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Washington Home Care Association

Washington Home Care Association

The Washington Home Care Association was formed in 2005 to advance the field of Home Care in Washington State and support member home care agencies. WAHCA is the state chapter of the Home Care Association of America (HCAOA)

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Inslee announces guidance for long-term care facilities

wahca · August 7, 2020 ·

As per Gov. Jay Inslee press…

Gov. Jay Inslee announced guidance today that allows long-term care facilities to offer visitation and other activities. Many long-term care facilities were forced to curtail social activities for residents and visitors earlier this year due to COVID-19.

Inslee was joined by Department of Social and Health Services (DSHS) Secretary Cheryl Strange, DSHS Assistant Secretary Bill Moss and Secretary of Health John Wiesman at a press conference Thursday for the announcement.

The announcement does not constitute an immediate reopening of all long-term care facilities, however. The plan goes into effect August 12, and even after it becomes effective, individual facilities must meet additional parameters before re-opening.

See the original post on medium.com

WAHCA August 2020 Public Policy Report

wahca · August 5, 2020 ·

Prepared by Leslie Emerick, Lobbyist

Legislative and Budget Overview

As we are all aware, 2020 is a big election year at the federal, state and local levels of government. August 4th was the Primary Election in Washington state which narrowed down the choices to the top-two candidates for the general election this fall. Interestingly, this does not necessarily mean that a Democrat and Republican are at the top of the ticket. In many races the top two candidates are from the same party. For better or worse, the legislative landscape impacts our legislative priorities for the home care industry.

Governor Jay Inslee (D) and Police Chief Loren Culp of Republic (R) will be the top two candidates for the Governor’s race. This would be Inslee’s third term as Governor. Inslee is in the lead with 52% of the votes with Culp having 17% in a very crowded field of candidates. Currently Democrats hold a 57-41 House majority and a 28-21 Senate seat majority. We are looking at some very close races on the West side of the mountains that could change the dynamics of the Senate but would not significantly impact the current majorities. All 98 seats of the House of Representatives are up for election and 26 of the 49 Senate seats.

Legislators in the 2020 legislative session will face very difficult issues due to the massive economic downturn caused by the coronavirus pandemic. They will need to address the $8.8 billion dollar budget shortfall and determine state spending and taxation priorities. After seeing what a 15% cuts-only budget looks like after the Governor’s request for state agencies to show the impacts, it will be pretty devastating for Medicaid services for home care patients in Washington state with deep cuts to long-term care programs and the potential elimination of the hospice benefit. Legislators are also likely to debate policy reforms related to the ongoing protests related to the Black Lives Matter movement and how to address policing in Washington state.

Although Governor Inslee has made it clear that he is not going to call the state legislature back into a Special Session prior to January 2021, the state legislature is continuing to work on the economic issues over the interim. I watched this newly established Senate Committee on Economic Recovery hearing and although it is quite long (over 2 1/2 hours), found it very interesting. The comments on telemedicine and the future of healthcare by Kaiser Permanente in the Healthcare segment of the meeting (which starts at 1.44.00) were excellent. Here is a link to the public hearing if you are interested: Senate Special Committee on Economic Recovery (SCER)  July 21, 10:00 am

Agenda (virtual work session): Welcome/introductions, Rebuilding an inclusive economy: an intersectional perspective, Broadband, Healthcare, Local economic development, adjournment.

Still no resolution for federal aid in Congress, but I am hopeful that a compromise aid package will be approved soon. 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

Sadly COVID-19 cases have been increasing in Washington state and the related proclamations continue to rapidly evolve as the state Department of Health officials evaluate the spread of the virus in counties throughout the state. Here is a link to the DOH COVID Data Dashboard. Below are the latest proclamations that I am aware of potentially impacting home care in our state. You can view the full list of COVID-19 related waivers that have been extended here.

Telemedicine payment parity for commercial plans extended through Aug. 1: On July 1, the Democratic and Republican leadership of the House and Senate extended Gov. Inslee’s proclamation addressing telemedicine payment parity for commercial health plans. This extension is through Aug. 1. This allows hospitals and providers to continue to bill commercial health plans for telemedicine services at the same rate as if the service was provided at an in-person visit. This is the fifth extension of this proclamation. WSHA will continue to advocate for the extension of this proclamation.

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 September 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 September 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 September 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 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. 

Posted by the Health Care Authority/Medicaid Provider Relief Fund deadline extended: The U.S. Department of Health and Human Services (HHS) has extended the deadline to apply for provider relief funds through August 28. To be eligible, you must be a provider that participates in the Medicaid and Children’s Health Insurance Programs (CHIP) programs. Visit the CARES Act Provider Relief Fund webpage for more information. Not sure if this helps our Medicaid Home Care Provider agencies, but I wanted you to be aware of it just in case!

Department of Health (DOH)

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 register by clicking here: https://attendee.gotowebinar.com/register/72481314164882192.

After registering, you will receive a confirmation email about joining the webinar.

New Law: Providing Information to Patients on the Death with Dignity Act: This is just a issue of interest that probably does not directly impact home care agencies, but is something you may want to be aware of as an -in-home services provider. For many years Catholic hospitals in our state, and probably around the country, have forbidden their staff to share information on the Death with Dignity Act during end-of life conversations and this bill would require it.

