Legislative Overview

The 2021 Legislative session will go down in the history books with the dueling drama of a pandemic and armed militia threats against our Governor, Legislators, and the state capitol buildings!! The capitol in Olympia is still in a state of “Restricted Access” for the near foreseeable future with Washington State Patrol taking high security measures to protect the capital campus and the employees in this time of militia related unrest. The National Guard has finally been sent home at a cost of over $1.6 million. The federal Department of Homeland Security has issued a recent warning for potential violence in all 50 state capitols. The capitol campus already had most employees from home due to the pandemic, but some continue to work at the capital during session.

The 2021 “virtual” legislative session is now moving into its fourth week (Feb. 1 being the 22^nd day of the 105-day legislative session) with new bill introductions starting to wind down. February 15^th is the first big policy bill cut-off, with fiscal bills cut-off on February 22^nd. Bills that have been introduced and received a public hearing must pass out of these committees to continue through the legislative process. Those bills that do not get a vote out of their respective committees by this date die for this legislative session. Since WA State has a biennial legislative session, bills that die for this session may be back next year.

So far, 1,167 bills have been introduced this session which is far less than a regular long session which typically introduces closer to 2,600 bills! Legislators were concerned about the ability pass bills in the virtual environment in a timely manner and limited the number of bills to be heard by House of Representatives to 7 bills, requested that they do not file “Companion” bills in the opposite house and focus on COVID-19, the 2-year operating budget, social justice, and climate issues. Here is a really good resource for accessing the legislature this session!

COVID-19 Information

The first bills passing the legislature this session was COVID-19 related, such as extending the month-to-month waivers until the end of the state emergency orders under the Governor. (COVID-19 Proclamations Extended under SCR 8402)  No one knows when the pandemic will “officially” end, so this offers some stability and consistency for health care providers and their organizations. There are several bills that direct the use of federal dollars for COVID-19 into various state funding accounts, much of which came into the state under the CARES Act.

There are also business-related bills, in particular one that provides additional funding to make up for the shortfalls in the Unemployment Insurance Account (SB 5061) due to millions being stolen through fraudulent accounts and the significant increase in unemployment due to the pandemic. SB 5061 has already passed both houses of the state legislature and is moving towards the Governor’s desk for signature! Just goes to show you that the legislature can move fast when it wants to!!

Much of my time has been spend working with the state DOH and King County to help expand access to care for in-home services agencies. The state has sent up large vaccination events in regions around the state. We were also part of the soft launch of www.findyourphasewa.com, which is fully operational now.

Getting vaccinated in King County – King County: DOH determines the distribution of vaccine for our state and eligibility for vaccination in phases.King County is currently in the state’s Phase 1a and Phase 1b, Tier 1 for vaccine distribution.

Mass Vaccination Sites: DOH, along with the assistance from the Washington National Guard and local and private sector partners, is launching four mass vaccination sites across the state for people eligible for the COVID-19 vaccine under Phase 1A or Phase 1B tier 1 (PDF). Locations will be appointment only and appointments must be made in advance. To get a vaccine, you first need eligibility confirmation from Phase Finder.

Crossing state lines for vaccine: Given the limited supply of vaccine that is available at this time and our state’s commitment to equitable and fair access to vaccine, the state of Washington is requiring that those seeking COVID-19 vaccines in its four mass vaccination sites must either live or work in Washington state. If you do not live or work in Washington, please do not make vaccine appointments or travel to Washington sites for vaccines. 

Location of Sites

Kennewick

Ridgefield

Spokane

Wenatchee

Tracking PPE Distribution Dashboard: https://coronavirus.wa.gov/what-you-need-know/personal-protective-equipment/tracking-ppe-distribution

Vaccine Coordination Meetings: I also attend the DOH Vaccine Partners meeting, and they reported that much more vaccination is heading to Washington state in the near future and they are working on multiple pathways to get the vaccine out into our communities, include mobile vaccinations for home bound patients or those with difficulty traveling.

Shawn, Sharla and I have been meeting with King County Public Health to discuss the vaccine roll out for home health, home care and hospice agencies for distribution of the COVID-19 Vaccine. It appears that most of our agencies have been able to access vaccines from various local sources in their communities. Please let us know if you are still having difficulties getting your staff vaccinated or your clients who qualify.

Department of Social and Health Services (DSHS)

Safe Start for LTC Recommendations & Requirements: Updates and Webinar

Rulemaking notice from DSHS regarding LTC Worker Qualifications: The department is planning to amend WAC 388-71-0975 to clarify how to interpret the long-term care worker qualifications and requirements in statute and rule that have specific time periods for compliance when there has been a period of time in which the underlying requirements were suspended and waived in whole or part by emergency proclamation by the Governor.

