December 24, 2020
With eight days to go before the expiration of the statewide eviction moratorium on Dec. 31, Gov. Jay Inslee announced Wednesday he would once again extend the ban on evictions to March 31. Inslee’s office did not offer more details on the moratorium extension, saying that more information would be available next week.

With respect to long term care facilities, providers can initiate lawful transfer/discharge proceedings for health and safety reasons or if there is a change in payer source that the facility is unable to accept. For example, if a resident converts to Medicaid and the provider does not accept Medicaid, transfer/discharge would be appropriate.
In addition, we remind providers that Governor Inslee’s Proclamation 20-19.4, revised on October 14, remains in effect. That revision clarified that “customary changes in the charges or fees for cost of care (such as charges for personal care, utilities, and other reasonable and customary operating expenses), or reasonable charges or fees related to COVID-19 (such as the costs of PPE and testing), are allowed as long as these charges or fees are outlined in the long-term care facility’s notice of services and are applied in accordance with the laws and rules that apply to those facilities, including any advance notice requirement”.

We understand this to mean that increases in charges are allowed if they represent customary operating expenses that are adjusted year after year, as well as increased costs of care, and including COVID related expenses. The key is “reasonable charges”. The intent of the Proclamation 20-19.4 was to do two things: (1) account for items that are in the normal course of business for LTC; and (2) still keep some parameters that would prohibit increases more akin to what the proclamation is trying to prevent, such as predatory or unreasonable increases. 
In a Dear Administrator letter released December 24, 2020, skilled nursing providers are informed of CR-103E, filed to extend emergency rules amending nursing home requirements related to physician services. Residential Care Services (RCS) filed an emergency rule effective April 29, 2020, related to WAC 388-97-1260 and physician services. The rule was extended on August 26, 2020, and is set to expire today, December 24. RCS filed CR103-E WSR 21-01-192 to extend the amended rule for a second time. The rule expires on April 21, 2021.

WAC 388-97-1260 was amended to permit the physician to delegate tasks to a registered nurse practitioner or a physician assistant, even if it is required to be performed by the physician in regulation and regardless of the frequency of the delegation. The amendment does not change the required frequency of physician/delegate visits, or the requirement for the physician to supervise the delegate. The delegate must only perform tasks within the scope of practice of their credential.

If providers have questions, the letter encourages them to email Lisa Herke, Nursing Home Policy Program Manager, or call her at (509) 209-3088.
The Department of Health and Human Services (HHS) plans to contact members that applied for Phase 2 or 3 stimulus relief from the HHS Provider Relief Fund and were initially informed that their application could not proceed due to an ineligible taxpayer identification number. HHS has indicated that this determination was done so in error and will provide an opportunity to apply for Phase 3 funding under a new January 6 application deadline.

At the national level, both AHCA/NCAL and Argentum continue to represent the needs of providers. In a memo from James R. Balda, President and CEO of Argentum, he shared the following information:
  • Due to an error, many providers did not receive notification that their TINs have been validated and were not notified to apply for the Phase 3 financial relief. As such, in the next day or two, those providers will be receiving a communication from HHS/UnitedHealthcare/Optum informing them of their eligibility to apply for Phase 3 financial relief by January 6th. If you have already applied for Phase 3 funding this message should not apply to you. If you did not apply for Phase 3 funding, we encourage you to make sure your relevant team members are on the lookout for this message to move forward with your application process as soon as possible.
  • HHS has noted that payments from Phase 3 will be distributed in three batches: the first of which has already been distributed; the second will be in the next few weeks; and the final batch will be distributed a few weeks thereafter. It is unlikely that the current stimulus package passed by Congress, but yet to be signed by President Trump, will impact Phase 3 financial relief in any way.
  • We are still cautiously optimistic that HHS will continue to consider launching a “Phase 3.5” that will address provider losses from the third quarter of 2020. We are still working to advance this advocacy, and we encourage you to be ready to provide relevant financial details (similar to those provided in Phase 3 applications) so you will be prepared should an announcement be made.

Please note that HHS indicated nearly 5,000 applications were incorrectly deemed ineligible. However, HHS has not shared the list of providers that were impacted.

AHCA/NCAL invites questions from members via email, and Argentum has also set up an email address where they can receive questions from providers who are part of their membership.
WHCA continues to post resources and information as it becomes available on our website. If you have questions or need additional information, please call the WHCA office at (800) 562-6170.