Legislative and Budget Overview
As we all know, elections have consequences! Not too surprisingly, Governor Jay Inslee won his third term as the Governor of Washington state against the police chief from Republic, WA. The Democrats still control both the House and Senate. At latest vote count, the Senate will retain a 28-21 Democratic majority. Three Senators retired and were replaced by same party, two being former House of Representative members. There are 6 new members of the Senate. At the latest vote count here are 16 new House members, Democrat majority with 56/42.
Updated numbers by the Economic and Revenue Forecast Council released Wednesday show that projected revenue collections through mid-2023 are more than $900 million above what had been originally forecast. But the state’s revenue projection for that same timeframe remains nearly $2.4 billion below what it was before the pandemic hit. That potential shortfall has steadily been shrinking since June, when numbers showed that state revenues through mid-2023 were projected to be nearly $9 billion lower than previous projections had shown. In September, they were projected to be $4.6 billion lower.
The Governor’s budget will come out in early December based on these new revenue forecasts making it less likely that the state will opt to make deep cuts to in-home services. The House and the Senate will submit their budgets sometime in the middle of the session based on February revenue forecasts. No final decisions will happen until the final compromise budget comes out in April 2021.
WAHCA, HCAW and WSHPCO Meet with Spokane Legislators: I organized a Zoom meeting on November 6th with key legislators from the Spokane area to discuss the Proposed Agency Decision Packages In-Home Services Budget Cuts for 2021-23 Budget. The meeting was successful in gaining their awareness around the negative impacts of these types of cuts and the increased costs that it would have on the state budget to eliminate hospice, home health rehab and reduce home care access and rates. Our speakers were:
- Jeff Wiberg -Family Resources Home Care spoke to the Home Care (DSHS/ALTSA): Provider Rate Cuts and Client Eligibility Cuts: 2.4 percent rate cuts across the board for Medicaid providers, including in-home providers, nursing homes, adult family homes, adult day health, private duty nursing, enhanced service facilities and assisted living facilities. (-$145.2M Total; -$66.6M GF-State) The client eligibility cuts would result in the loss of ALTSA services for over 12,000 people served in their own homes, community settings and nursing homes, and a reduction in DSHS and Area Agency on Aging (AAA) staff due to a smaller number of clients receiving services. (-$805.3M Total; -$385.6M GF-State; -69.6 FTE)
- Gretchen Anderson – Sunshine Home Health spoke to the cuts for Home Health (Health Care Authority
- Chris McFaul-Horizon Hospice spoke to the Hospice Benefit (Health Care Authority)
- Kurt Sigler, Maxim Health Care Spokane Operations Manager spoke about the impacts of a 2.4% budget cut on Private Duty Nursing
Potential Taxes under Consideration by the State Legislature: The Tax Structure Work Group, are holding listening sessions to allow legislators to hear from you on a variety of tax policies to help the Tax Structure Work Group craft alternative scenarios to share with the public in 2021. The only one that mentions healthcare specifically is the Retail Sales & Use Taxes, but the B & O tax may be a concern as well. We are watching this closely when the session starts…
Governor Proclamations & COVID-19 Waivers
A letter from Residential Care Services: Indoor visits are suspended for all LTC settings except for end-of-life care and essential support persons. End-of-life circumstances are generally defined as a sharp decline in health status. In these circumstances, only one person may visit, and that person must be designated by the long-term care resident or client, or their legal representative. The visitor restrictions apply to all four phases at this time. All other criteria to allow visitors, such as screening protocols and use of personal protective equipment (PPE), remain in effect for those visitations allowed under the new proclamation.
The latest COVID-19 Waivers have been extended until December 7th. We assume new ones will be posted soon thereafter hopefully until January 2021. We are hearing that the Democrats in the legislature will extend the waivers until the end of the emergency.
DSHS/ALTSA Covid Waiver Extensions: https://www.dshs.wa.gov/sites/default/files/ALTSA/rcs/documents/multiple/020-10-08-2.pdf
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 December 7, 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 December 7, 2020, whichever occurs first. This means that a caregiver 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 December 7, 2020, 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.
Barriers to long-expired credential reissuance: The requirement to retake nursing assistant or nursing training and pass the competency examination prior to reissuance when a nursing assistant-certified credential has been expired for over three years is waived.
The COVID-19 situation is rapidly evolving. You can monitor the following sources for updates:
- Department of Health COVID-19 webpage: https://www.doh.wa.gov/Emergencies/Coronavirus
- Governor Inslee’s COVID-19 webpage: https://www.governor.wa.gov/issues/issues/covid-19-resources
- 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 (DOH)
New Secretary of Health: (Seattle Times, Nov. 17, 2020) Gov. Jay Inslee announced Tuesday that Washington’s next secretary of health will be Dr. Umair Shah, the health director for Texas’s largest county. The new appointment comes as the state sees an increase in new COVID-19 infections and hospitalizations, and as Washingtonians brace for more cases, deaths and economic damage as the coronavirus surges. Shah — who replaces Secretary John Wiesman and will oversee the Washington Department of Health (DOH) — will begin his new job Dec. 21.
In a news conference announcing the appointment, Inslee said hospitalizations of infected people are increasing on both sides of the Cascade Mountains. Meanwhile, state health officials Tuesday reported a new daily record of 2,589 confirmed COVID-19 cases, and 23 new deaths.
But Inslee praised Shah, who has since 2013 served as executive director for Harris County Public Health, the county that encompasses Houston. There, he managed a public-health staff of 700 that serves the county’s 4.7 million residents, according to Inslee’s office.
