COVID-19 UPDATE #39
June 3, 2020
DSHS REVISES GUIDANCE ON MANDATORY TESTING FOR ASSISTED LIVING
On May 28,   2020, the Department of Health (DOH) ordered every assisted living facility with a memory care unit to complete universal testing of memory care residents and staff by June 26, 2020. On the same day, the Department of Social and Health Services (DSHS) issued its guidance on implementing the testing requirement for memory care residents and staff. Predictably, on June 3, 2020, DSHS issued a revised guidance adding further “clarification” to the mandatory testing requirement. The revised guidance does not alter the broad outlines of the original testing program, but it does contain significant changes to the original document of which all assisted living memory care providers should be aware.

Important changes to the earlier DSHS guidance include:
  • DSHS’s “suggestion” that a signed written consent from the resident or resident representative would be “preferred.” WHCA is working on a simple written consent form for residents, resident representatives, and staff. We will make those forms available through a WHCA COVID-19 member notice as soon as they have been reviewed by our attorneys.
  • DSHS requires “staff members not employed by the facility” to be tested. It should be noted that the revised guidance continues to define a staff member as any employee, contractor, volunteer, or other personnel who provides health care, personal care, social, administrative, clerical, dietary, environmental, or any other kind of services in the facility. DSHS states that these non-employee staff members should request testing from their employers or personal health care provider. For example, a temporary staffing agency must pay for testing of its staff.
  • DSHS states that providers will not need to request the test kits or the PPE. The test kits and the PPE will be sent to facilities in separate shipments. The shipments should be arriving by June 6, 2020. Instructions and Frequently Asked Questions will be included in the test kit package.

In addition to these new requirements, the revised DSHS guidance includes additional detailed instructions regarding testing. This additional information includes:
  • Stating that the facility is responsible for ensuring that testing is done by a person qualified to administer the test;
  • Specifying that a licensed health care practitioner order is required for all resident and staff testing, (a licensed health care practitioner includes medical doctor, advanced registered nurse practitioner, or physician’s assistant);
  • Requiring test requisitions to include insurance information on specimens submitted for all residents. For residents without insurance, write “UNINSURED” where the type of insurance is requested.
  • Clarifying that insurance information is not required for staff as DOH will pay for staff testing. Test requisitions must clearly delineate staff from residents by writing “STAFF” where the type of insurance is requested;
  • Noting that instructions for proper packaging and mailing the test kits to the laboratories will be included with the test kits;
  • Clarifying that an assisted living facility that wants to test all residents and staff (not just memory care residents) by the June 26 deadline should work with DOH to obtain necessary test kits and PPE;
  • Eliminating any mention of facilities having a choice of returning samples to labs that the facilities usually contract with;
  • Specifying that facilities must send all resident and staff test samples to one of the two following DOH contracted laboratories:
  • Facilities located in Regions 1 and 2 must send their staff samples to UW Virology Testing.
  • Facilities located in Region 3 must send their staff samples to Molecular Testing (Vancouver).
  • Specifying that facilities must not send tests to State Public Health Laboratories.

WHCA understands that these changes and “clarifications” can be frustrating. Especially given the fact that that the state is pushing for all assisted living with memory care units testing to be completed by June 26, 2020. Given the slow rollout of the state’s initiative, we think it unlikely that the deadline can be met. WHCA has already engaged with the Governor’s office around this issue and has requested an extension. As always, we will continue to keep you informed. If you have any questions, please email Vicki McNealley.
DSHS REVISES GUIDANCE ON MANDATORY TESTING FOR SKILLED NURSING
On May 28,   2020, the Department of Health (DOH) ordered every skilled nursing facility to complete universal testing of residents and staff by June 12, 2020. On the same day, the Department of Social and Health Services (DSHS) issued its guidance on implementing the testing requirement for nursing home residents and staff. Predictably, on June 3, 2020, DSHS issued a revised guidance adding further “clarification” to the mandatory testing requirement. The revised guidance does not alter the broad outlines of the original testing program. But, it does contain significant changes to the original document of which all SNF providers should be aware.