The department filed an emergency rule for WAC 388-71-0975 as WSR 21-01-018 on December 3, 2020. If you are interested in participating in the rule making process, please contact Angel Sulivan at angel.sulivan@dshs.wa.gov.

Rulemaking Regarding Specialty Training for Dementia and Mental Health: (CR 103)DSHS filed a permanent rule on January 28 to create new and amending sections in chapter 388-112A WAC Residential Long-Term Care Services Training. These changes are necessary to clarify instructor qualifications and requirements for the additional specialty courses required by RCW 70.128.060(8). To read the rule filing and final language, click here.

Monthly Public Webinar for the Consumer Directed Employer project: 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.  Visit the CDE webpage.

• February 16:  10:30 am – 11:30 am    Register here

The Webinar will cover: Status updates on project activities, upcoming tasks, roles of service coordinators, how to get help, upcoming readiness assessments

Department of Health (DOH)

Department of Health Vaccine Updates: https://www.doh.wa.gov/Emergencies/COVID19/Vaccine, Find COVID-19 vaccine information for health care providers.

Nursing Assistant Waivers: DOH Notice-On Wednesday, January 20, 2021, a GovDelivery message titled “Nursing Assistant Waivers Extended Until State of Emergency Terminated” incorrectly stated that the requirement to verify that a nursing assistant has completed basic caregiver training and core delegation training before delegation is waived. Please note: the core delegation training requirement before delegation is not waived. Only the basic caregiver training requirement is waived. We apologize for any confusion. Below is the information that was sent out on January 20, 2021:

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 pursuant to RCW 43.06.210, or until rescinded; 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 pursuant to RCW 43.06.210, or until rescinded; 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 pursuant to RCW 43.06.210, or until rescinded; 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 deadline: 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.

DOH Announcement: Help us to learn what you need to prevent the spread of COVID-19 and other infectious diseases:  To better fight COVID-19, the Washington State Department of Health (WA DOH) and the Centers for Disease Control and Prevention (CDC) created an infectious disease survey for frontline healthcare workers. This survey is part of a project called Project Firstline. Project Firstline is designed to prevent the spread of infectious diseases in healthcare settings across Washington through interactive trainings and resources. For more information, please go to:  Prevent COVID-19 infections in healthcare settings (govdelivery.com)

PREP Act Authorization for Health Care Workers with Expired or Inactive Licenses to Administer COVID-19 Vaccines: DOH, in partnership with our health profession boards and commissions, is taking action to support retired health care workers or those with inactive licenses to more easily get back into the workforce to administer the COVID-19 vaccine. The goal is to ensure we have a robust workforce to help us bring an end to the COVID-19 pandemic.

Please find the attached Public Readiness and Emergency Preparedness Act (PREP Act) authorization from Secretary of Health Dr. Umair Shah for health care workers with expired or inactive licenses to administer COVID-19 vaccines under certain circumstances.

To participate, health care workers must register at: https://www.waserv.org. Step-by-step instructions to register:  https://www.doh.wa.gov/Emergencies/COVID19/HealthcareProviders.

Before registering, participants will need to have access to previous Washington state credential numbers, which may be obtained through the Department of Health’s Provider Credential Search, accessible at https://fortress.wa.gov/doh/providercredentialsearch/. After registering, participants must wait to receive confirmation from DOH that they are authorized to administer COVID-19 vaccines under Dr. Shah’s authorization. Certain health care workers with expired/inactive licenses may qualify for PREP Act coverage under both state and federal authorizations. Secretary of Health Shah’s authorization for Washington State currently allows broader participation.  Questions about registration? Please email: waserv@doh.wa.gov. More Resources:

• Centers for Disease Control and Prevention COVID-19 vaccine training
• Department of Heath COVID-19 vaccine training resources
• Washington State Pharmacy Association immunization training
• Oregon Health Science University dental immunization training
• Vaccine Adverse Event Reporting System (VAERS):

o VAERS Overview video
o VAERS demonstration video

DOH and LNI’s Fit Testing Training Webinars: Please review the information below for important information including a recording of the webinar and additional resources on fit testing.

1. Recordings, videos and resource links (for everyone) – Please note due to the size of the slide deck slides are NOT available at this time.
2. Sign-up for small group fit testing practice and coaching (for those doing their own fit testing)
3. Obtaining a fit testing kit (for those doing their own fit testing)
4. Accessing the 3M online medical clearance system (for those doing their own fit testing)
5. Accessing mobile fit testing (for everyone)

RECORDING of 1/20 webinar (same content as 1/13) – Click here: https://attendee.gotowebinar.com/recording/1294987615467886607

Fit Testing Demonstration Videos from webinar

Part 1 Click here: https://attendee.gotowebinar.com/recording/9064256624105775619

Part 2 Click here: https://attendee.gotowebinar.com/recording/6512252752642420994

Full version UW of video shown by LNI during webinar (importance of fit): https://attendee.gotowebinar.com/recording/3987538759800525570  Questions from the Q&A will be posted to DOH’s web page in the near future. We encourage you to reach out to us if you have specific questions about your agency or facility. Please email carolyn.ham@doh.wa.gov. 

To request Consultation from LNI https://www.lni.wa.gov/safety-health/preventing-injuries-illnesses/request-consultation/

The Respiratory Protection Plan template from LNI is located here:  https://lni.wa.gov/safety-health/_docs/Respirator-Program-Template%20-Guide-for-N95-Use-in-LTC-During-the-COVID-19-Pandemic.docx (alternatively, try accessing from this webpage, https://lni.wa.gov/safety-health/safety-topics/topics/coronavirus#industry-and-topic-specific-resources  scroll down to ‘Long Term Care Facilities’ and click on “Respirator Program Template and Guide for N95 use at Long Term Care Facilities During the COVID-19 Pandemic”) The facial hair guide from CDC NIOSH is here: https://www.cdc.gov/niosh/npptl/pdfs/facialhairwmask11282017-508.pdf

2. Sign-up for small group fit testing practice and coaching (for doing their own fit testing)

Starting in February, DOH’s Occupational Health Nurse will be providing small group coaching for facilities and agencies who are doing their own fit testing. These practice sessions will last for 1 hour each and will be video chats via the MS Teams application. You will watch live demonstrations, and then you will practice fit testing skills and receive feedback. There will also be time for questions. You need to have a fit testing kit on hand participate in the training sessions. We will be offering these sessions again later this year, so if you don’t have a kit yet, don’t worry. There will be additional opportunities. To sign up for these, please fill out this SurveyMonkey: https://www.surveymonkey.com/r/GQ5GSLZ

If you are interested in obtaining a fit testing kit and you have more than 20 staff who need fit testing, please email DOH at carolyn.ham@doh.wa.gov with the following information. We do not recommend this option for smaller facilities.

Facility Name, Facility Address, Number of staff to be fit tested, Contact person

4. Accessing the 3M online medical clearance system (for those doing their own fit testing)

If you are doing your own fit testing with a kit, you can use DOH’s account for 3M online medical evaluations. For facilities doing their own fit testing, email carolyn.ham@doh.wa.gov to get access. If you want to have a company provide mobile fit testing at your location, they will manage the medical clearance process for you – please read below for more information.

• Beginning in January 2021, facilities and agencies in all counties in Washington State are eligible for no-cost fit testing through funding provided by the Department of Health. Eligible facility and agency types are:

• Assisted Living Facilities
• Skilled Nursing Facilities/Nursing Homes
• Adult Family Homes
• Supported Living Agencies
• Home Care Agencies
• Home Health Agencies
• Hospice Agencies

Each county has been assigned a fit testing provider who is participating in the DOH N95 Fit Testing Project. Appointments for fit testing with these providers will begin after February 1^st. To access this program, facilities should contact the fit testing provider assigned to their county directly. You do not need to contact DOH to qualify, please directly contact the fit testing provider for your area. To find the provider assigned to your county, please review the chart or map below. If your county isn’t listed below, please contact DOH (carolyn.ham@doh.wa.gov) to find out who your fit testing provider will be. Please note, if you need online medical evaluations ONLY (do NOT need mobile fit testing), you can contact DOH at carolyn.ham@doh.wa.gov.

Nursing Care Quality Assurance Commission (NCQAC)

NCQAC has been working on a draft for an Advisory Opinion Telehealth for nursing. I attended their workgroup meeting this week and it looks like home care aides and certified nursing assistants can work under Nurse Delegation to assist with a patient as long as the delegator has telemedicine in their scope of practice.

Office of the Insurance Commissioner (OIC)

Health insurance and coronavirus (COVID-19) frequently asked questions | Washington state Office of the Insurance Commissioner

L&I Coronavirus Response Data

• Coronavirus (COVID-19) data dashboard (last update: Feb. 3, 2021): Coronavirus-related enforcement, inspections, consultations, and workers’ compensation claims.

