAC know about.

Nurse Delegation Bill Proposed for 2021 Legislative Session: Rep Eileen Codyis proposing a bill for the 2021 legislative session to allow for more flexibility in hospitals. Below is a draft of the bill that was discussed at a November 5^th meeting. At the meeting I requested that a section of the proposed bill that was struck out (Sect. 1(3)(b) remain in the statute for ease of home health and hospice providers. Although the broader bill language would allow for this section in the revision, I requested that it stay in for clarity. They also changed the language from certified nursing assistant to credentialed health care provider in the section.

(b) registered nurse, working for a home health or hospice agency regulated under chapter 70.127 RCW, may delegate the application, instillation, or insertion of medications to a registered or certified nursing assistant under a plan of care.

LTC Workforce Development Committee: The Nursing Care Quality Assurance Commission (NCQAC) has a report to the legislature due June 30, 2021 on how to increase the number of LTC workers in the pipeline. They are acutely aware of the nursing shortage and are working on ways to create more pathways for home care aides and CNA’s to become RNs. I also participate in the subcommittee on Curriculum and their latest meeting was on November 9th.

Public Policy

WA State Telemedicine Collaborative: Next meeting was on November 17^th.  Possible new legislation to keep some of the lifted restrictions permanently such as being able to bill for audio only telemedicine visits! Telemedicine Trainings will begin December 7^th with the Collaboration to meet the January 1, 2021 deadline for all health care providers using and billing for telemedicine!

Prepared by Leslie Emerick, Lobbyist

Legislative and Budget Overview

The legislative environment that we operate in is significantly impacted by what is happening in our society. The COVID-19 pandemic and related unemployment has severely impacted our states population and our economy has taken a severe hit as a result. Sometime later this summer or early fall we may need to have a Special Session convened by the Governor to address the severe budget shortfall. The 2021 WA State Legislative session will be dominated by economic/budget, health care and social justice issues due to the protests against racism around the state and the country.

As an association we will need to adjust our legislative priorities accordingly. A good example is that 3% across the board spending cuts are being proposed for Medicaid home care at DSHS and  hospice has been offered up as an “optional service” under the Health Care Authority and could be part of the pending cuts to the states operating budget. We may need to defend keeping the home care benefit accessible for clients on Medicaid!

Although most counties in Washington state are moving to the next Phase of opening back up after the coronavirus shut down, in some counties the infection rates continue to rise significantly creating concerns about a set-back combating the virus. Initially the virus impacted the west side of the state with King County hit hard by the initial outbreak. Now the virus is moving east, impacting home health and hospice agencies on both sides of the state. Covid-19 Risk Assessment Dashboard

According to the Seattle Times, “The virus has created a crisis in county hospitals, which face critical staffing shortages as the count of patients with COVID-19 last week reached all-time highs. At Virginia Mason Memorial in Yakima, where staffing problems have been aggravated by workers ill or quarantining from COVID-19, the hospital can’t handle more admissions, and over two days last week arranged for 22 COVID and other patients to be taken to facilities in Western Washington. A hospital forecast projects the worst is yet to come. Hospitalizations are expected to climb sharply until mid-July, when they are anticipated to be roughly double the current level.

Budget reductions come more into focus with latest revenue forecast

Depending on which articles you read, the state is either $8.8 billion in the hole or $4.5 billion which may sound confusing…but the basic difference is whether you count the states roughly $3 billion dollar “rainy day” fund that has been created for exactly budgetary times like these and which fiscal biennium you are reporting on. The $8.8 billion projection is through fiscal year 2023.

The state Economic and Revenue Forecast Council’s quarterly revenue estimate projected a shortfall of $4.5 billion in the state’s current budget biennium alone. Even if the state used all of its reserve funds, that would leave a more than $1 billion shortfall that must be addressed in the current biennium. Revenue in the 2021-2023 biennium is expected to be reduced by $4.3 billion.