Important changes to the earlier DSHS guidance include:
  • DSHS’s “suggestion” that a signed written consent from the resident or resident representative would be “preferred.” WHCA is working on a simple written consent form for residents, resident representatives, and staff. We will make those forms available through a WHCA COVID-19 member notice as soon as they have been reviewed by our attorneys.
  • DSHS requires “staff members not employed by the facility” to be tested. It should be noted that the revised guidance continues to define a staff member as any employee, contractor, volunteer, or other personnel who provides health care, personal care, social, administrative, clerical, dietary, environmental, or any other kind of services in the facility. DSHS states that these non-employee staff members should request testing from their employers or personal health care provider. For example, a temporary staffing agency must pay for testing of its staff.
  • DSHS states that providers will not need to request the test or the PPE. The test kits and the PPE will be sent to facilities in separate shipments. The shipments should be arriving by June 6, 2020. Instructions and Frequently Asked Questions will be included in the test kit package.

In addition to these new requirements, the revised DSHS guidance includes additional detailed instructions regarding testing. This additional information includes:
  • Stating that the facility is responsible for ensuring that testing is done by a person qualified to administer the test;
  • Specifying that a licensed health care practitioner order is required for all resident and staff testing, (a licensed health care practitioner includes medical doctor, advanced registered nurse practitioner, or physician’s assistant);
  • Requiring test requisitions to include insurance information on specimens submitted for all residents. For residents without insurance, write “UNINSURED” where the type of insurance is requested.
  • Clarifying that insurance information is not required for staff as DOH will pay for staff testing. Test requisitions must clearly delineate staff from residents by writing “STAFF” where the type of insurance is requested;
  • Noting that instructions for proper packaging and mailing the test kits to the laboratories will be included with the test kits;
  • Eliminating any mention of facilities having a choice of returning samples to labs that the facilities usually contract with;
  • Specifying that facilities must send all resident and staff test samples to one of the two following DOH contracted laboratories:
  • Facilities located in Regions 1 and 2 must send their staff samples to UW Virology Testing.
  • Facilities located in Region 3 must send their staff samples to Molecular Testing (Vancouver).
  • Specifying that facilities must not send tests to State Public Health Laboratories.

WHCA understands that these changes and “clarifications” can be frustrating. Especially given the fact that the state is pushing for all SNF testing to be completed by June 12, 2020. Given the slow rollout of the state’s initiative, we think it unlikely that the deadline can be met. WHCA has already engaged with the Governor’s office around this issue and has requested an extension. As always, we will continue to keep you informed. If you have any questions, please email Elena Madrid.
CMS ANNOUNCEMENT ON NHSN DATA AND GUIDANCE ON COVID-19-RELATED SURVEY ACTIVITY IN SKILLED NURSING CENTERS
On June 1, CMS released a memorandum ( QSO-20-31-ALL ) addressing NHSN data, COVID-19 survey activities, enhanced enforcement, and engagement of Quality Improvement Organizations (QIOs).

This guidance is effective immediately and will cease to be in effect when the Secretary determines there is no longer a Public Health Emergency due to COVID-19. At that time, CMS will send public notice that this guidance has ceased to be effective via its website. Read more .
UPDATES TO PROVIDER RELIEF FUND FAQs ADDRESS TIN AND GROSS RECEIPTS
Late yesterday, June 2, HHS released updated FAQs with long awaited guidance on Tax Identification Numbers (TIN) and has explained use of Gross Receipts. In addition to the TIN FAQs, HHS also added or updated other FAQ topic areas. That information is listed below the TIN information. To find updated Gross Receipts language, AHCA/NCAL recommends downloading a copy of the FAQs as a PDF and conducting a key word search. Read more .
REVISED NOTIFICATION GUIDELINES FOR SKILLED NURSING CENTERS
AHCA/NCAL has updated the COVID-19 Reporting and Notification Guidelines for Nursing Homes , according to the new regulations for notifying residents, representatives, and families of COVID cases that went into effect on May 8, 2020. These guidelines supplement the information in this detailed summary AHCA previously provided, and provide further clarification from CMS on how providers should report cumulative COVID cases and clusters of three or more residents/staff with new onset respiratory symptoms within 72 hours. Read more .
ADDITIONAL RESOURCES
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.