During the 2019 Legislative Session, House Bill 1608 passed. As of June 2020, the law requires that health care entities provide the following information, at the time of hiring, contracting with, or privileging health care providers and staff, and on a yearly basis thereafter:

“Health care entities are prohibited from limiting health care providers’ ability to give medically accurate information to their patients if a provider is acting in good faith, within the provider’s scope of practice, education, training, and experience, including specialty areas of practice and board certification, and within the accepted standard of care. This includes information related to the Death with Dignity Act (RCW 70.245).”

Further definitions and requirements of the law are explained on the Department of Health 1608 FAQ page. In accordance with the law, the Department also has information online regarding the Death with Dignity Act here. A one-page handout that health care professionals can print and use for easy reference is available here (PDF).

Nursing Care Quality Assurance Commission

Special Meeting on Apprenticeships for Nursing Technician, Home Care Aides and Nursing Assistants: August 5, 2020 1:00 PM. There is grant funding available for apprenticeships and they are trying to set up a 3-tiered pathway for students who want to become nurses starting at the home care aide level, to nursing assistant to licensed nurse practitioner (LPN). Please open the link to the briefing paper on the issue.

Here is the agenda item for the Emergency NCQAC Business Meeting by Chair Jeannie Eylar– DISCUSSION/ACTION In January 2020, the NCQAC adopted a briefing paper explaining the issue of apprenticeships in nursing. The NCQAC adopted the attached briefing paper and moved to open WAC 246-840- 840 through 905 related to Nursing Technicians. The WAC allows registered nursing students to become nursing Technicians. The NCQAC would like to add licensed practical nurses to these rules. The NCQAC feels nursing technicians would potentially qualify as an apprenticeship and therefore, education programs may apply for registered apprenticeship programs for nursing technicians. This has been adopted in emergency rules and the NCQAC is seeking permanent rules. Nursing Assistants attend a training program prior to completing a competency evaluation. This training program could be recognized as an apprenticeship program leading to further education in nursing. The NCQAC may discuss this option and consider adding nursing assistants to the briefing paper.

Nursing Assistant Training: Washington’s nursing assistant testing will resume in counties that are in Phase 2 or higher, effective the week of August 10, 2020. In relation to COVID-19 and an interest in safe and efficient testing of candidates, here are some important changes to know about:

  • Testing that resumes during the week of August 10 will begin with administration of the skills portion of the exam only. Testing for the written (or oral) exam will resume a few weeks later in a computer-based testing (CBT) format at Pearson’s third-party testing centers. This change has several advantages:
    • Candidates will be able to schedule specific time slots for their skills exam, which will mean that fewer candidates will be on site at one time and they will be able to plan on a more focused time-frame for testing.
    • By removing the two hours previously allotted for the written (or oral) test at the start of the testing day, more skills testing slots can be slated for each day.
    • Because social distancing is necessary for the written (or oral) exam, using Pearson’s third-party testing centers for computer-based testing increases overall capacity for test-taker volume.
  • About a month after computer-based testing at third-party Pearson test centers is launched, a new option for computer-based testing—called “OnVUE” will be launched, enabling candidates to take the computer-based written (or oral) exam from flexible alternate locations, such as their own homes. This will facilitate improved access for those in remote areas where testing centers are less plentiful.
  • Pearson VUE has worked to develop safety protocols for testing in alignment with Washington’s Phase 2 guidance. They have provided notification to all test centers, evaluators, and candidates. Review information about the new testing protocols.

Please know that with these changes to testing, existing testing appointments will need to be canceled to accommodate scheduling skills and written (or oral) testing separately as described. Pearson VUE has reached out to test sites and candidates to notify them and provide information about next steps. Pearson VUE will continue to monitor government guidance and notifications from public health officials and will make adjustments if conditions change so that testing services can be safely implemented for candidates, evaluators, and test center staff.

Long-Term Care and Nursing Education Virtual Summit: This is a virtual summit to bring stakeholders together to develop strategies for student engagement and employment in long-term care settings. ZOOM Summit will be held onAugust 26th, 9:00 a.m. – 3:00 p.m. Agenda link: https://www.doh.wa.gov/Portals/1/Documents/Mtgs/2020/AG-NCQAC.pdf. For more information, please contact Paula Meyer at [email protected].

Who: Policymakers, nursing students, registered nurses, long-term care employers, and nurse education program stakeholders.

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:

  • Learn about the role of nurses in long-term care settings.
  • Understand barriers/challenges for students, nursing programs and employers.
  • Identify gaps in nursing education for long-term care patients and their needs.
  • Identify strategies to quickly change the focus of nursing education and increase long-term care experiences.
  • Identify strategies to address the stigma of working in long-term care settings.
  • Identify methods to recruit and retain quality nursing workforce to long-term care settings.
  • Develop a work plan to enhance clinical placement opportunities for student nurses, enhance the educational experience for students, and strengthen and expand capacity for long-term care nurse training in Washington.

Long-Term Care Report Coronavirus Report: (updated on August 4th) https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/data-tables/Weekly-COVID-19-Long-Term-Care-Report.pdf.

Palliative Care Roadmap: The PC Roadmap is coming along quite well!! Shawn D’Amelio, WAHCA President has been an active member of the review committee and assured that home care descriptions are accurate and have a link to our association website. 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. 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.

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 of the curriculum workgroup was on June 8th.