Virtual In-Home Services Days

I am working on a new format for our In-Home Services Day and will share ASAP with our updated talking points ASAP! More to come…

Please see attached bill tracking and upcoming public hearings list!

Prepared by Leslie Emerick

These are the public hearings coming up next week in the WA State Legislature on bills we are tracking for the association. Our Legislative “Hot Team” met this morning with Vicki Hoak to determine positions on bills for the upcoming week. If you want to look closer at the bills, click on the bill numbers in the list and it will take you to the Bill Information page at the WA State Legislature. The easiest way to review is to look at the Bill Reports summaries prepared by committee staff. Please let us know if you have any questions of concerns.

Upcoming Events

Labor, Commerce & Tribal Affairs (Senate) – Virtual, – 1/18 @ 9:00am

1. SB 5097 – Public Hearing – Expanding coverage of the paid family and medical leave program. (Concerns/High) WAHCA will sign in with concerns and written testimony.
2. SB 5115 – Public Hearing – Establishing health emergency labor standards. (Neutral/High)

Health Care & Wellness (House) – Virtual, – 1/18 @ 1:30pm

• HB 1120 – Public Hearing – Concerning state of emergency operations impacting long-term services and supports. (Support/High) WAHCA will sign in to Support.

Health Care & Wellness (House) – Virtual, – 1/20 @ 8:00am

• HB 1124 – Public Hearing – Concerning nurse delegation of glucose monitoring, glucose testing, and insulin injections. (Support/High) WAHCA will sign in to Support.

Labor & Workplace Standards (House) – Virtual, – 1/20 @ 10:00am

• HB 1087 – Public Hearing – Clarifying the continuity of employee family and medical leave rights. (Neutral/Medium)

Labor, Commerce & Tribal Affairs (Senate) – Virtual, – 1/21 @ 8:00am

• SB 5046 – Public Hearing – Concerning workers’ compensation claim resolution settlement agreements. (Remote testimony.) (Neutral/Medium)

Labor & Workplace Standards (House) – Virtual, – 1/22 @ 8:00am

• HB 1076 – Public Hearing – Allowing whistleblowers to bring actions on behalf of the state for violations of workplace protections. (Remote testimony.) (Neutral/Medium)

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High Priority Bills

Bill Details	Status	Sponsor	Position
HB 1073	Paid leave coverage	H Labor & Workpl	Berry	Neutral
Expanding coverage of the paid family and medical leave program.
HB 1120	Long-term services/emergency	H HC/Wellness	Tharinger	Support
Concerning state of emergency operations impacting long-term services and supports.
HB 1124	Nurse delegation/glucose	H HC/Wellness	Cody	Support
Concerning nurse delegation of glucose monitoring, glucose testing, and insulin injections.
HB 1196	Audio-only telemedicine	H HC/Wellness	Riccelli	Neutral
Concerning audio-only telemedicine.
SB 5061 (HB 1098)	Unemployment insurance	S Labor, Comm &	Keiser	Neutral
Concerning unemployment insurance.
SB 5090 (HB 1097)	Worker protections	S Labor, Comm &	Keiser	Neutral
Increasing worker protections.
SB 5097	Paid leave coverage	S Labor, Comm &	Robinson	Concerns
Expanding coverage of the paid family and medical leave program.
SB 5115	Health emergency/labor	S Labor, Comm &	Keiser	Neutral
Establishing health emergency labor standards.
SB 5178	Health care waivers	S Health & Long	Cleveland	Neutral
Establishing automatic waivers of select state health care laws to enable timely response by the health care system during a governor-declared statewide state of emergency.
SCR 8402	Emergency orders extension	H 2nd Reading	Liias	Neutral
Extending certain gubernatorial orders issued in response to the COVID-19 state of emergency.

