Prepared by Leslie Emerick, Lobbyist
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.”
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.
Home Health agency waivers:
WAC 246-335-525(14) in-person demonstration of CPR skills
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(13) in-person demonstration of CPR skills
WAC 246-335-625(15) on-site annual observation/evaluation of staff providing care
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 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
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:
- Enhanced pay for home care and home health workers under hazardous conditions.
- Essential benefits needed such as child-care for many of the workers
- Making home care and home health priority providers
- Enhanced support for Medicaid caregiving programs
- Qualified immunity for caregiving like hospitals and nursing homes
- 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.