December 28, 2020
The large scale rollout of the Pfizer vaccine begins in Washington State today,
December 28, 2020, with the arrival of CVS and Walgreens vaccination clinics in nursing homes throughout the state.

A number of states are far ahead of Washington in rolling out their vaccination programs. In fact, West Virginia reports that its first round of vaccinations for SNF and ALF residents and staff will be completed by the end of the day today. Other states are set to follow this example in the days ahead. Obviously, Washington State has a long way to go.

But one of the advantages of not leading the pack is that Washington can learn from others. To that end, issues that merit your attention include:
  • The American Health Care Association is reporting that long term care facilities are significantly overestimating the number of people expected to be vaccinated. This results in pharmacies thawing too much vaccine, which must be used within six hours, and states scrambling to reallocate the vaccine before expiration. Facilities are advised to survey residents and staff two to three days before the vaccination clinics to determine how many plan to take the vaccine and report that information to CVS or Walgreens in a timely manner. 
  • Staff reticence in accepting the vaccine can be due to a number of factors. Providers are advised that frequent and regular communication about the benefits and safety of the vaccine, along with posting and distribution of educational information, can be very helpful. Help with these materials can be found here.
  • To address concerns over staff calling in sick after receiving the vaccine, please review AHCA's staffing considerations guidance. Be aware that AHCA is reporting not hearing many reports of staff calling in sick from states or providers that have completed vaccinations.
  • There have been concerns about CVS requiring a Medicare card for vaccinations. In discussions with their leadership, DOH is being told facilities do not need the actual card as long as they can provide the information necessary (from the card) to bill.
  • The Centers for Disease Control and Prevention (CDC) has updated its Vaccination Tool Kit for Long Term Care Facilities. The toolkit provides administrators and clinical leadership with information and resources to help build vaccine confidence among health care personnel and residents. 
  • Vaccination Prioritization of Assisted Living remains an issue. Initial recommendations from the CDC called for prioritizing independent living and assisted living staff and residents for early phases of vaccination. Due to lower than expected vaccine supplies, we question the state’s commitment to independent living. We continue to press the state to ensure that assisted living and independent senior living remain a priority. 
  • Whether or not an employer can mandate vaccinations continues to be an issue of interest. Last week the EEOC shared guidance indicating that employers can require proof of COVID-19 vaccination from employees, with some exceptions. The guidance confirms that employers will be permitted to implement and maintain mandatory vaccination policies, provided employers reasonably accommodate certain types of employees. The guidance also explains the meaning of reasonable accommodation and offers two main categories for exceptions: employees who cannot be vaccinated for disability-related reasons; and employees who refuse the COVID vaccine because of sincerely-held religious beliefs. Employers are advised to move cautiously, under the advice of legal counsel, in implementing mandatory vaccination programs, however, they are not out of the question. 
With four days to go before expiration of the statewide eviction moratorium on December 31, 2020, Governor Jay Inslee announced Wednesday he would once again extend the ban on evictions to March 31, 2021. Inslee’s office did not offer more details on the moratorium extension, saying that more information would be available this 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 Proclamation 20-19.4 was to do two things: (1) account for items that are in the normal course of business for long term care; 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 dated December 24, 2020, assisted living providers are informed of the filing of a CR-103E (Emergency Rule) to extend emergency rules in Chapter 388-78A WAC. The original emergency rules suspended administrator training requirements in WACs 388-78A-2524(1), 388-78A-2525(1), and 388-78A-2526(1). Pursuant to the letter, these emergency rules became effective April 23, 2020, have been extended, and are being extended once again. They are now set to expire April 15, 2021. They are published in WSR 21-01-129. If you have any questions, please email Jeanette Childress, LTC Policy Program Manager, or call her at (360) 764-9804.
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.