Letter to DOH Regarding Vaccines for Home Care Workers from HCAOA/WAHCA:
The Home Care Association of America Washington State Chapter represents hundreds of agencies that bring care into the homes of thousands of our state’s older citizens and people with disabilities every day. Throughout the pandemic, home care aides have provided one-to-one care in individuals’ homes to keep them safe and prevent the spread of the coronavirus. Home care is critically important as we face record numbers of cases and hospitalizations heading into the holiday season. Home care is the answer to keeping our most vulnerable safe from this disease and our frontline workers are essential as Washington battles COVID-19.
As you continue to fine-tune our state’s plan for the distribution of a COVID-19 vaccine, we urge you to include home care aides as health care workers to receive this vaccine first. If we are to contain the spread of the virus, home care workers play an essential role in the fight against the coronavirus and should be among the first to receive the vaccine.
Home care agencies monitor the conditions of our frontline workers every day and are in an excellent position to monitor the well-being of our clients, who are at home, yet are vulnerable to the virus. We continue to provide our frontline workers with PPE, testing when appropriate and offer ongoing training on infectious disease control.
Update on vaccine candidates from DOH: This week we heard encouraging news about a second COVID-19 vaccine candidate. We are excited that there are potentially two very effective vaccines close to being ready for approval.
Both pharmaceutical companies developing these vaccines are indicating strong vaccine effectiveness among participants in Phase 3 clinical trials. One of the companies has announced they will apply for Emergency Use Authorization through the U.S. Food and Drug Administration (FDA). As these vaccines go through the approval process, we will learn more about how well they work. They will also be vetted for safety.
Provider enrollment: Health care providers began enrolling earlier this month to be COVID-19 vaccine administrators. As of November 16, 375 providers have turned in applications. Most applications are still in progress, but we have fully approved six sites. We want to encourage clinics, pharmacies and health care offices across the state to apply to be vaccine administration sites. If you are a health care provider and want to enroll, learn how and get enrollment materials at www.covidvaccinewa.org.
Vaccine planning: Estimates on the amount of doses we will receive have varied. We do not have new information from the federal government about our allocation or timing for receiving vaccine. We also do not have information on how often we will continue to get additional doses. To see Washington’s interim plan that addresses who might get the vaccine in what phases, go to www.covidvaccinewa.org.
Palliative Care Roadmap Completed and Available!! I have some good news, Pat Justis has located funds for a third printing of the PC Roadmap! One of her Program Managers has an underspent budget and would like to fund this, so we just have to spend it before 3/31/2021. Pat believes that our second printing of 5,000 will be expended by then.
We are excited that this new booklet is now available to order. And best of all, the booklet is free with no shipping charges!! It’s posted on DOH Rural Health webpage. (https://www.doh.wa.gov/Portals/1/Documents/Pubs/609013.pdf) and offers permission for others to post it to their own web sites. For ordering: https://prtonline.myprintdesk.net/DSF/ and register.
Nursing Care Quality Assurance Commission (NCQAC)
Emergency Volunteer Health Care Workers Needed: The NCQAC has been experiencing a backlog of licenses for nurses and are working to rectify it. DOH is continuing to look for medical practitioners and caregivers who are willing to support health care and long-term care facilities in the event of a surge this fall related to COVID-19. Those volunteers could be health practitioners licensed in another state who can practice in Washington if their other licenses are in good standing and they register with us. Or, they could be health practitioners licensed in Washington who want to volunteer to help meet demands in an emergency. Right now, we are urgently looking for Certified Nursing Assistants, Licensed Practical Nurses, and Health Care Assistants. Interested volunteers can visit our website at www.doh.wa.gov/emergencyvolunteer to learn more about our emergency volunteer program or email email@example.com with specific questions.
NCQAC Draft Advisory Opinion for Telehealth Nursing Services: This may be of importance due to the amount of telemedicine that home health and hospice agencies have been providing, especially during the pandemic. NCQAC concludes that the appropriately prepared and competent advanced registered nurse practitioner (ARNP), registered nurse (RN), licensed practical nurse (LPN), nursing technician (NT), and nursing assistant (NA), may perform telehealth delivery of nursing care services in settings appropriate for telehealth care within their legal and individual scope of practice. This document touches on a number of areas including nurse delegation, documentation and standard of care. Please let me know if you have any comments or concerns that you would like to let staff at NCQAC know about.
Nurse Delegation Bill Proposed for 2021 Legislative Session: Rep Eileen Codyis proposing a bill for the 2021 legislative session to allow for more flexibility in hospitals. Below is a draft of the bill that was discussed at a November 5th meeting. At the meeting I requested that a section of the proposed bill that was struck out (Sect. 1(3)(b) remain in the statute for ease of home health and hospice providers. Although the broader bill language would allow for this section in the revision, I requested that it stay in for clarity. They also changed the language from certified nursing assistant to credentialed health care provider in the section.
(b) registered nurse, working for a home health or hospice agency regulated under chapter 70.127 RCW, may delegate the application, instillation, or insertion of medications to a registered or certified nursing assistant under a plan of care.
LTC Workforce Development Committee: The Nursing Care Quality Assurance Commission (NCQAC) has a report to the legislature due June 30, 2021 on how to increase the number of LTC workers in the pipeline. They are acutely aware of the nursing shortage and are working on ways to create more pathways for home care aides and CNA’s to become RNs. I also participate in the subcommittee on Curriculum and their latest meeting was on November 9th.
WA State Telemedicine Collaborative: Next meeting was on November 17th. Possible new legislation to keep some of the lifted restrictions permanently such as being able to bill for audio only telemedicine visits! Telemedicine Trainings will begin December 7th with the Collaboration to meet the January 1, 2021 deadline for all health care providers using and billing for telemedicine!