According to The Olympian, “Gov. Inslee has directed state agencies under his authority to cancel a scheduled 3 percent pay raise for many of the state’s highest-paid general government employees and to begin furloughs for most state employees. More than 40,000 state employees will be required to take one furlough day per week through July 25. The state employee furloughs started June 29^th. After July, employees will be required to take one furlough day per month at least through the fall, the governor’s office said. Inslee said employees also will be allowed to take voluntary unpaid furloughs. The governor also announced cancelled pay raises for 5,600 non-union state employees and furloughs that would affect many more, about 40,000 individuals total. These measures are expected to save the state $55 million this year. If state agencies not under the governor’s authority – such as the Legislature, courts and separately elected offices – took similar steps, it would save the state another $91 million this year.”

As a reminder, about 70% of Washington’s current operating budget is protected by state law, such as K-12 education and some federal Medicaid programs, meaning officials can only cut from the other 30%. Unprotected spending items include higher education, corrections, many human services and natural resources. The legislature will need to determine whether they want to do a “cuts-only” budget like they did in 2009 or whether they will look at increasing tax revenues, probably on the wealthier citizens in our state….

On June 8, OFM is posted preliminary state agency reduction proposals to their website: https://ofm.wa.gov/budget/state-budgets. This was a budget exercise to show what 15% budget cuts look like at the state agencies. The cuts to hospice are in the Health Care Authority Medical Assistance and Health Benefits Exchange. There are also deep cuts to DSHS Home and Community Services and providers such as private duty nursing for medically fragile adults with 3% across the board reductions to funding. The cuts were an exercise to show the depth of the reductions that will have to be made unless Congress passes funding for state and local governments impacted by COVID-19. Currently a funding bill has passed the House but not the Senate in Washington DC.

In an announcement from the Governor’s Office, Inslee lobbies for Congress to pass the HEROES Act for state and local aid:

“The Governor has reached out to Speaker Nancy Pelosi and the U.S. House Democratic Caucus on the need to encourage the Senate to pass the HEROES Act, a state and local aid package approved by the House last month. Under the legislation, Washington would receive $10.7 billion in state funds, and an additional $1 billion to local governments. Washington state’s operating budget currently faces a forecasted shortfall of more than $8 billion over the next three years.

The state will face dramatic cuts to services for the people of Washington without more federal aid to mitigate the COVID-19 pandemic and its economic impacts. Substantial cuts to state and local governments will only mean more painful decisions that potentially exacerbate the recession and undermine our economic recovery.”

Governor Proclamations Related to COVID-19

Governor Inslee’s COVID-19 webpage: https://www.governor.wa.gov/issues/issues/covid-19-resources

Inslee extends Safe Start proclamation, issues facial coverings guidance:

Gov. Jay Inslee announced the extension of the Safe Start proclamation until August 6. This extension clarifies the interaction between Safe Start and Department of Health Secretary John Wiesman’s facial coverings order. It includes: 

• The Yakima County business prohibition is extended statewide: No business may operate, allow a customer to enter a business, or conduct in-person business with a customer in any public setting unless the customer is wearing a face covering (as required, and with the exceptions outlined, in Order of the Secretary of Health 20-03;
• Individuals are prohibited from entering a place of business without wearing a face covering (again, per Order of the Secretary of Health 20-03); and
• Employers must notify the employer’s local health jurisdiction within 24 hours if the employer suspects COVID-19 is spreading in the employer’s workplace, or if the employer is aware of 2 or more employees who develop confirmed or suspected COVID-19 within a 14-day period.

Home Care Workers Guidance – issued June 22

Full list of current reopening guidance.

Nursing Assistant and LTC Workers COVID-19 Waivers Extended through August 1, 2020

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 July 1, 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.

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 July 1, 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.

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 July 1, 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.

Barriers to the practice of health care provider volunteers: The requirement to verify that an NA has completed basic caregiver training and core delegation training before delegation, and the Washington state nursing care quality assurance commission community-based and in-home care setting delegation decision tree are waived. You can view the full list of COVID-19 related waivers that have been extended here. The COVID-19 situation is rapidly evolving. You can monitor the following sources for updates:  

• Washington State COVID-19 webpage: https://www.coronavirus.wa.gov
• Federal COVID-19 webpage: https://www.coronavirus.gov
• Pearson Vue testing suspension information: https://home.pearsonvue.com/Standalone-pages/Coronavirus-update/United-States.aspx

Department of Health

Department of Health COVID-19 webpage: https://www.doh.wa.gov/Emergencies/Coronavirus

Uniform Health Care Facility Enforcement Act: In the 2020 session, the Legislature passed House Bill 2426 directing the Department of Health (department) to review the statutes for all health facility types we license, evaluate appropriate levels of oversight, and identify opportunities to consolidate and standardize licensing and enforcement requirement across facility types. The Legislature further directed the department to work with stakeholders on recommendations for a uniform health care facility enforcement act for consideration in the 2021 session.

The health care facilities covered by the law include:

The department will be convening stakeholders on Thursday, August 20, 2020 from 10:00-12:00 for an initial discussion of the current regulatory framework, approaches taken by other states, and opportunities to consolidate and standardize requirements in Washington. 

Please save the date for this meeting and register by clicking on this link: https://attendee.gotowebinar.com/register/72481314164882192.

After registering, you will receive a confirmation email containing information about joining the webinar. Additional information will follow prior to the meeting to help inform and facilitate the conversation.

Update from the DOH State Surveyor’s office:  DOH’s regular survey work is still on hold – their teams are focusing on initial surveys and complaint investigations that allege patient harm.

Palliative Care Roadmap: The PC Roadmap is coming along quite well!! We have had numerous editing meetings for the “PC roadmap” with DOH staff and a smaller group of palliative care experts as to the direction and content for the report. As you may remember, we had excellent representation from across the state with many different types of palliative care providers and experts at the table for the initial source of content for the booklet. The booklet will be very similar to the Dementia Roadmap published by DSHS a few years ago. It is to be used as a resource for patients, their families and practitioners when a patient has been diagnosed with a serious or life-threatening illness. Hard copies must be available for distribution no later than September 30, 2020. More to come!

Palliative Care-Rural Health Integration Advisory Team (PC-RHIAT): The WA Rural Palliative Care Initiative (WRPCI) is a pilot effort to better serve patients with serious illness in rural communities. This is an ongoing workgroup thatI am involved in and I’m on the advisory team for the Community Engagement Workgroup. To learn more about the Washington Rural Palliative Care Initiative please visit :  https://waportal.org/partners/home/washington-rural-palliative-care-initiative

DSHS Issues: Coronavirus: https://www.dshs.wa.gov/alert/covid-19-information

Residential Care Services (RCS), in coordination with Department of Health and stakeholders, has prepared plans for a phased reopening of long-term care providers in Washington state.  These plans are currently being reviewed by the Governor’s office and are anticipated for release in the near future. The conference call to discuss these plans has been cancelled twice. May be due to the increasing number of COVID-19 cases in the state…. more to come!  Many in-home care providers have had trouble accessing these state residential care facilities with their caregivers due to concerns around spreading the virus in their facility.

FAQ: COVID-19 Testing of Residents and Staff of Nursing Homes and Assisted Living Facilities with Memory Care Units

Monthly Public Webinar for the Consumer Directed Employer project: You are invited to participate in a webinar on the Consumer Directed Employer project on July 23, 2020 at 3:00 pm. This webinar is intended for members of the public who are interested in learning more about the Consumer Directed Employer project.  Visit the CDE webpage. Please Register online. The Webinar will cover status updates on project activities, upcoming tasks, June poll question results, revised rollout approach and questions and answers from June webinar.

Labor and Industries: Coronavirus: https://www.lni.wa.gov/agency/outreach/novel-coronavirus-outbreak-covid-19-resources

Employers must notify local health department if COVID-19 spreading at the workplace:

Employers must notify the employer’s local health jurisdiction within 24 hours if the employer suspects COVID-19 is spreading in the employer’s workplace, or if the employer is aware of two or more employees who develop confirmed or suspected COVID-19 within a 14-day period.