Medium Priority Bills

Bill Details	Status	Sponsor	Position
HB 1002	COVID-19 grants/B&O tax	H Finance	Walen	Neutral
Providing a business and occupation tax exemption for qualifying grants related to COVID-19 relief.
HB 1021	Unemployment benefit charges	H Labor & Workpla	MacEwen	Neutral
Concerning relief of benefit charges when discharge is a result of a gubernatorial declaration of emergency or related executive order.
HB 1065	Epidemic, pandemic vaccines	H HC/Wellness	Eslick	Neutral
Concerning epidemic or pandemic vaccines.
HB 1076	Workplace violations/qui tam	H Labor & Workpl	Hansen	Neutral
Allowing whistleblowers to bring actions on behalf of the state for violations of workplace protections.
HB 1087	Family/med leave continuity	H Labor & Workpla	Berry	Neutral
Clarifying the continuity of employee family and medical leave rights.
HB 1094 (SB 5092)	Operating budget 2021-2023	H Approps	Ormsby	Neutral
Making 2021-2023 fiscal biennium operating appropriations.
HB 1095	Emergency assistance/tax	H Finance	Walen	Neutral
Concerning the taxation of governmental financial assistance programs addressing the impacts of conditions giving rise to a gubernatorial or presidential emergency proclamation by creating state business and occupation tax and state public utility tax exemptions, a sales and use tax exemption for the receipt of such financial assistance, and clarifying the sales and use tax obligations for goods and services purchased by recipients of such financial assistance.
HB 1097 (SB 5090)	Worker protections	H Labor & Workpla	Sells	Neutral
Increasing worker protections.
HB 1098 (SB 5061)	Unemployment insurance	H Labor & Workpl	Sells	Neutral
Concerning unemployment insurance.
HB 1127	COVID-19 health data privacy	H HC/Wellness	Slatter	Neutral
Protecting the privacy and security of COVID-19 health data collected by entities other than public health agencies, health care providers, and health care facilities.
HB 1188	B&O tax payment deferral	H Finance	MacEwen	Neutral
Providing a business and occupation tax payment deferral to address the economic impacts of the COVID-19 pandemic on businesses in the state.
HB 1191	Health coverage	H HC/Wellness	Thai	Neutral
Ensuring equity in health coverage.
HB 1218	Long-term care residents	H HC/Wellness	Bateman	Neutral
Improving health, safety, and quality of life for residents in long-term care facilities.
SB 5039	Gubernatorial emergencies	S State Govt & E	Wilson	Neutral
Subjecting all gubernatorial emergency orders to legislative approval after thirty days.
SB 5046	Worker comp claim agreements	S Labor, Comm &	Conway	Neutral
Concerning workers’ compensation claim resolution settlement agreements.
SB 5092 (HB 1094)	Operating budget 2021-2023	S Ways & Means	Rolfes	Neutral
Making 2021-2023 fiscal biennium operating appropriations.
SB 5114	Reopening/public health	S State Govt & E	Braun	Neutral
Concerning safely reopening Washington.
SB 5190	Health care workers/benefits	S Labor, Comm &	Holy	Neutral
Providing health care workers with presumptive benefits during a public health emergency.
SB 5204	Whole WA health trust	S Health & Long	Hasegawa	Neutral
Creating the whole Washington health trust.
SB 5229	Health equity continuing ed.	S Health & Long	Randall	Neutral
Concerning health equity continuing education for health care professionals.

Prepared by Leslie Emerick, Lobbyist

Legislative and Budget Overview

What an incredible year 2020 has been for all of us! The COVID 19 pandemic has tested our health care system in ways we never thought possible…or hoped we would never experience. I am so proud to represent health care providers who are on the front lines of fighting this pandemic by caring for vulnerable populations and trying to keep their staff safe during this crisis. Thank you all for the amazing work that you do and your endurance during this very difficult time…. you rock!

The results of the recent election are sinking in and legislators are gearing up for the 2021 legislative session which officially starts January 11^th, 2021. Leadership in the Democratic House and Senate Caucus did not change much. There have been some major leadership changes in the Republican Senate with Minority Leader Senator Mark Schoesler stepping out of his leadership role. The caucus elected Sen. John Braun, R-Centralia, as its new leader and Sen. Ann Rivers, R-La Center, as the new caucus chair. Sen. Shelly Short, R-Addy, was reelected as Republican floor leader and Sen. Keith Wagoner, R-Sedro-Woolley, is the new Republican whip. We have solid working relationships with all these legislators and will continue to work in a bipartisan manner next session. The committee membership is still being sorted out, but Senator Cleveland and Representative Cody will remain Chairs of the Health Care Committees.

The new state revenue forecast was released on November 18^th and it continues the positive trends we saw in September…. including reserves, the next biennium’s budget is now balanced! Legislators, budget writers, and the Governor’s executive budget offices have committed to rejecting deep health care cuts considering the improved forecast so it’s highly unlikely that we will see the draconian cuts that were being proposed over the interim. I will continue to track and respond to the Governor’s budget release in mid-December.

