Prepared by Leslie Emerick, Lobbyist
Legislative and Budget Overview
The legislative environment that we operate in is significantly impacted by what is happening in our society. The COVID-19 pandemic and related unemployment has severely impacted our states population and our economy has taken a severe hit as a result. Sometime later this summer or early fall we may need to have a Special Session convened by the Governor to address the severe budget shortfall. The 2021 WA State Legislative session will be dominated by economic/budget, health care and social justice issues due to the protests against racism around the state and the country.
As an association we will need to adjust our legislative priorities accordingly. A good example is that 3% across the board spending cuts are being proposed for Medicaid home care at DSHS and hospice has been offered up as an “optional service” under the Health Care Authority and could be part of the pending cuts to the states operating budget. We may need to defend keeping the home care benefit accessible for clients on Medicaid!
Although most counties in Washington state are moving to the next Phase of opening back up after the coronavirus shut down, in some counties the infection rates continue to rise significantly creating concerns about a set-back combating the virus. Initially the virus impacted the west side of the state with King County hit hard by the initial outbreak. Now the virus is moving east, impacting home health and hospice agencies on both sides of the state. Covid-19 Risk Assessment Dashboard
According to the Seattle Times, “The virus has created a crisis in county hospitals, which face critical staffing shortages as the count of patients with COVID-19 last week reached all-time highs. At Virginia Mason Memorial in Yakima, where staffing problems have been aggravated by workers ill or quarantining from COVID-19, the hospital can’t handle more admissions, and over two days last week arranged for 22 COVID and other patients to be taken to facilities in Western Washington. A hospital forecast projects the worst is yet to come. Hospitalizations are expected to climb sharply until mid-July, when they are anticipated to be roughly double the current level.
Budget reductions come more into focus with latest revenue forecast
Depending on which articles you read, the state is either $8.8 billion in the hole or $4.5 billion which may sound confusing…but the basic difference is whether you count the states roughly $3 billion dollar “rainy day” fund that has been created for exactly budgetary times like these and which fiscal biennium you are reporting on. The $8.8 billion projection is through fiscal year 2023.
The state Economic and Revenue Forecast Council’s quarterly revenue estimate projected a shortfall of $4.5 billion in the state’s current budget biennium alone. Even if the state used all of its reserve funds, that would leave a more than $1 billion shortfall that must be addressed in the current biennium. Revenue in the 2021-2023 biennium is expected to be reduced by $4.3 billion.
According to The Olympian, “Gov. Inslee has directed state agencies under his authority to cancel a scheduled 3 percent pay raise for many of the state’s highest-paid general government employees and to begin furloughs for most state employees. More than 40,000 state employees will be required to take one furlough day per week through July 25. The state employee furloughs started June 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
Workplace Violence Prevention Training: On July 1, 2020 HB 1931: Concerning workplace violence in health care settings, goes into effect and it impacts in-home services agencies licensed under RCW 70.127. It requires workforce violence prevention planning and training for hospitals, including in-home services providers under Here is a link to the relevant RCW 49.19: https://app.leg.wa.gov/RCW/default.aspx?cite=49.19. In particular see:
| 49.19.020 | Workplace violence plan—Security and safety assessment. |
| 49.19.030 | Violence prevention training. |
Public Policy Development
HCAOA Legislative Call with Vicki Hoak: The monthly call was on July 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: