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 4^th 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 26^th, 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 4^th) 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 8^th.

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