Prepared by Leslie
My how has the world changed in the last month…. As you are all painfully aware, Washington state has been the lead on addressing the COVID-19 virus as we were the first state to see a US death in the Seattle area where it spread rapidly from an elder care facility in Kirkland. Our state health department has been planning for a pandemic for a long time and has been ahead of the curve by setting up an Incident Response Team at the Department of Health and initiating emergency measures early through Governor Inslee.
Although the state legislature budgeted around $200 million out of our “rainy day” funds to address the pandemic before the end of the session on March 12th, and the state is seeing millions in federal dollars coming in, it will not be enough to address the financial impacts on the state budget which is experiencing a deep loss of tax revenues that keep services afloat.
According to the Seattle Times, April 3, 2020: “With the coronavirus effectively shuttering Washington’s economy and crushing state tax collections, Gov. Jay Inslee used his veto pen Friday to slash $445 million in spending from the state operating budget. In a perhaps unprecedented move, Inslee made line-item vetoes to 147 programs as he signed the state supplemental operating budget, which tweaked Washington’s two-year spending blueprint. But with the outbreak choking the economy, budget experts suggested the damage to tax collections could be worse than during the Great Recession. The darkening economic portrait might even require a special legislative session for further spending cuts before lawmakers are scheduled to return in January 2021.”
We are hearing rumblings that the state legislature may do an emergency session tapping additional state funding from the “rainy day fund”…but I think that may be after they see how far the federal dollars go that are now starting to come into the state. The next state revenue council forecast comes out in June this year.
|New Governor Proclamation requires accommodations for high-risk employees On Monday, Gov. Inslee issued Proclamation 20-46 “High-Risk Employees—Workers’ Rights – which requires employers to take extra measures to accommodate employees who are considered at high risk for severe illness or death if they contract COVID-19. According to the Centers for Disease Control and Prevention (CDC), these are people over 65 and those with certain chronic underlying health conditions, regardless of age. The proclamation requires all Washington employers, private and public, to provide all available options for alternative work assignments to protect the employee from exposure to COVID-19, if requested. If a reasonable accommodation is not possible, the employee must be permitted to take leave or file for unemployment benefits. (Jaclyn Greenberg) Read more >|
Final Supplemental Operating Budget (ESSB 6168) Related Issues
ESSB 6168 Making 2019-2021 fiscal biennium supplemental operating appropriations.
(aa) $75,000 of the general fund—state appropriation for fiscal year 2021 and $96,000 of the general fund—federal appropriation are provided solely to implement House Bill No. 2380 (home care agencies). If the bill is not enacted by June 30, 2020, the amounts provided in this subsection shall lapse. (See bill info below)
Administrative Rate for Home Care Agencies Section Vetoed by Governor: (28) $306,000 of the general fund—state appropriation for fiscal year 2020, (($317,000)) $634,000 of the general fund—state appropriation for fiscal year 2021, and (($794,000)) $1,198,000 of the general fund—federal appropriation are provided solely to increase the administrative rate for home care agencies by five cents per hour effective July 1, 2019, and by an additional five cents per hour effective July 1, 2020.
Palliative Care Insurance Workgroup: This proviso is included in the final state operating budget! This proviso based on the WA State Bree Collaborative Palliative Care Workgroup Report which included a recommendation to increase the availability of palliative care through revision of benefit structure such as a per member per month (PMPM) benefit. The report will also recommend to “Convene a workgroup to determine next steps for insurance coverage of specialty palliative care as defined in this report.” The work group shall report its recommendations to the full joint legislative executive committee on aging and disability issues by November 1, 2020.
Medicaid Home Health: Those of you who participated in the In-Home Services Day this year you may remember the Medicaid Home Health Reimbursement bill that was on our “song sheet”. I have bad news and good news about this issue. HB 2451 Medicaid Home Health, matching Medicaid to Medicare rates did not pass the legislature this session. The good news is that their was a budget proviso in ESSB 6168 that increases funding for Medicaid Home Health by 33%!Here is the language in ESSB 6168 (Page 196):
(80) $770,000 of the general fund—state appropriation for fiscal year 2021 and $800,000 of the general fund—federal appropriation are provided solely to increase home health rates beginning January 1, 2021.
We are not in the clear yet as we do not know how deep the virus related recession will be for our state…but let’s hope they continue to see the value of home health serving the Medicaid population of our state and preserve this much deserved rate increase.
From the Governor’s Veto Message: The supplemental budget includes task forces, work groups, reports, pilot programs, new programs, and program expansions that would be smart investments for the state under normal circumstances. However, under the extraordinary situation we now face, we cannot afford all of them at this time. For this reason, I have vetoed the following sections:
Section 221(59), pages 265-266, Department of Health, Telemedicine Work Group: This section directs the Department of Health, within existing resources, to convene a work group to collect information and establish guidelines and recommendations for how the Office of the Insurance Commissioner can include telemedicine services in network adequacy requirements. The staff and stakeholders necessary to convene this work group are the same individuals working to address the COVID-19 outbreak. This work group requirement would divert critical resources from the pandemic response. For these reasons I have vetoed Section 221(59) and am directing the Department of Health to perform as much of the activity as feasible within available resources, given that this is important work in the current environment.
Administrative Rate for Home Care Agencies Section 204(34), page 154: Section 204(28), page 152, DSHS Aging and Long-Term Care Services Administration,
Dementia Education Section 204(38), pages 154-155: DSHS Aging and Long-Term Care Services Administration
Specialized Dementia: DSHS, Aging and Long-Term Care Services Administration
WAHCA Bills from 2020 Session
HB 2380 Changing the home care agency vendor rate and repealing electronic timekeeping. Effective date 6/11/2020. Allows the home care agency vendor rate calculation to reflect the average home care agency employer tax rate. Adds employer premiums for the state Paid Family and Medical Leave Act to the premiums addressed in the home care agency vendor rate calculation. Clarifies language in how rate parity between home care agencies and individual providers of home care services relates to changes in benefits. Repeals electronic timekeeping requirements that are inconsistent with federal law.
E2SSB 6205/(HB 2681) Preventing harassment, abuse, and discrimination experienced by long-term care workers. Summary: Home care agencies and the Consumer Directed Employer must adopt and maintain a comprehensive written policy about how they will address instances of discrimination, abusive conduct, and challenging behavior by July 1, 2021. (Effective June 10, 2020)
ESSB 6492 Workforce Surcharge: Summary: Except for certain advanced computing businesses, the workforce education investment surcharge is eliminated and replaced with an increase in the B&O service rate from 1.5 percent to 1.75 percent for businesses earning more than $1 million annually in the preceding calendar year. Businesses conducting service activities, but not meeting the $1 million threshold, continue to pay B&O tax at the 1.5 percent rate. Hospitals are excluded from the increase. For the purpose of determining whether a business has met the $1 million threshold, the income of any affiliates of the business is also included in the calculation. An affiliate is any business that directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with another business.
SSB 6061 – Telemedicine training: March 25, 2020 – Governor signed. Effective date 6/11/2020.
Beginning January 1, 2021, health care professionals who provide clinical services through telemedicine, other than physicians and osteopathic physicians, must complete either:
- a telemedicine training made available by the telemedicine collaborative; or
- an alternative telemedicine training, which may include training offered by hospitals and other health care facilities, continuing education courses, or trainings developed by a health professional board or commission.
Health care professionals must sign and retain an attestation that they completed either the telemedicine collaborative or alternative telemedicine training.
ESSB 5385 – Telemedicine reimbursement: March 19, 2020 – Governor signed. Effective date 3/19/2020. Beginning January 1, 2021, regulated health insurance carriers, the state employee health plans, and Medicaid managed care plans must reimburse a provider for health care service provided through telemedicine at the same rate as health care service provided in-person.
SSB 6267 – Long-term services trust: March 19, 2020 – Governor signed. Effective date 6/11/2020. An employee who attests they have long-term care insurance is permitted to apply for an exemption from the premium assessment. An exempt employee is permanently ineligible from receiving LTSS Trust Program benefits.
Department of Health Issues
DOH COVID-19 Response/Governor’s Office: DOH has been on the forefront of fighting the COVID-19 virus in our state and is in charge of the Incident Command Center for the state. For information and updates on the statues of COVID-19 in WA State:https://www.doh.wa.gov/Emergencies/Coronavirus
On March 26, Governor Jay Inslee issued proclamation 20-25 on healthcare worker licensing. The proclamation waived certain statutes and rules with the intent to increase the health care system’s capacity to respond to COVID-19. The proclamation is in effect until midnight on April 25, 2020, unless extended by legislative approval.
The information below summarizes the rules that were waived for health professions. The Governor’s powers to issue proclamations that waive law during emergencies (RCW 43.7.06.220(4)) states that no orders concerning waiver or suspension may continue longer than thirty days unless extended by the legislature.
Waiver of continuing education requirements for returning from expired to active status:
The Governor has waived continuing education and training requirements to return from expired to active licensing status through April 25, 2020 by waiving WAC 246-980-115(1)(c), and (2)(a) language “submit proof of twelve continuing education hours as required by RCW 74.39A.341 and WAC 246-980-110 for each year it has been expired.”
Extension of health profession license expiration dates
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.
Long-term care worker rules proclamation: The governor has issued a proclamation suspending certification requirements in community-based settings (adult family homes, assisted living facilities and home care agencies). You can find it here. This means that NARs can work in a community-based facility past 200 days before obtaining their NAC or HCA credential.
DOH Temporarily Suspends Routine State Compliance Inspections
|DOH has temporarily suspended routine state compliance inspections in all health care facilities it regulates. This change will allow health care facilities to focus their energy, resources, and staff on the COVID-19 response and caring for patients. It will also allow the department to focus our work on technical assistance, resolution of on-going enforcement actions, and investigations of complaints that pose the greatest risk to patients. This approach is consistent with guidance published by the Centers for Medicare & Medicaid Services (CMS). Additional CMS guidance is located here. We will continue the following state compliance activities and investigating complaints that allege immediate risk to patient safety or patient abuse/neglect. The DOH will continue to:|
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.”
Nursing Care Quality Assurance Commission (NCQAC) Nurse Licensing
Extension of renewal fees: For nurses and nursing assistants whose birthdates are between April 1, 2020, and September 30, 2020, the renewal fee due date is extended to September 30, 2020. Your renewal date on Provider Credential Search and NURSYs will continue to show your birthdate, but the renewal date will be September 30, 2020.
120-Day or 4-Month Rule for Nursing Assistant Training – Proclamation 20-37 from Governor Inslee waives the requirement for nursing assistants-registered (NARs) to complete training and testing to become certified nursing assistants within four months of employment with a nursing home, effective through April 29, 2020.
NAR Work Hours in Sanctioned Facilities – While the NCQAC can now temporarily allow programs to count students’ NAR work hours as their clinical hours when documentation of hours and competency evaluation by the supervising LPN or RN is provided –this not true in sanctioned facilities. Federal regulations for sanctioned facilities mandate that clinical training will not be conducted or assessed by any employee of the sanctioned nursing facility.
Skills Checklist for NAR Work Hours – A process and checklist to document these hours is in development and expected to be available next week.
Nursing Assistant Students Still Deemed Essential – March 27 communication to programs continues to be in effect regarding skills lab and clinical rotations. This means:
In-Home Services Roundtable: The next Department of Health (DOH) In-Home Services Roundtable will be April 23, 2020. Home care, home health, and hospice agency representatives and other interested parties are encouraged to attend. 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. The Roundtable will be held at the following address: Contact In-Home Services program manager if you have any questions at email@example.com.
|Long-Term Care Workforce Development Steering Committee: I have been regularly attending the workgroup meetings of the Curriculum and Testing Committees 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 committee I am on is reviewing potential curriculum for CNA’s that would be transferable to many environments. Palliative Care Roadmap: We have had a number of meetings editing the “PC roadmap”, with DOH staff to review and sort the compiled information that was gathered at the first big meeting. Shawn D’Amelio attended the first meeting where they took broad feedback for the larger workgroup and will be part of the broader review as we narrow down the content to more manageable levels. The booklet will be very similar to the Dementia Roadmap published by DSHS a few years ago. Hard copies must be available for distribution no later than September 30, 2020. Palliative Care-Rural Health Integration Advisory Team (PC-RHIAT): This is an ongoing workgroup thatI am involved in. I am 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|
Labor and Industries Issues
L&I offering struggling employers grace period to pay workers’ comp premiums in response to pandemic:
April 6, 2020 L&I is now offering a grace period for premium payments, along with payment plans for employers facing financial difficulties during the pandemic. Under this new offer, employers can request for their payment to be deferred for up to 90 days or can ask for a 90-day payment plan. The delayed payments will be penalty- and interest-free. As part of the agreement, businesses must file their quarterly report on time, which is no later than April 30, 2020. Quarterly reports can be filed online through QuickFile. For additional services, call the L&I Office of Information and Assistance at 360-902-5800.
See Professional and Provider resources for ALTSA Provider/Administrator letters, PPE guidance, CMS waivers, and other information of note.
COVID-19 Problems with Medicaid home care, home health and hospice accessing residential facilities: I have been in contact with Candace (Candy) Goehring / Director / DSHS Residential Care Services Aging and Long-Term Support Administration/ (360-725-2401 firstname.lastname@example.org regarding this issue. Here response was “We have sent out communication to all our facility and agency types to describe for them that hospice and home health staff are not considered visitors and are to be allowed to provide the essential health and social services to their patients. If you can provide us with the names of facilities that are not allowing visitors in we will contact them and provide education about allowing entry to the facility. The hospice and home health staff will need to allow health screening before entry.
I suggest reaching out to the facilities management first, but if all else fails, please consider reporting them to DSHS if they refusal to allow Medicaid home care, health or hospice visits for any discipline to DSHS at: 1-800-562-6078 or on line reporting at https://www.dshs.wa.gov/altsa/residential-care-services/residential-care-services-online-incident-reporting
Consumer Directed Employer (CDE): 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. After registering, you will receive a confirmation email containing information about joining the webinar. April 21, 2020 at 10:30am Register online
Public Policy Updates
WA State Telemedicine Collaborative: 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.
WA State Dementia Collaborative: This is an ongoing meeting that I attend on a quarterly basis as part of the Health and Medical group. There are ongoing discussions about how to integrate dementia care into more medical settings. https://www.dshs.wa.gov/altsa/dementia-action-collaborative. If anyone wants to order some more Dementia Roadmaps for your agency, please go to: www.dshs.wa.go/altsa/dementa-action-collaborative.
Additional Covid-19 Resources:
Office of the Insurance Commissioner: https://www.insurance.wa.gov/coronavirus
WA State Telehealth Collaborative: https://www.wsha.org/policy-advocacy/issues/telemedicine/washington-state-telemedicine-collaborative/
- Telemedicine Frequently Asked Questions for Patients: http://www.wsha.org/wp-content/uploads/Telemedicine-Frequently-Asked-Questions-for-Patients-Dec-2018.pdf
- Telemedicine Frequently Asked Questions for Providers: http://www.wsha.org/wp-content/uploads/Frequently-Asked-Questions-about-Telehealth-for-Providers-Dec-2018.pdf
WA State Employment Security Department: https://esd.wa.gov/newsroom/covid-19
WA State Department of Commerce: http://startup.choosewashingtonstate.com/links/crisis/covid-19-resources/
Governor Inslee’s COVID-19 webpage: https://www.governor.wa.gov/issues/issues/covid-19-resources