This year is the 105-day long session where they develop the two-year operating budget. Just a reminder that there are three operating budgets introduced during a legislative session, the Governor’s, the House and the Senate and they all must come to a compromise by the end of the session in mid-April this year…unless they need a Special Session. With Democrats controlling the legislature and the Governor’s office they will be motivated to reach a decision by the end of session…but it is a complex budget year, so you never know. More to come!

This past week was considered the Fall Legislative Days where they held virtual meetings in all the committees. I mainly listened to the health care committees which had good updates on the pandemic efforts by state agencies and budget updates from fiscal staff. I have been meeting with legislators on the Health Care committees prior to session starting to discuss our priorities…which at this point was mainly expressing concerns about the proposed budget cuts to in-home services!

I have been participating in the Long-Term Care Coalition and they have some meetings coming up:

Dec 16 at noon: an informational session with incoming freshmen legislators to introduce the coalition, give an overview of the long-term care system, and position ourselves as resources for legislators.

Jan 4, 2-3pm: coalition legislative planning session to share information and intelligence on what is coming down the legislative pike affecting long-term care.

2021 Draft Legislative Proposals under Consideration by Stakeholders

Health Emergency Labor Standards Act: is being proposed for the 2021 legislative session by Senator Karen Keiser a D, who is Chair of Senate Labor & Commerce. She also serves on Health Care and is a former chair. The legislation and is currently being viewed by stakeholders prior to introduction. It is problematic in many respects for many employers, and in particular for health care employers. The bill will no doubt generate some significant concerns from the business community. Please keep in mind that this is a draft bill and will not be officially introduced until after the middle of January sometime. I would not be surprised if AWB and some of the bigger health care organizations get involved as well. Since it is out for stakeholder feedback, it will probably change before it is introduced so this will not be the final draft.

Nurse Delegation Bill: Rep Eileen Codyis proposing a bill for the 2021 legislative session to allow for more flexibility in hospitals, but it impact most nurse delegation settings. Below is the latest draft of the bill. I am working on an amendment that clarifies the distinction between home care and home health agencies. The proposed language is to be placed in Section 1 (3)(d)(iv)

(iv) Delegation of tasks in an in-home care setting may be done by a registered nurse working as an independent contractor hired by a home care agency regulated under chapter 70.127 RCW.

This issue has been a constant source of confusion for home care and home health agencies around nurse delegation over the years. Having it clearly laid out in statute would help clarify for the agencies who use or want to use nurse delegation. I have suggested that committee staff contact John Hilger the In-Home Services Program Manager at DOH to help provide insight as to why this clarification would be helpful.

Governor Proclamations & COVID-19 Waivers

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 January 21, 2021, 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 January 21, 2021, 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 January 21, 2021, 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

Inslee announces statewide COVID-19 exposure notification tool: Gov. Jay Inslee, along with the DOH, announced the launch of WA Notify, a simple, anonymous exposure notification tool to help stop the spread of COVID-19. By adding WA Notify to their smartphones, Washington residents will be alerted if they spent time near another WA Notify user who later tests positive for COVID-19.

CDC’s New Quarantine Guidelines: DOH is adopting  the new Centers for Disease Control and Prevention (CDC) guidelines to reduce quarantine for people who have been exposed to COVID-19. Although both the DOH and CDC currently recommend a quarantine period of 14 days, there are circumstances that allow for a shortened quarantine. These include:

• If a person who is in quarantine has no symptoms, quarantine can end after Day 10.
• If a person who is in quarantine receives a negative COVID-19 test and has no symptoms, quarantine can end after Day 7. Get tested within 48 hours before ending quarantine.

There is a small chance that people who choose to shorten their quarantine period may transmit the infection to others post-quarantine. Therefore, it is critical that the person who has been in quarantine continues to monitor their symptoms and wear a mask through Day 14. If they develop symptoms, they should isolate themselves to avoid infecting others and get tested. Both Washington state officials and the CDC recognize that a 14-day quarantine can impose personal burdens that may affect physical and mental health as well as cause economic hardship. This change in guidelines is meant to help reduce that burden, while continuing to keep our community safe.