The Department of Labor & Industries (L&I) updated its rules website: Rules filed June 30, 2020 Division of Occupational Safety and Health (DOSH)

Topic: Expedited (CR-105) – Occupational Exposure to Bloodborne Pathogens

Brief Description: The purpose of this expedited rulemaking is to update a reference to align with RCW 70.24.017, Definitions. The proposal also includes a housekeeping update, as well as reformatting to reflect clear rule writing. No requirements are affected. Amendments being proposed:

• WAC 296-823-13005 Make hepatitis B vaccination available to employees: Update subsection (3) as it is part of the requirements, and not the exception.
• WAC 296-823-16010 Test the blood of the source person: Update note 1, as law now provides for orders for testing for any bloodborne pathogen.

Written objections due by: August 31, 2020

CR-105 Expedited Proposal

Proposal Language

Workplace Violence Prevention Training: On July 1, 2020 HB 1931: Concerning workplace violence in health care settings, goes into effect and it 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 Here is a link to the relevant RCW 49.19: https://app.leg.wa.gov/RCW/default.aspx?cite=49.19.  In particular see:

49.19.020	Workplace violence plan—Security and safety assessment.
49.19.030	Violence prevention training.

Public Policy Development

HCAOA Legislative Call with Vicki Hoak: The monthly call was on July 8^th with state lobbyists and association members from around the country. A hot topic of discussion was around whether to advocate on the state level for mandatory testing of home care aides and how that would be funded. As you are aware, in WA state skilled nursing facilities, adult family homes and other LTC facilities now require testing for employees. Is this the path WA State wants to advocate for and try and get funding through DOH for?

We discussed the state budget cuts and the implications for home care agencies and our current advocacy. All agree that federal funding will be needed to help solve the states budget crisis due to COVID-19 nationally. In response to the ongoing public health crisis due to COVID-19, within the next month we expect the United States Congress to consider polices that could impact Medicaid home and community-based services.

We need Congress to fully understand that over three million frontline home care aides are caring for eight million Americans during this public health crisis.  And to make sure that happens, every voice is needed! We are respectfully asking you to lend your voice in supporting legislative proposals that include increased federal funding for Medicaid HCBS and enhanced wages for the heroic efforts of the frontline home care aides.  We are also asking Congress to support financial assistance to states to ensure that Medicaid HCBS programs can remain viable for the clients we serve day in and day out. To advocate and send a letter to your Congressional representatives go to: https://www.hcaoa.org/advocacy/advocacy-action-network/

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. Next meeting of the curriculum workgroup in June 8^th.

WA State Dementia Collaborative:  Dementia Friendly Communities Conference, a 2-day virtual event, 9 a.m. – 12 p.m. Tues/Wed September 29 & 30, 2020. Registration opens on July 30^that www.tinyurl.com/DementiaFriendly2020. Please pass it on!

An Updated resource sheet with lots of virtual opportunities: “Resources for Dementia Caregivers during Covid-19 Outbreak – July 2020” –link to here. Lots of great educational events too!

Alzheimer’s Disease International recently released a report on From Plan to Impact III: Maintaining dementia as a priority in unprecedented times. This report provides an update on the progress towards the World Health Organization (WHO)’s Global action plan on the public health response to dementia 2017-2025, particularly in relation to the COVID-19 pandemic. The report draws attention to the challenges and opportunities that have been brought on by the COVID-19 pandemic, and calls for governments to take immediate action from the lessons that the outbreak has presented. (June 2020). You could also:

• Watch the recording of the report’s launch event
• Download the slides from the launch event

Prepared by Leslie Emerick, Lobbyist

Legislative Overview

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 17^th, 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

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 29^th 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 8^th 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

Coronavirus: https://www.lni.wa.gov/agency/outreach/novel-coronavirus-outbreak-covid-19-resources

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 1^st, 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.”