COVID-19 UPDATE #78
September 11, 2020
CMS DIRECTION REGARDING STAFF REFUSALS FOR
COVID-19 TESTING IN SKILLED NURSING
According to CMS QSO Memo 20-38, skilled nursing facilities must have procedures in place to address staff who refuse testing. For this requirement, staff is defined by CMS to include employees, consultants, contractors, volunteers, and caregivers who provide care and services to residents on behalf of the facility, and students in the facility’s nurse aide training programs or from affiliated academic institutions.
 
Procedures should ensure that staff who have signs or symptoms of COVID-19 and refuse testing are prohibited from entering the building until the return to work criteria are met.
If outbreak testing has been triggered and a staff member refuses testing, the staff member should be restricted from the building until the procedures for outbreak testing have been completed. The facility should follow its local jurisdiction policies with respect to any asymptomatic staff who refuse routine testing.
N95 FIT TESTING: CAN RNs PERFORM THE MEDICAL EVALUATION? NEW INFORMATION!
The quick answer to this question is “yes.” WHCA has recently received clarification on this issue from the Nursing Care Quality Assurance Commission (NCQAC). The NCQAC has stated that an RN can perform the medical evaluation/screening; however, any medical evaluation form completed by an employee that indicates any problems or issues that might interfere with their ability to wear a respirator must be referred to a licensed healthcare provider for further evaluation. Labor and Industries Division of Occupational Safety and Health (DOSH) has also indicated that they will accept medical evaluations performed by a registered nurse.
 
To recap this issue, WHCA has previously informed members of the necessity of implementing a Respiratory Protection Program in your facility. As described in the program, the medical evaluation form is a questionnaire that solicits information that must be reviewed by a physician or other licensed healthcare professional (PLHCP) to determine an employee’s ability to use a respirator. The medical evaluation must be completed before initial fit testing is performed and before the decision is made that an employee is required to use a respirator in the work environment. It is mandatory that employees be evaluated by a physician or other PLHCP who provides a written recommendation regarding their ability to use respirators. The PLHCP needs to be an individual whose legally permitted scope of practice allows them to independently provide, or be delegated the responsibility to provide, some or all of the healthcare services required in the medical evaluation.  If an RN is performing this function and there are any problems or physical limitations noted, the employee should be referred to a PLHCP for further consultation.
 
WHCA is now offering free Fit Testing Train the Trainer sessions around the state. Click here to view a list of training dates. A comprehensive list of fit testing resources can be found here.
 
If you have further questions regarding this issue, please email Diana Hitchings.
KING COUNTY RECOMMENDS SNFs CONDUCT WEEKLY COVID TESTING OF STAFF REGARDLESS OF OUTBREAK STATUS
In the last two weeks, many of you who attend the Thursday, Department of Health Q&A webinars may have heard representatives from Public Health Seattle-King County state the recommendation that all SNFs in King County should be conducting weekly COVID-19 testing of staff regardless of current outbreak status.

This issue brought up questions from our members regarding the direction of King County as opposed to the CMS regulatory requirement for staff testing. Currently, according to the CMS county positivity rates, King County facilities without an outbreak or suspected case of COVID-19 would be required to conduct monthly testing of all staff.

Clarification was sought with King County representatives and it was stated that the recommendation to do weekly testing is just that; based on the expertise of their health professionals they are “recommending” weekly staff testing. There is no current intention of making it mandatory. Nor will King County be financially supporting the weekly routine testing of SNF staff at this time.

If a facility has questions regarding their specific facility situation and status regarding COVID-19 testing because of the King County recommendation, please reach out to your contact at Seattle-King County Public Health to discuss. If a facility chooses not to follow the King County “recommendation” for weekly staff testing, this should be done with extreme caution and after a thorough discussion with King County professionals.

Keep in mind that the CMS requirements are a minimum standard and must always be met as a requirement of participation. See F866 and CMS QSO 20-38 for additional information. If you have questions, please contact Elena Madrid.
DEAR ADMINISTRATOR LETTER SHARES CHANGES TO SAFE START FOR LTC IMPACTING ASSISTED LIVING
In a Dear Administrator letter to assisted living, adult family home, enhanced services facilities, and certified community residential services and supports providers dated September 10, 2020, the Department of Social and Health Services (DSHS) shares changes to the Safe Start for Long Term Care Recommendations. One change for all provider types is related to medically and non-medically necessary trips during Phase 1. The other change is related to adult family homes. The letter also clarifies recommendations and requirements related to outdoor visits at homes and facilities that have a staff or resident test positive for COVID-19.
REMINDER: PHASE 2 PROVIDER RELIEF FUND APPLICATION DEADLINE IS THIS SUNDAY, SEPTEMBER 13
If you are a private pay or Medicaid-certified assisted living/memory care community, ensure that you apply for the HHS Phase 2 General Distribution round of Provider Relief Funds. HHS announced last week that private pay assisted living operators are eligible to apply. Non-skilled nursing facility Medicaid providers are also eligible. Note that the deadline for the application is this Sunday, September 13, and we do not expect this deadline to be extended. Read more.
REMINDER: LICENSE EXPIRATION EXTENSION ENDING, RENEW BY SEPTEMBER 30 TO AVOID LATE FEE
To allow healthcare professionals the ability to focus on patient care during the COVID-19 outbreak, the Secretary of Health extended expiration dates for licenses due for renewal between April 1, 2020, and September 30, 2020. All late fees were waived during this period.
 
What does this mean for you?
For health care professionals who took advantage of the extended time to renew, this is a reminder that you must renew your credential on or before September 30 for your credential to remain active and avoid late fees.  
 
How do you renew if you need to?
If you opted to delay renewal and have passed your normal expiration date, you will need to renew your credential by:
  • Renewing through the online licensing system (credit card, debit card or E-check accepted), or
  • Returning your DOH renewal notice with payment by mail (check or money order accepted.)  

Some professions are not able to renew late online at this time. You can find a list of professions who are able to renew after their normal expiration date on the License Expiration Extension Frequently Asked Questions page.
 
No late fees will be due as long as your payment is received online prior to 11:59 pm on September 30, or postmarked no later than September 30. If you have questions, please call the Department of Health (DOH) call center at (360) 236-4700.
HHS POINT OF CARE ANTIGEN TESTING DEVICE TRAINING RESOURCES
The Centers for Medicare and Medicaid Services (CMS) launched an initiative to distribute rapid point-of-care antigen COVID-19 testing devices to nursing homes across the country. Recently, the Department of Health and Human Services (HHS) hosted training sessions on the testing devices to help providers understand the devices and limitations and cautions on their use in nursing homes. Below are links to the slides from each training session. 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.