May 21, 2020
In the near future, the Washington State Secretary of Health will be issuing written directives to skilled nursing facilities related to mandatory COVID-19 testing. Under Secretary John Weisman’s order, all residents and staff will be required to be tested for COVID-19 within two weeks of the issuing of the directive. All skilled nursing facilities that have completed testing for all residents and staff anytime after April 1, 2020, will likely be exempted from this requirement. All tests and PPE will be provided to each skilled nursing facility in order to ensure prompt completion of this directive. More details will be forthcoming.

Following the completion of skilled nursing facility testing, the state will begin working with assisted living facilities with dedicated memory care units to accomplish testing for all residents and staff there. Assisted living facilities without memory care units will follow after testing in memory care units is complete. Any facility having already conducted testing of residents and staff since April 1, 2020, will be exempted from the testing requirement. Routine testing of staff, likely to be every two weeks, will also be expected in all long term care facilities. 

There are many questions yet unanswered, and WHCA is working with regulatory agencies to solidify answers to those questions. Those questions include but are not limited to:
  • If facilities have already conducted their own testing, how or will they be expected to forward their results, and if so, to whom?
  • Who will do the ordering of tests in assisted living and memory care units? Who will order tests for staff?
  • Who will bear the cost of staff testing if the staff person does not have insurance?
  • Who will conduct the testing in facilities where staff is unable?
  • What types of tests will be conducted? (There was some discussion, particularly in memory care settings, where anterior nasal testing would likely be better than the deep-dive nasopharyngeal tests.)
  • If a resident and/or staff has tested positive and recovered, will they be required to take another test?

While there seem to be more questions than answers, WHCA wants to keep members informed regarding these testing issues and will update you as we get more answers. If you have questions, please email Elena Madrid or Vicki McNealley .

In the meantime, please reassess your PPE allotment and consider once again steps you will take in your community if any positive cases result from this testing.
On May 19, the U.S. Department of Health and Human Services (HHS) posted four FAQs on Change of Ownership (CHOW).

The four CHOW FAQs are: 
  • Can an organization that sold its only practice or facility under a change in ownership in 2019 and is no longer providing services, accept payment and transfer it to the new owner? 
  • If the current TIN owner has not yet received any payment from the Provider Relief Fund, it may still receive funds in other distributions. Can a provider that purchased a TIN in 2019 accept a Provider Relief Fund payment from a previous owner and complete the attestation for the Terms and Conditions? 
  • If, as a result of the sale of a practice/hospital, the TIN that received a General Distribution payment is no longer providing health care services as of January 31, 2020, is it required to return the General Distribution payment? 
  • How does the organization account for these acquisitions when submitting revenue information in the Payment Portal? 

The UnitedHealth Group CARES Provider Hotline has given guidance that does not align with the FAQs. AHCA/NCAL has requested clarification on how to address action steps already taken related to CHOWs based on Hotline Guidance, as well as a list of other questions to HHS.
The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) has adopted revised policies  for enforcing OSHA’s COVID-19 requirements, which will become effective May 26, 2020. The previous memorandum  will be rescinded.

OSHA is increasing in-person inspections at all types of workplaces. In geographic areas with sustained elevated community transmission or a resurgence, OSHA will prioritize on-site inspections for high-risk workplaces, such as health care providers treating patients with COVID-19.

OSHA is also revising its previous enforcement policy for recording cases of COVID-19. Under OSHA’s recordkeeping requirements, COVID-19 is a recordable illness. Employers are responsible for recording cases of COVID-19 if the case: 

Under the new policy issued, OSHA will enforce recordkeeping requirements for employee COVID-19 illnesses for all employers. OSHA acknowledges the difficulty in determining whether a COVID-19 illness is work-related, especially when an employee has experienced potential exposure both in and out of the workplace. OSHA’s guidance emphasizes that employers must make reasonable efforts, based on the evidence available to the employer, to determine whether it would be considered work-related.
As long term care providers work to respond to the COVID-19 pandemic impacting our region, there have been many questions. We have incorporated frequently asked questions into our FAQs for Assisted Living and FAQs for Skilled Nursing . We encourage you to review the updated documents if you have questions regarding COVID-19. You may find answers there and links to other helpful information and resources. You are always welcome to contact the WHCA office at (800) 562-6170 to seek help and answers as well.
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.