Department of Social and Health Services (DSHS)

Safe Start for LTC Facilities: https://www.dshs.wa.gov/sites/default/files/ALTSA/covid-19/LTC_Phases.pdf

Residential Care Services: A letter regarding from the following topic is now available online: Reminder to Allow Health Care Provider Visits

Aging and LTC Support Rulemaking: WAC 388-71-0975 EMERGENCY ADOPTION

WSR 21-01-018, Effective Date: December 3, 2020

The department is amending WAC 388-71-0975, Who is required to obtain certification as a home care aide, and when, to clarify how to interpret the long-term care worker qualifications and requirements in statute and rule that have specific time periods for compliance when there has been a period of time in which the underlying requirements were suspended and waived in whole or part by emergency proclamation by the Governor. Angel Sulivan (360) 725-2495

Department of Health (DOH)

HCAOA Letter to DOH requesting COVID 19 Vaccines for Frontline Home Care workers: Our agencies have been committed to serving COVID-positive and presumptive positive patients during this pandemic. Our ability to continue do so assures that hospital beds are used for those patients who need them most. Because of the crucial role that home health, home care and hospice agencies have in the healthcare delivery system, we would respectfully ask their frontline health care workers be considered part of Phase 1 or the “Jumpstart phase” as categorized by the National Academy of Medicine Framework for Equitable Allocation of COVID-19 Vaccine.

DOH Message to In-Home Care Agencies: I was contacted by the DOH Healthcare-Associated Infections Section to discuss increasing COVID-19 outbreaks in home care. We discussed ways the department could assist in-home services agencies to deal with the outbreak. Based on our conversation, they sent out the following update!

DOH Healthcare-Associated Infections Section would like to share some important information and resources with you about preventing the spread of COVID-19 between staff and clients/patients. Below you will find resources on Personal Protective Equipment, N95 Respirators and Screening of Staff. We are also working on updating our guidance documents to reflect current evidence and guidance from the CDC. We will share those links with you as soon as they become available. Please email us questions at HAI-COVID@doh.wa.gov.

Personal Protective Equipment: When community transmission is moderate or high (as it is throughout Washington state currently), healthcare providers should wear a surgical face mask and eye protection for ALL patient care encounters, regardless of patient/client COVID-19 status. Clients should wear a cloth face covering or facemask during care, if possible. Screen clients for symptoms and exposure upon entry to the home. Healthcare providers, including caregivers, should wear a disposable surgical face mask, and remove it after each patient visit or if become soiled.

N95 Respirators

• N95 Respirators (or facemask if N95 is not available) should be worn by staff when they are caring for a patient or client with known or suspected COVID-19. A “fit test” is a procedure that tests the seal between the respirator’s facepiece and your face. It is done by someone who is trained in fit testing and takes a minimum of 15 to 20 minutes. (Source: OSHA). It is the responsibility of agencies to make significant efforts to provide fit-tested N95 respirators to their staff who are caring for known or suspected COVID-19 patients/clients. If N95 respirators are not available, a surgical face mask with a face shield may be worn and provides acceptable protection. We understand that sourcing N95 respirators and fit testing for staff can be difficult. Here are some resources to assist you:

The Department of Health has funds to provide some limited fit testing to in-home care agency staff and can also provide qualitative fit testing kits and training so agencies can fit test staff. If you are interested in accessing this resource, please fill out this survey as soon as possible: https://www.surveymonkey.com/r/NQLNXYH  This funding ends December 31^st, so please respond promptly if you are interested.

• To obtain N95 respirators, you should attempt to order through your normal PPE suppliers. If you are having difficulty obtaining them contact your local Emergency Management Agency. Your local agency’s contact information can be found here: https://www.dshs.wa.gov/altsa/residential-care-services/ppe-facilities
• For information in setting up a Respiratory Protection Program, visit this site to get information from LNI. https://lni.wa.gov/safety-health/preventing-injuries-illnesses/create-a-safety-program/sample-safety-programs-plans You can also feel free to contact our Occupational Health Nurse, Mikkie Nakamura, who can assist you with questions about Respiratory Protection Programs. Mikkie.Nakamura@doh.wa.gov
• N95s are not designed to be reused, however when supplies are low they can be. Please visit this website for information from the CDC on respirator reuse https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html

Screening of Staff and Exclusion from Work

• Screen staff for symptoms or exposures to COVID-19 daily before beginning work. Staff who have been exposed to someone with COVID-19 should be excluded from work for 14 days after their last exposure. Staff who are symptomatic should be encouraged to seek COVID-19 testing promptly. They should also be excluded from work until they meet the Return to Work Criteria https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html
• Make and share policies for flexible medical leave with staff and instruct them on how and who to tell if they believe they are sick with COVID-19. Sick staff should stay home.
• If multiple staff are excluded from work due to exposure, refer to the CDC Guidance on Strategies to Mitigate Healthcare Personnel Staffing Shortages https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html
• Information for staff on unemployment compensation related to exclusion from work: https://esd.wa.gov/newsroom/covid-19-worker-information

 COVID-19 vaccine distribution plan UPDATE: DOH) continues to make progress with our COVID-19 vaccine distribution planning efforts. This is a really good video from DOH!!