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

Latest release by DSHS /ALTSA (August 4, 2020): COVID-19 Proclamations Extended until September 1, 2020

LTC Worker Requirement Webinar: DSHS and the DOH hosted a webinar on July 24, 2020 regarding Long-Term Care Worker qualification requirements impacted by the COVID-19 outbreak.  They will continue to advocate for an extension of the proclamation (which has since been extended). The webinar covered the following topics:

  • Timelines for Long-Term Care worker certification
  • Training requirements and timelines
  • Fingerprint background checks

This document was developed in response to questions asked during a preliminary budget reduction stakeholder webinar on June 25, 2020. ALTSA FY2020 Preliminary Budget Reduction Proposal Questions and Answers.pdf.  The answers contained within this document are based on preliminary budget reduction modeling completed in June at the direction of the Office of Financial Management (OFM). These are preliminary exercises and are subject to change.  DSHS Staff welcomes your suggestions for alternatives to meet our target.Please email your suggestions to our inbox at: [email protected] between now and August 7th to coincide with budget proposal timelines.

Accessing Residential Care Facilities: The Frequently Asked Questions document for COVID-19 testing of residents and staff of Nursing Homes and Assisted Living Facilities with Memory Care Units was updated on July 9, 2020. Click here to access the updated document. 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. 

Public Webinar for the Consumer Directed Employer project

Currently, the Individual Provider home care workers administrative functions are managed by DSHS and Area Agency on Aging case managers and contract staff, and DSHS manages the payroll system. The Individual Provider workforce in Washington State has grown to approximately 40,000 workers and the complexity of managing this workforce has greatly increased. Changing to the Consumer Directed Employer model will allow case managers to spend more time assessing, service planning, and supporting people in need of services across our system. People receiving in-home care will retain the right to select, supervise, manage, and dismiss the individual providing their care. IPs will have one entity to work with for payroll, requirement tracking, taxes and all other employment items. This webinar is intended for members of the public who are interested in learning more about the Consumer Directed Employer project.  August 18, 2020 at 10:30 am  Register online

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.

L&I updated rules: Rules filed June 30, 2020 Topic: Expedited (CR-105) – Occupational Exposure to Bloodborne Pathogens: 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: 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 Barb Hansen has developed a slide show for this training based on a PowerPoint from the WA State Nurses Association that is available upon request. Here is a link to the relevant RCW 49.19: https://app.leg.wa.gov/RCW/default.aspx?cite=49.19. 

Public Policy

Join the Bree Collaborative: on August 26, 2020 from 12:00 – 1:00 pm for a free webinar on our Alzheimer’s Disease & Other Dementias Report and Recommendations. Please click this URL to join. https://us02web.zoom.us/j/89981270382. To view the Bree Collaborative Alzheimer’s Disease & Other Dementias Report and Recommendations, please visit: https://www.breecollaborative.org/wp-content/uploads/Alzheimers-Dementia-Recommendations-Final-2017.pdf

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 30that www.tinyurl.com/DementiaFriendly2020. Please pass it on!

WAHCA July 2020 Public Policy Report

wahca · July 15, 2020 ·

Prepared by Leslie Emerick, Lobbyist

Governor Inslee in Yakima with Secretary of Health, John Wiesman to discuss COVID-19 surge in Yakima County. Masks now mandatory.

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 29th. 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:

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

Public Policy Development

HCAOA Legislative Call with Vicki Hoak: The monthly call was on July 8th 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 8th.

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 30that 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

WAHCA June 2020 Public Policy Report

wahca · June 15, 2020 ·

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 17th, 2020 or to wait until more information comes in on federal funding. Congress is currently discussing whether to send the states funding to assist with the economic downturn. Only the Governor has the authority to initiate a Special Session and we are hearing from some state Senators that the session may be in August. New fiscal year spending begins on July 1, 2020. One issue is that cost-of-living allowances (COLAs) for state employees go into effect at that time and it will be difficult to pull them back. Agencies have been asked to project cuts up to 15% which can be devastating for some of the smaller state agencies. Hiring freezes have already taken effect and some new programs were already vetoed by the Governor.

Below is a link from the Office of Financial Management (OFM) State listing the cuts being proposed by state agencies. Some are pretty draconian, such as cutting some DSHS funding for home and community services such as home care and private duty nursing for medically fragile patients and hospice is on the list of potential cuts at Health Care Authority. https://ofm.wa.gov/budget/state-budgets/state-agency-fiscal-year-2021-savings-options

Reminder: These are preliminary and have not been put into effect yet. Only the state legislature has the authority to make these deep of cuts in the state budget.)

Dept of Health and Human Services (DSHS): https://ofm.wa.gov/sites/default/files/public/budget/statebudget/savings/300DSHS.pdf

Health Care Authority Medical Assistance Program: https://ofm.wa.gov/sites/default/files/public/budget/statebudget/savings/107HCA-HBE.pdf

Dept. of Health (DOH): https://ofm.wa.gov/sites/default/files/public/budget/statebudget/savings/303DOH.pdf

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

Letter from Bill Moss, Assistant Secretary, Aging and Long-Term Care Services Administration (ALTSA) Stakeholder Message 06-05-2020.pdf

Subject: Preliminary ALTSA reduction proposals for State fiscal year 2021, June 5, 2020

