September 23, 2020
On September 21, the Department of Health and Human Services (HHS) released new information regarding reporting requirements for recipients of funds from the CARES Act Provider Relief Fund as well as additional information related to potential future audits. This update provides guidance for our sector that CARES Act funds can be used to make up for lost revenue up to 2019 net operating income levels. AHCA/NCAL has worked with HHS to advocate for an updated definition of revenue, which is a significant improvement over a preliminary set of reporting guidance shared with stakeholders in August. AHCA/NCAL continues to work with HHS on these issues. Read more.
WHCA continues to meet with Residential Care Services (RCS) and other stakeholders regarding CMS Memo QSO 20-39 regarding Nursing Home Visitation. CMS guidance is not consistent with Washington State’s Safe Start Plan phased reopening requirements. Several questions have been raised and forwarded to CMS for clarification. As WHCA is working with RCS and CMS, if you have questions regarding the CMS visitation guidance, please email those questions to Elena Madrid.

RCS and CMS Seattle have agreed that providers and regulators need additional time to digest the implications of the CMS revision. Accordingly, because portions of Washington’s phased reopening/visitation plan are more stringent than CMS revisions, Washington skilled nursing providers will continue to follow Washington’s phased reopening/visitation plan until RCS is able to provide further guidance.

Ombudsman Visits
The Washington State LTC Ombudsman has started focused in-person facility visits to residents this month. Thank you to those facilities for working positively with the Ombuds office to make this happen. As stated in previous CMS guidance and regulations, F562 and F583 require that a Medicare and Medicaid certified nursing home provide representatives of the Office of the State Long-Term Care Ombudsman with immediate access to any resident.

During this time, in-person access may be limited due to infection control concerns and/or transmission of COVID-19; however, in-person access may not be limited without reasonable cause. CMS directs facilities that representatives of the Office of the Ombudsman should adhere to the core principles (outlined in QSO 20-39) of COVID-19 infection prevention. If in-person access is not advisable, such as the Ombudsman having signs or symptoms of COVID-19, facilities must, at a minimum, facilitate alternative resident communication with the ombudsman, such as by phone or through use of other technology. Facilities are also required to allow the Ombudsman to examine the resident’s medical, social, and administrative records as otherwise authorized by State law.

Compassionate Care Visits
CMS has also expanded and clarified information and requirements around what was termed “compassionate care visits.” While end-of-life situations have been used as examples of compassionate care situations, the term “compassionate care situations” does not exclusively refer to end-of-life situations, but can and should include examples that are not limited to:
  • A family visit for newly-admitted resident who is struggling with the change in environment and lack of physical family support.
  • A resident who is grieving after a loved one passed away.
  • A resident who needs cueing and encouragement with eating or drinking, previously provided by family and/or caregiver(s), and is experiencing weight loss or dehydration.
  • A resident, who used to talk and interact with others, is experiencing emotional distress or declines in function. 

CMS states that allowing a visit in these situations would be consistent with the intent of “compassionate care situations.” Also, compassionate care visits can be conducted by any individual that can meet the resident’s needs, such as friends, clergy or lay persons offering religious and spiritual support, and family. Through a person-centered approach, facilities should work with residents, families, caregivers, resident representatives, and the Ombudsman program to identify the need for compassionate care visits.
In a Dear Administrator letter dated September 17, 2020, the Department of Social and Health Services (DSHS) provides information on CR-101 filed September 3, 2020, to begin permanent rule making on WAC 388-97-0300 and other related rules. The CR-101 is available on the Aging and Long Term Support Administration (ALTSA) web page under “NH Rule Filings.”
In a Joint Hazard Alert issued by the Department of Labor and Industries (L&I) and Department of Health (DOH), healthcare workers are provided updated instruction on guidance that must be followed. After introducing background information motivating the additional measures, the alert addresses requirements regarding the following:
  • Supplies of Respirators and Other PPE
  • Employee Training on COVID-19 Procedures, Respirator Procedures, and Infection Control
  • Social Distancing
  • Respirator Program Requirement Highlights

If you have questions or need additional information, please contact the Division of Occupational Safety and Health (DOSH) at (800) 423-7233.
Skilled nursing facilities and assisted living communities who are receiving the Abbott BinaxNOW™ test kits can refer to the following contact information and training resources from Abbott. Read more.
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.