June 5, 2020
Earlier today ALTSA Assistant Secretary Bill Moss issued a letter  outlining potential budget cuts for the state’s upcoming fiscal year which runs from July 1, 2020, through June 30, 2021. The letter is ALTSA’s response to the Office of Financial Management’s (OFM) directive to all state agencies to develop contingency budgets incorporating 15% across-the-board cuts for the upcoming fiscal year. In addition to proposed cuts in Medicaid eligibility and ALTSA staff cuts, the proposal also calls for the elimination of the current $29 COVID-19 nursing home add-on generated from the enhanced FMAP funding and a proposed 3% reduction in all Medicaid rates including nursing home and assisted living.

It is important to recognize that these proposed cuts represent a fiscal exercise by ALTSA to fill an anticipated budget shortfall of over $200 million (GFS). These proposals are a “shot across the bow” outlining a worst case scenario. Nothing has been finalized or decided. An accompanying letter from DSHS Secretary Cheryl Strange noted that the proposal only “marks the beginning of a conversation.” 

For our purposes, this proposal should serve to energize the sector because now we know what is at stake! WHCA is already working to stop any reductions and we are preparing to carry our fight to the Legislature and to the people of the state of Washington. Medicaid reimbursement in our state has been an embarrassment for decades. After bearing the brunt of a devastating pandemic, we cannot afford, nor can we accept, any reductions in payment rates.

The future of the current $29 COVID-19 nursing home add-on generated from the enhanced FMAP funding is inherently unclear. If President Trump decides that the national emergency has miraculously ended by June 30, 2020, that funding could well go away by June 30, 2020. On the other hand, if the enhanced FMAP funding continues past June 30, 2020, OFM could decide to direct those funds elsewhere. WHCA will fight any such move.

However, it is import for the nursing home sector to understand that the upcoming
July 1, 2020, rebase will go forward. Neither the Department nor OFM has the authority to stand in the way of the legislatively-mandated rebase. Nor can the legislatively-determined reimbursement formula be overturned, absent action by the Legislature. If you have questions, please contact Robin Dale.  Thanks to Bill Ulrich of CBSI for his help in preparing this article.
The order from the Secretary of the Department of Health (DOH) dated May 28, 2020, has been fraught with concerns, questions, and lack of clarity regarding how our skilled nursing facilities and assisted living communities with memory care units comply. The efforts made by our assisted living and skilled nursing members in an attempt to meet the requirements of this order are more than commendable.

The vast numbers of questions in need of guidance and clarity from our state officials have not gone unheard by WHCA staff. We are advocating on your behalf and continue to seek answers, clarity, and relief from the fast-approaching deadlines.

As we continue to work with the Governor’s Office and state entities on the complex issues you have brought forth, we will also keep you appraised of any information or updates as soon as received. In the meantime, please continue to share questions or complications you encounter with us regarding the testing of your residents and staff. We also highly encourage you to submit these questions back to DOH via their email contact line . This will provide a track record of your concerns with the state and assist in providing state leaders with a better understanding of the obstacles and challenges your facilities are facing in your attempts to implement this order.

WHCA also encourages each facility to keep track of all dates and condition of shipments received, communications with the state entities regarding testing, complications encountered, time/resources needed, and actions taken on behalf of your facility to comply with the DOH order. Please continue to reach out to Elena Madrid or Vicki McNealley for assistance.
Back in May, WHCA informed our members that FEMA would be sending out two shipments totaling a 14-day supply of personal protective equipment (PPE) to nursing homes across the nation.

By the beginning of July, each facility was to receive two separate packages containing a seven-day supply of eye protection, surgical masks, gowns, and gloves. WHCA has heard that these shipments are starting to hit facilities in our state. Unfortunately, some of the “PPE” received may not meet quality or safety standards necessary for COVID protection in our facilities.

Please examine these shipments closely and only use if they meet current safety standards for your staff and residents. Concerns regarding these PPE shipments from FEMA have been shared with the American Health Care Association, the Washington State Department of Health, and the Department of Social & Health Services. Also, any photos of subpar PPE can be forwarded to Elena Madrid.
CMS has released data related to COVID-19 cases reported in skilled nursing centers across the country. The website established is titled COVID-19 Nursing Home Data , and the site includes opening commentary on the nature of the data, some factors to consider, and reasons why initial data may not be accurate. Their statement toward the data is, “CMS cautions users to consider these factors when performing an analysis. For example, data over the first few weeks should not be used to perform trend analysis and longitudinal analyses. We expect the data [to] stabilize as nursing homes become more familiar with how to submit data via the NHSN Long Term Care Facility Module.”

The page features include:
  • Resident Cases and Deaths
  • Search for a Nursing Home
  • Total Resident Cases and Deaths by State
  • Resident Cases and Deaths (by State) per 1,000 Residents Graph
  • Resident Average Deaths (by State) per 1,000 Residents
  • Nursing Home Dataset

Providers should visit the site and see what information is recorded for their facility to ensure accuracy and to be prepared to answer any questions if they arise. Some centers who reviewed their data have found errors in the data as it appears on Nursing Home Compare. Centers are encouraged to check Nursing Home Compare for data accuracy. AHCA/NCAL has prepared a sample op-ed letter that provides some talking points and information providers can use in the event you need to respond to the media.
The grace period for National Healthcare Safety Network (NHSN) reporting has officially ended and CMS will automatically issue civil monetary penalties (CMPs) if facilities fail to report by the June 7, 2020, deadline. Nursing homes are required to report COVID-19 related information to NHSN at least weekly. Centers who fail to report to NHSN will be issued per day CMPs by CMS and amounts will increase if nursing homes fail to report in subsequent weeks. Read more .
Washington produced a handy chart showing generally when an employee is eligible for workers' comp, unemployment, and paid sick leave for reasons related to COVID-19.

Generally speaking, if an employee tests positive for COVID-19, they may have access to the following resources while they are quarantined (which including workers' compensation and unemployment).
  • Employees should be allowed to use any available paid time off. Employees can choose whether they would like to use sick leave (or PTO, if PTO is serving as the facility’s required sick leave program); you can mandate use of vacation time, if that is consistent with your policy/practices.
  • Employees who test positive also might qualify for workers’ compensation benefits for their period of quarantine. Washington expanded coverage of workers’ compensation to include COVID-19 quarantines, but they still must find that contracting COVID-19 was connected to work. We suggest facilities help employees to apply.
  • Employees may be eligible for unemployment benefits under the emergency rule.

The Family First Coronavirus Recovery Act (FFCRA) emergency paid sick leave covers absences for employees ordered to self-quarantine because the employee has COVID-19 (and the employee is not able to work remotely). This leave would provide employees up to 80 hours of paid sick leave, for which the facility would be reimbursed. Facilities are not required to offer this benefit. Health care providers can limit when they offer this benefit, so long as they are consistent. For example, they can offer this paid time off to employees forced to quarantine, but not to employees seeking time off to care for a child whose daycare is not available.
Since the COVID-19 virus initially affected our region, WHCA has been working with our member facilities to help them access resources and information on how to respond to this public health crisis. We have developed a list of the frequently asked questions for both assisted living and skilled nursing providers. We continue to update the documents with new information. You can access the Assisted Living FAQs and Skilled Nursing FAQs at any time.
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.