The COVID-19 virus has had a significant impact on state revenues. On May 13, the Office of Financial Management (OFM) sent a directive to state agencies to propose preliminary options for reducing their General Fund-State (GF-S) expenditures from their current budgets by fifteen percent in state fiscal year 2021, which begins July 1. For the Aging and Long-Term Support Administration (ALTSA), that equates to over $220 million General Fund-State dollars and approximately $400 million in total dollars as nearly all of our expenditures are matched by federal Medicaid matching funds.   These potential reductions are truly devastating and reflect an economic downturn expected to match or exceed that of the Great Recession. In completing the directive set forth by OFM, we followed a few key principles that align with our Mission, Vision and Values: Ensure that our clients with the greatest need continue to receive services; Continue our priority of safety and protection of vulnerable adults; Preserve our services to the greatest extent possible; Preserve our workforce by proposing furloughs and implementing hiring, travel and purchasing freezes to avoid complete job loss. As a reminder, this is just the beginning of this discussion and we welcome your feedback and ideas for measures required to meet the reduction target. The following are the reduction categories we are proposing with savings estimates for state fiscal year 2021: Client Eligibility: Elimination of the optional Medicaid Personal Care (MPC) state plan program. Increasing the level of functional need required to meet Nursing Facility Level of Care in Washington’s Medicaid state plan and waivers will decrease the number of Medicaid clients in home and community residential settings by approximately 20,500 people; nursing home clients by approximately 680 people; and a corresponding reduction of a significant number of ALTSA staff and AAA full-time equivalent positions. ($129.8M GF-S; $282.3M total funds) Includes eliminating state funded non-citizens and Senior Drug Education programs, Medicaid funded Adult Day Health and Day Care services, reducing Adult Family Home Meaningful Day programs. ($15.5M GF-S; $2.7M) To assist clients in nursing homes to transition to their own residence with in-home care supports, ALTSA proposes paying for rental subsidies so that clients can afford to relocate to their own home. Even though the subsidy is state-only funding, the cost is still less than paying half of a nursing home rate, thus saving money. ($1.0M GF-S; $1.0M Total Funds) Savings is achieved by assuming an across–the-board three percent rate reduction for all ALTSA providers, including those who collectively bargain wages and benefits and capturing the additional 6.2 percent of Medicaid matching from July through September as savings. ($60.6M GF-S; $9.4M total funds) Including unpaid furlough days. ($15.0M GF-S; $25.8M total funds)

Monthly Public Webinar for the Consumer Directed Employer project:

In November 2019, DSHS signed a contract with Consumer Direct of Washington (CDWA). DSHS remains committed to initiating the transition to the CDE by the legislatively required date of June 30, 2021.The move to a CDE model will shift the IP employment-related activities to the CDEs and will help DSHS realize the goal of increasing the capacity of DSHS/AAA case management, customer service, and other social services staff to focus on core case management activities. New federal requirements were enacted in 2016 as part of the “21st Century Cures Act”.  The Act requires states to implement an electronic visit verification (EVV) system for personal care services delivered in the home.  The CDE will implement the EVV system for IPs. Home Care Agencies will implement separate EVV systems for Home Care Agency workers. You are invited to participate in a webinar on the Consumer Directed Employer project. This webinar is intended for members of the public who are interested in learning more about the Consumer Directed Employer project.  To learn more: Visit the CDE webpage. Register online

LTSS Trust Commission is looking for a Consumer Representative to serve on Commission

 The Long-Term Services and Supports (LTSS) Trust Commission is looking for a consumer representative to serve on the Commission.  This group will make recommendations to the WA State Legislature and state agencies on the new LTSS Trust program as it is implemented in the coming years.

The Commission includes state legislators, representatives from three state agencies, and 10 Governor appointed members representing various stakeholders and advocates. One of the Governor appointed positions that still needs to be filled is a recipient of long-term services and supports or designee or representative of consumers under the program.  The Commission will meet four to six times a year in Olympia and Commission members will be reimbursed for their travel expenses. Here is the link on Governor Inslee’s website if you know of someone interested: https://govforms.dynamics365portals.us/application-form/

Where it says, “Please choose the board or commission for which you would like to be considered:”, applicants should choose “Long-Term Services and Supports Trust Commission“. Please contact Crystal Williamson, [email protected] or call 360.725.3532 for more information.

COVID-19 Related Issues

First wave of supplies to ship as part of state’s plan for widespread testing in LTC facilities  (This order may impact home care workers who assist in long term care and assisted living facilities.)

On May 29, DOH issued an order that requires widespread testing within long term care facilities. Residents and staff in nursing homes will be tested within approximately two weeks, with a completion goal date of June 12. All residents and staff in assisted living facilities with a memory care unit will be tested within four weeks, with a completion goal date of June 26.

Nursing home and other long-term care residents are at high risk for infection, serious illness and death from COVID-19, and testing, along with other infection prevention and control measures, is a critical tool to identify cases and stop transmission. Once test results are received, positive results should be reported following normal protocol, and be referred to local health jurisdictions for case investigation, contact tracing and isolation/quarantine support. If a resident tests positive, DOH recommends that the facility follow Centers for Disease Control and Prevention guidance on cohorting both residents and staff. Staff who are asymptomatic and test positive should not return to work for 10 days (from the test day). Federal guidance recommends a baseline universal test for all residents and staff before a facility progresses between any phases of reopening.