Timeline: Vaccine Authorizations and Approvals: Vaccine safety is of the utmost importance to our communities in Washington. The FDA’s Vaccines and Related Biological Products Advisory Committee will meet December 10th to review the Emergency Use Authorization (EUA) application submitted by Pfizer on November 20th. An EUA allows the FDA to make a product available during a declared state of emergency before it has a full license. If the EUA is approved, the vaccine will then be vetted by the Scientific Safety Review Workgroup, as part of the Western States Pact. The review by this workgroup will provide another layer of scrutiny and expert review to this process and should take about 1 to 2 days. This will be done while the vaccine is still being processed and shipped, so it should not cause any delay in making vaccine available to people in Washington.

First Vaccine Arrival: We are hopeful we will have a vaccine to begin administering by mid-December. The federal government has given us an estimate of 62,400 doses of the Pfizer vaccine for our initial allocation. They have also told us we should receive an estimated total of around 200,000 doses of the Pfizer vaccine by the end of December.  Regular weekly shipments should begin in January.

Allocation and Prioritization: We are working on finalizing our guidance around initial vaccine allocation and prioritization framework. This framework includes feedback from the communities, partners, sectors, and industries that are heavily impacted by COVID-19, and by the National Academies of Medicine’s Framework for Equitable Allocation of Vaccine for the Novel Coronavirus. We are also using guidance from the Advisory Committee on Immunization Practices.

What we know for sure right now is that the first phase of vaccination, called 1a, will focus on workers in healthcare settings serving patients who either have confirmed or suspected COVID-19, along with staff and residents of long-term care facilities. We’ll know more about who will be vaccinated in later phases based on input from our community engagement and decisions made by ACIP. Getting vaccine to the people of Washington is a large, coordinated effort and the timeline for when all eligible people can receive the vaccine is still a work in progress.

Provider Enrollment: Providers who have fully enrolled in the COVID-19 Vaccine Program by December 6 will be eligible to receive part of the first shipment. As of December 1, we had 116 providers fully enrolled, with many more applications partially completed or pending approval. Clinics, pharmacies, and hospitals are encouraged to enroll right away. Enroll at www.COVIDVaccineWA.org.

We will coordinate with CDC to ship vaccine directly to enrolled providers once vaccine is available. Providers will then be responsible for storing and administering the vaccine. We are meeting with enrolled and interested providers regularly to provide updates and technical assistance.

Safe Medication Return Program: Washington’s Safe Medication Return Program, a pioneering effort aimed at reducing medication misuse, abuse, and poisonings had gone live on the website. This program creates a unified, statewide, medication return program that will give Washington residents free, convenient, and environmentally responsible options for disposing of unwanted medication. Physical drop boxes are available. People may also request free mail-back envelopes so they don’t need to leave their homes to participate.

People may return most medications. That includes over-the-counter and prescription medications, controlled substance medication, and even household pet medications. Unused and unneeded medications in a household pose a potential risk for poisoning and overdose deaths. Improperly discarded medication also presents an environmental hazard. Flushing medicine down the toilet or throwing it in the trash pollutes water and soil.

Washington is the first state to implement such a program as a result of state law. Funded by drug manufacturers at no cost to taxpayers, the program encourages people to return unwanted and expired medications. MED-Project is the approved program operator, under DOH’s oversight.

Palliative Care Roadmap Completed and Available!! I have some good news, Pat Justis has located funds for a third printing of the PC Roadmap!  It’s posted on DOH Rural Health webpage. To order: https://prtonline.myprintdesk.net/DSF/

NCQAC draft Advisory Opinion for Telehealth Nursing Services: This is of importance due to the amount of telemedicine that home health and hospice agencies have been providing 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.

Public Policy

WA State Telemedicine Collaborative: The last 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!

Dementia Action Coalition (DAC) Care Transitions Workgroup: Meeting on December 3:

I am a member of this new DAC Workgroup charged with identifying strategies, practices and/or programs that would help to minimize unnecessary care transitions with a focus on emergency room visits, hospitalizations and readmissions. Increasing awareness among primary care clinicians and care partners of potentially avoidable causes for ED visits, hospital admissions, and readmissions for people with cognitive impairment and dementia. I am sending them information on the NY Home Health and Hospital Collaborative as well!!