COVID-19 UPDATE #48
June 25, 2020
DSHS NEEDS HELP IDENTIFYING TEST KITS THAT CANNOT BE MAILED
Candace Goehring, Director of Residential Care Services (RCS), has informed WHCA that there continues to be a shortage of the CAT B shipping boxes that must be used for shipping COVID test samples to the labs. Using other shipping boxes and no labeling is against the law and poses risks for the people that are transporting the test samples.

The Department of Health is working to obtain more CAT B shipping containers. If your facility has test samples that have been collected and cannot be shipped, please contact the Department of Health via email to let them know and to seek instructions. 
LABOR AND INDUSTRIES DIVISION OF OCCUPATIONAL SAFETY AND HEALTH ISSUES CITATIONS FOR N95 RESPIRATOR ISSUES
WHCA has been notified by a member that they recently received multiple citations resulting from a Division of Occupational Safety and Health (DOSH) inspection for failing to meet the Respiratory Protection Standard . The standard includes requirements for a written program, medical evaluation, and initial fit testing and training. Employers must comply with the requirements in the standard to ensure workers have and are properly using appropriate respiratory protection when necessary to protect their health. The requirements are outlined in section 1910.134(c) . The Occupational Safety and Health Administration (OSHA) has also issued Temporary Enforcement Guidance that explains citation guidelines for state inspectors.

Employer Resources Northwest (ERNwest) has worked to develop a sample Respirator Program Guide for healthcare facilities that will help guide you through the compliance process. This document provides a “Respiratory Protection Program” template that is free to use for all members of the Washington Health Care Association. This template was modified by staff of ERNwest to comply with Washington State regulations. ERNwest is WHCA’s partner in the WHCA Retro program .
HHS UPDATES PROVIDER RELIEF FUND FAQs
On June 22, the Department of Health and Human Services (HHS) made several updates to the Provider Relief Fund FAQs . Below is a summary of changes to the FAQs specific to long term care providers.

HHS added detail on calculating lost revenue and revenue (page 7). “You may use any reasonable method of estimating the revenue during March and April 2020 compared to the same period had COVID-19 not appeared. For example, if you have a budget prepared without taking into account the impact of COVID-19, the estimated lost revenue could be the difference between your budgeted revenue and actual revenue. It would also be reasonable to be the difference between your budgeted revenue and actual revenue. It would also be reasonable to compare the revenues to the same period last year.”

On page 38, HHS also notes that patient out-of-pocket costs should be counted as revenue. Later on page 39, HHS indicates that revenue lost under Medicaid value-based purchasing programs may be counted as lost revenue.

Duration of Terms and Conditions (page 9) “Some Terms and Conditions related to the provider’s use of the funds, and thus they apply until the provider has exhausted these funds. Other Terms and Conditions apply to a longer time period, for example, regarding maintaining all records pertaining to expenditures under the Provider Relief Fund payment for three years from the date of the final expenditure.”

Change in Ownership Additional Detail (page 9) HHS elaborates upon scenarios in which sellers may not transfer funds.

Medicaid Allocations (page 38) HHS notes that even a small General Distribution payment makes a provider ineligible for the Medicaid Allocation. The Department also added detail on who may apply, noting that if a provider did not bill Medicaid/CHIP during the eligibility window, providers may apply for Medicaid allocation funding as long as they provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19 after January 31, 2020, and can produce evidence of such care. Additionally, HHS limits on page 39 which providers who enrolled as Medicaid/CHIP providers in 2020 may apply. Also, on page 39, the Department notes that providers who bill under Medicaid Managed Care may apply.

Tax Information On pages 38 and 41, HHS clarifies needed tax documentation information. 
DSHS UPDATES FAQ DOCUMENT REGARDING COVID-19 TESTING
The Frequently Asked Questions (FAQ) document for COVID-19 testing of residents and staff of skilled nursing and assisted living facilities with memory care units has been updated today, June 25. The updates include additional sample packaging and shipping information and photos. Click here to access the updated document.
SECRETARY OF HEALTH ISSUES ORDER FOR MANDATORY FACE COVERINGS IN PUBLIC
On June 23, Washington State Secretary of Health John Wiesman announced an order that mandates the use of cloth face coverings in most public areas. The order takes effect June 26.

The Washington State Department of Health (DOH) provides information to help the public understand how to prevent the spread of COVID-19, protect their communities and comply with the order for face coverings. Additional rules from the Washington State Department of Labor & Industries (L&I) apply to employers and employees.
OFFICE OF IMMUNIZATION AND CHILD PROFILE REQUESTS HELP VIA SURVEY
The Office of Immunization and Child Profile is in need of your assistance for adult influenza information gathering. The survey should take less than 10 minutes and will close on July 1.

The Washington State Department of Health (DOH), in partnership with the Centers for Disease Control and Prevention (CDC) is initiating an enhanced influenza vaccination campaign as a critical part of COVID-19 response work. Increasing influenza vaccination coverage is an essential step to decrease stress on the health care system at a time when SARS-CoV-2 is expected to be circulating. Due to this concern, the CDC is offering states the opportunity to request flu vaccines for adults.

The immunization program is reaching out to measure providers’ interest in flu vaccines for uninsured and underinsured adults 19 years of age and older for the 2020-2021 season. This is a preliminary gathering of information and no doses will be allocated or guaranteed at this time.

Click here to take the survey. If you have questions, please email Washington Childhood Vaccines or call (360) 236-2829.
AHCA/NCAL HOSTING SURVEY ON COVID-19 TESTING AVAILABILITY
The American Health Care Association and its National Center for Assisted Living (AHCA/NCAL) is asking members to complete a survey on COVID-19 test availability and use in long term care settings (AL, SNF, ID/DD). Information from this survey will help AHCA/NCAL identify challenges and advocate for more availability and clearer guidance on how testing should be used and reimbursed on a national level. This survey is similar to one we asked members to complete in May, as continuing to monitor this rapidly-changing situation is critical to our advocacy efforts. Click here to complete the survey by Monday, June 29. We appreciate your help to compile this important data.
DSHS HOSTING WEBINAR ON PHASED REOPENING OF LTC FACILITIES
The Department of Social and Health Services (DSHS) leaders will be providing a webinar for assisted living providers and a webinar for skilled nursing facilities next week to provide insight on phased reopening of long term care communities. The skilled nursing webinar will be July 1 at 1 PM PST. The assisted living webinar will be July 2 at 1 PM PST. You must pre-register to attend. After registering, you will receive a confirmation email containing information about joining the meeting. If you have questions, please email the DSHS Training Unit. 
WASHINGTON STATE HOSPITAL ASSOCIATION HAS MASKS AVAILABLE FOR PURCHASE
WHCA is partnering with the Washington State Hospital Association, and its subsidiary Washington Hospital Services, to supply procedural masks to health care organizations in the state. WSHA has been importing and distributing masks to its membership since April and has a secure relationship with a supplier who is able to offer them bulk pricing. They have agreed to expand the distribution network to include WHCA members, who will now be able to purchase the masks in small quantities, but at the price point of a high-volume order. If you have questions about this initiative, please email Valerie Aussem of WSHA.

FDA-approved disposable ASTM Level 1 simple procedural masks , non-sterile: these procedural masks are $0.70 per unit, including delivery. The minimum order quantity is 2,000 masks. Product details are available via the order form . Payment will be collected before your order is shipped and is not due at the time you place your order. Orders will be filled on a first-come, first-served basis.
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.