Safe Start Washington – Phased Reopening County-by-County Governor Jay Inslee: In collaboration with the Washington State Department of Health, the Governor has established a data-driven approach to reopen Washington and modify physical distancing measures while minimizing the health impacts of COVID-19. Washington will move through the phased reopening county-by-county allowing for flexibility and local control to address COVID-19 activity geographically. This approach reduces the risk of COVID-19 to Washington’s most vulnerable populations and preserves capacity in our health care system, while safely opening up businesses and resuming gatherings, travel, shopping and recreation. The plan involves assessing COVID-19 activity along with health care system readiness, testing capacity and availability, case and contact investigations, and ability to protect high-risk populations. The plan allows counties and the secretary of Health to holistically review COVID-19 activity and the ability for the county to respond when determining if a county is ready to move into a new phase.

“Safe Start Washington” guidelines issued on May 29th https://www.governor.wa.gov/sites/default/files/SafeStartPhasedReopening.pdf

Use of face coverings required at work: Beginning June 8, all employees will be required to wear a cloth facial covering, except when working alone in an office, vehicle, or at a job site, or by any individual who is deaf or hard of hearing.

Washington Coronavirus Hazard Considerations for Employers (except COVID-19 care in hospitals & clinics) Face Coverings, Masks, and Respirator Choices https://www.lni.wa.gov/agency/_docs/wacoronavirushazardconsiderationsemployers.pdf

What Phase is your county in and what does that mean for your program’s practice? https://coronavirus.wa.gov/what-you-need-know/covid-19-county-variance-application-process

Chart of Washington’s Phased Approach: https://www.coronavirus.wa.gov/sites/default/files/2020-05/PhasedReopeningChart.pdf

Long-term care worker rules proclamation: The legislature has approved an extension for the governor’s proclamation suspending certification requirements in community-based settings (adult family homes, assisted living facilities, and home care agencies). The proclamation, which you can find here, is effective until the termination of the COVID-19 state of emergency or June 17, whichever occurs first. This means that a nursing assistant-registered can work in a community-based setting past 200 days before obtaining a nursing assistant-certified or a certified home care aide credential.

NAR four-month rule proclamation: The legislature has approved an extension for the governor’s proclamation suspending certification requirements in nursing homes. The proclamation, which you can find here, is effective until the termination of the COVID-19 state of emergency or June 17, 2020, whichever occurs first. This means that a nursing assistant-registered can work in a nursing home past 120 days before obtaining a nursing assistant-certified credential.

Healthcare worker licensing proclamation: The legislature has approved an extension for the governor’s proclamation removing certain barriers for licensure. The proclamation, which you can find here, is effective until the termination of the COVID-19 state of emergency or June 17, whichever occurs first. Below is a summary of what the waivers pertaining to nursing assistants do.

Barriers to continued and uninterrupted healthcare practice, including continuing education and other training requirements and license renewal deadlines: Licensed health profession rules requiring continuing education (CE), AIDS education, and training in suicide assessment, treatment, and management are waived. This includes the 8 hours of CE required to maintain the medication assistant endorsement and the requirement to demonstrate clinical skills to an instructor in a practice setting in nursing assistant training programs.

Department of Health

Nursing Care Quality Assurance Commission: Save the Date for the Long-Term Care and Nursing Education Virtual Summit: July 21, 2020, 9:00 a.m. – 3:00 p.m.

Who: Policymakers, nursing students, registered nurses, long-term care employers, and nurse education program stakeholders

What: A virtual summit to bring stakeholders together to develop strategies for student engagement and employment in long-term care settings. 

Why: Washington’s population is rapidly aging, and one in three citizens will require long-term care services. Our state has a rich history of providing care to senior and disabled citizens in a variety of long-term care settings, including nursing homes, assisted living, adult family homes and supported living. However, these providers are finding it increasingly difficult to hire and retain nurses. While the long-term care setting provides an excellent career opportunity for nurses, long-term care is not often the setting of choice for student nurse clinical experiences or employment as graduate nurses. From direct patient care to managing and leading staff, nurses are the backbone of the long-term care workforce, and are essential to quality resident care. The demand for excellent nurse leaders and service providers will only grow in the coming decade. This summit is intended to bring nursing students, long-term care employers and nurse education programs together to:

Where: This meeting will be held by ZOOM. The agenda and link will be available as we get closer to the date of the event. For more information, please contact Paula Meyer at [email protected].

Long-Term Care Workforce Development Steering Committee: I have been regularly attending the workgroup meetings of the Curriculum and Committee for reviewing and assessing what would be in a core curriculum for all types of certified nursing assistants and have been participating in monthly workgroup meetings. The last meeting was on June 8th and there was a discussion about how to better include diversity issue in the trainings.

Palliative Care Roadmap: We are getting close to the final version of the “PC roadmap” with DOH staff and a smaller group of palliative care experts as to the direction and content for the report. Shawn D’Amelio, WAHCA Board President, has been at the table helping to craft the sections related to home care. Hard copies must be available for distribution no later than September 30, 2020. Here is the latest draft if you have any final suggestions!

Review PDF

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 1st, 2020

“I have been asked to provide you a response related to your question about training requirements in HB 1931 and whether or not we can delay the implementation date. Unfortunately, we do not have the capacity to alter dates related to legislatively mandated laws that are coming into effect, however under the currents circumstances related to the COVID19 pandemic we have issued DOSH Directive (DD) 1.60.  This directive covers training and certification requirements and is not all inclusive. (DOSH 1.60:  https://lni.wa.gov/dA/e64fe9ea26/DD160.pdf)

Due to the social distancing requirements during the COVID19 pandemic and the requirement to provide hands on training with role play this training would fall under the guidance of DD 1.60.

If you have any other comments or questions please let me know. Ryan Allen, CDE [email protected] Industrial Hygiene Technical Policy Manager, 360-902-5530”

Which mask for which task?  The new Department of Labor & Industries (L&I) guidance document, “Which Mask for Which Task?,” describes various types of jobs based on the level of risk to workers, from negligible risk to extremely high. The publication spells out which face-covering, mask, or respirator is required for that task. Along with details about the appropriate protective face covering, the guidance also includes photos to help workers and employers identify the type of mask required.

“We know that choosing the correct face covering, mask or respirator can be confusing. It’s a new experience for most employers and people on the job,” said L&I Assistant Director Anne Soiza. “This guidance should help employers and workers understand the risk level for various tasks, and make the right choice to protect workers from the coronavirus. Employers needing assistance can call on our statewide consultants for help.”

WAHCA May 2020 Public Policy Report

wahca · May 9, 2020 ·

Prepared by Leslie Emerick, Lobbyist

A new world of video conferences due to COVID-19 and social distancing!  

Legislative Overview

WAHCA was invited to the Long-Term Care Coalition: The meeting was held on March 29th with state legislators to discuss how the COVID-19 pandemic is affecting their members. There were around 18 legislators on the call from both houses of the legislature. The WA State Hospital Association was the facilitator for the call. Representatives from skilled nursing facilities, adult family homes and assisted living participated in the call.

Rep Kelly Chambers was able to get Shawn D’Amelio, WAHCA President a seat at the table representing home care agencies in these discussions. There is great concern by legislators around how skilled nursing facilities and other long-term care housing is handling the crisis. All participants lamented the lack of access to PPE and testing. The group requested that there be a standing order from Dr. Kathy Lofy, WA State Medical Officer from Dept of Health for testing so they don’t have to get a physician to sign the orders.

The group asked that DOH be the lead for all coronavirus information instead of 3 different health care agencies. It gets a little confusing getting information from DOH, DSHS and HCA. They are also looking for limited liability for their businesses during the pandemic for health care provider claims. Workers can be operating under dangerous conditions, but they requested a higher standard for what might be considered gross negligence.

Reductions Coming in State Operating Budget: Even once Washington’s economy fully reopens, the effect on state revenues from the coronavirus shutdown is expected to be felt for months and maybe years to come. State officials are preparing for the inevitable budget cuts. State agency directors and elected officials received a letter from David Schumacher, Director of the Office of Financial Management, asking them to identify areas in their budgets where savings could be found, delaying the hiring of employees and reducing or delaying the implementation of programs.  According to a local newspaper, Schumacher said “with about three-fourths of the budget unable to be cut — areas that are legally or constitutionally protected, like basic education and Medicaid — that means cuts to social programs and higher education are on the table.

In February, state revenues looked to increase by about $606 million in the current two-year budget cycle that ends mid-2021, and an additional $536 million for the next two-year budget that ends mid-2023, pushing projected revenues for that budget cycle to $55.7 billion. Two months later, with a stay-home order in place and many businesses closed, that forecast has been turned upside down.

Gov. Jay Inslee vetoed $445 million of spending in the recently passed state Supplemental budget in hopes of making a dent in the loss of state revenues as the COVID-19 pandemic continues to keep the state’s economy largely shut down. Even with those vetoes, Inslee has said the Legislature will probably have to be called back into a special session before their next regularly scheduled session begins next January. Staff in both the Senate and House have been in the process of reviewing options for a remote special session.

Inslee signs new COVID-19 order for phased re-opening of Washington’s economy: (5/4/2020) Some businesses could re-open as early as this week under the new COVID-19 order signed by Gov. Jay Inslee today. The state’s “Safe Start” plan is a phased approach to re-opening Washington’s economy. Under the plan, smaller counties can apply for a variance from the order which would allow them to open even more businesses than allowed statewide. Safe Start sets a careful approach to emerging from the pandemic. It allows for modifications of business closures and physical distancing measures while minimizing the health impacts of COVID-19. 

While Stay Home, Stay Healthy is being extended to the end of May, the governor announced his Safe Start plan which amends some components of the original order and allow for a start to re-open the state. Through the Washington “Safe Start” plan, more businesses and activities would re-open in phases with adequate social distancing measures and health standards in place. Each phase will be at least three weeks — data and metrics will determine when the state can move from one phase to another. Read the full Safe Start policy plan here.

Department of Health

DOH Lead State Agency/Coronavirus: https://www.doh.wa.gov/Emergencies/Coronavirus

Hospice, Home Health and Homecare have moved into Tier 1 for the Prioritization of PPE! This should be good news for our hospice workers and patients. Access to PPE is still a big issue for some organizations who are creatively reusing the gear and coming up with ways to use less PPE. https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/PPEPrioritizationofAllocation.pdf

TIER #1—distribute N95 respirators and surgical masks

• Hospitals, including psychiatric hospitals, with confirmed/suspected COVID-19 case(s)

• EMS Services licensed or recognized in Washington – encountering and transporting confirmed/suspected COVID-19 case(s)

• Long term care facilities/home health/home care/hospice/hospice care centers of N95 masks for those with confirmed/suspected COVID-19 case(s) o Surgical masks for facilities or providers with no known COVID-19 case(s)

• Alternate care facilities with confirmed/suspected COVID-19 case(s)

• All hospitals for emergent surgeries, TB patients, etc.

• All public health agencies for outbreak investigations

DOH has published new guidance for in-home care providers working in the absence of PPE – see attachment below. Also attached for your reference is a DSHS published guidance “Caring for Clients with COVID-19.”

PPE Guidance.pdf

Caring for COVID clients.pdf

DOH Waivers of WACs During COVID-19:  Here is the most current list of home health and hospice In-Home-Services waivers approved of by DOH. All of the background check WACs are addressing waiving the fingerprint requirement since WSP is temporarily not offering this service.

In-Home Services general section waiver:
WAC 246-335-320(2)(d)(ii) Initial background checks through WSP
WAC 246-335-325(4) WSP background checks during licensing renewals

Home Health agency waivers:

WAC 246-335-525 (6)(a), (c) initial and 2-year background checks through WSP
WAC 246-335-525(9)  in-person orientation to agency policies and procedures

WAC 246-335-525(14) in-person demonstration of CPR skills

WAC 246-335-530(7) evidence of initial and subsequent background checks in employee record
WAC 246-335-525(16) on-site annual observation/evaluation of staff providing care

WAC 246-335-540(1), (2) on-site plan of care development

WAC 246-335-540(3)(c) types and frequency of on-site services to be provided

WAC 246-335-545(6)(b) on-site monthly supervision visit

WAC 246-335-550(3)(f) Patient signed and dated notes documenting services provided during each patient visit. Paper notes / log are transported back and forth between patient and caregiver’s homes.

Hospice agency waivers:

WAC 246-335-625 (6)(a), (c) initial and 2-year background checks through WSP
WAC 246-335-625(9)  in-person orientation to agency policies and procedures

WAC 246-335-625(13) in-person demonstration of CPR skills

WAC 246-335-625(15) on-site annual observation/evaluation of staff providing care

WAC 246-335-630(6) evidence of initial and subsequent background checks in employee record
WAC 246-335-640(1), (2) on-site plan of care development

WAC 246-335-640(3)(d) types and frequency of on-site services to be provided

WAC 246-335-645(6)(b) on-site monthly supervision visit 

WAC 246-335-650(3)(f) Patient signed and dated notes documenting services provided during  each patient contact. Paper notes / log are transported back and forth between patient and caregiver’s homes.

DOH In-Home Services Roundtable, April 23, 2020: Due to COVID-19 in-person restrictions, over 50 home care, home health, hospice agency representatives and other interested parties attended the meeting via GoToMeeting to discuss issues related to In-Home Services. The purpose of these meetings is to provide agencies an opportunity to meet with DOH staff, to receive licensing, survey, and industry related information and updates, to have the opportunity to ask questions / raise concerns, and to collaborate with colleagues.

John Hilger, In-Home Services Program Manager, hosts these meetings and brings in speakers from within DOH and other relevant subject matter experts from state agencies. John started the meeting talking about the impact of the COVID-19 virus has had at DOH and that the agency leads the Incident Management Team for the state in dealing with the pandemic. This has significantly impacted employees at DOH as many are working on addressing the pandemic, often from home.

We discussed the suspension of surveys for in-home care providers and what the world will look like when life goes back to “normal”….which may take a while! John said to “do a good job documenting anything that is done “differently” during this pandemic” and believes that there will be leniency on many regulations during surveys due to circumstances related to serving patients during this emergency period related to COVID-19.

A big issue for home health agencies is when DOH will amend their rules to allow a Physicians’ Assistant to sign home health orders which is now allowed by CMS. The Health Care Authority have already amended their rules through emergency rulemaking and DOH needs to do the same ASAP! Flexible language allowing ARNPs to sign orders was already in the DOH rules.

There was a discussion about Personal Protective Equipment (PPE) and the shortage that many health care providers are experiencing. Home care is on the 2-3 tier for accessing the PPE unless they are working with a COVID-19 patient in their home and then would become tier 1 and able to more readily access and receive PPE. Here is a link to the prioritization guidelines for PPE

In-Home Services Orientation classes are now being held via GoToMeeting for potential applicants who want to start new agencies. We also discussed information for providing home care, home health and hospice care: https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/HomeHealth-Hospiceguidance.pdf

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.

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. Led by the WA State Office of Rural Health at DOH, this public-private partnership involves over 24 different organizations to assist rural health systems and communities to integrate palliative care in multiple settings, such as emergency department, inpatient, skilled rehabilitation, home health, hospice, primary care, and long-term care. To learn more go to: https://waportal.org/partners/home/washington-rural-palliative-care-initiative

Palliative Care Roadmap: 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, including Shawn D’Amelio from WAHCA, with many different types of palliative care providers and experts at the table for the initial source of content for the booklet. Now it’s time to start narrowing it down and organizing the content. 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!

DSHS Issues

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

In light of the unprecedented emergency circumstances associated with the COVID-19 pandemic, DSHS, will be raising the vendor rate or authorizing an add-on to the usual vendor rate through a temporary service code (“Pandemic-related Extraordinary Services”) to specific providers who serve Medicaid clients and have been identified as requiring additional funding. This rate increase includes Assisted Living Facilities (ALFs), Enhanced Services Facilities (ESF),  Adult Family Homes (AFHs), Home Care Agencies, Community Choice Guides (CCG), Home Delivered Meals (HDM), Supportive Housing, Behavior Support Agencies, Nurse Delegators, Private Duty Nursing, and Skilled Nursing. https://fortress.wa.gov/dshs/adsaapps/Professional/MB/HCSMB2020/h20-037%205.5.20%20revisions.docx. These temporary vendor rate increases, and add-on service codes will be retroactive to March 1, 2020. The exception to this time frame is the Pandemic-related extraordinary service add-ons for agencies that have committed to serve clients that are suspected or positive for COVID-19 which will be available May 1, 2020-June 30, 2020.

Labor and Industries Issues

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

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 have made an inquiry as to whether the department can delay the July 1, 2020 implementation date due to the coronavirus pandemic.

Department of Natural Resources

Access to overstocked PPE – KN95 Masks through Dept of Natural Resources. Selling at their cost: $3.30 per mask, 150,000 masks available, may be minimums. DNR will deliver with mileage rate reimbursement. Contact [email protected] for more information.

Public Policy Updates

Littler Home Care Update with HCAOA and NAHC (4/30/20): Discussions were around the upcoming Stimulus 4 bill being worked on in Congress and how to help frontline home care workers during the pandemic. The two national associations have sent a letter to Congress addressing these concerns:

  1. Enhanced pay for home care and home health workers under hazardous conditions.
  2. Essential benefits needed such as child-care for many of the workers
  3. Making home care and home health priority providers
  4. Enhanced support for Medicaid caregiving programs
  5. Qualified immunity for caregiving like hospitals and nursing homes
  6. Need a national response to provider liability

WA State Telemedicine Collaborative: I attend the monthly meetings held by the Telemedicine Collaborative. At the last meeting we discussed that they amend RWC 48.43.735 Reimbursement of health care services provided through telemedicine or store and forward technologies (7) (f) & (g) to remove “does not include the use of audio-only telephone”. Not all patients have access to broadband services, wi-fi or a smart phone. It is discriminatory and unnecessary to require a two-way audio-visual connection when relaying vital statistic information for patient home monitoring such as weight, blood pressure and oximetry. The health care data could easily be relayed via a follow-up phone call with a patient. They were willing to consider it as a potential legislative proposal in the future to amend the law.

WA State Dementia Collaborative: Updated “Resources for Dementia Caregivers during Covid19 – May 2020” includes added resources and May events. As discussed at our meeting, people with dementia and their caregivers are having challenges. They can benefit from knowing about support services, online education and engagement opportunities –  Please share!  

Upcoming events that may be of interest – Live Webcasts: COVID-19 and Dementia

Public health agencies around the country are fully mobilized in the response to COVID-19. As the pandemic continues to have an impact across the United States, specialized public health action is needed to protect one of our most vulnerable populations: people living with dementia. The novel coronavirus poses unique risks and challenges to this population as well as the caregivers, health care workers, and families who support them. Our new website — alz.org/publichealth-covid19 — can help guide the public health response. This site will be updated regularly as more information is available and more resources are developed for the public health field.

Three settings — in homes and communities, emergency departments and hospitals, and long-term care (LTC) facilities — all require special public health attention to meet the unique challenges posed by dementia during the COVID-19 pandemic. Join the Alzheimer’s Association for a series of three 30-minute livecasts on May 18 and 19. Public health professionals will quickly learn about challenges posed by dementia in these settings, immediate steps to better protect health and safety for this population, and resources their departments can use. These short web presentations will feature speakers from the Centers for Disease Control and Prevention and highlight new tip sheets for each setting. Please register for each session separately.

  • Dementia Challenges in Homes and Around the Community — Monday, May 18 from 10 to 10:30 PACIFIC
  • Dementia Challenges in Emergency Departments and Hospitals — Monday, May 18 from  11 to 11:30 PACIFIC
  • Dementia Challenges in Long-Term Care Settings — Tuesday, May 19 from  12 to 12:30 PACIFIC

Find each tip sheet on alz.org/publichealth-covid19, which highlights dementia-specific COVID-19 challenges, distinct public health action, and facts and resources to guide the response. Stay up-to-date with the latest developments from the Alzheimer’s Association at alz.org/covid19help. The Centers for Disease Control and Prevention (CDC) also has a COVID-19 microsite about and for older adults. At cdc.gov/aging/covid19, find information about risk, face coverings, managing stress and anxiety, guidance for long-term care facilities, and other resources. The full CDC library on COVID-19 is at cdc.gov/covid19

Webinar on Supporting Older Adults in Emergencies: Preparedness, Response, and Recovery

ACL, CDC, HRSA, and NIA are partnering to provide a new series of webinars: Focus on Aging: Federal Partners’ Webinar Series. This webinar series will address important topics for public health and health care professionals, aging services organizations, the research community, and other stakeholders in aging. Each webinar will include information specific to individuals with Alzheimer’s disease and other types of dementia, as well as their caregivers.

This May 13 webinar will be the first of the Focus on Aging series, and will emphasize emergency preparedness. Register for the webinar 1:30 – 3:00 PM ET on Wednesday, May 13, 2020.

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