COVID-19 UPDATE #85
September 30, 2020
UPDATE: STATE OF EMERGENCY RENEWAL EXTENSION EXPIRES TODAY
Nursing licenses that expire on September 30, 2020, and have renewal fees that were postmarked or delivered to the Department of Health by September 30, will be considered by the Department as active until October 16, 2020. This is NOT an extension of the deadline to submit renewals, just an extension of active status to allow for processing times. DOH is not extending the renewal deadline; they are extending licenses set to expire September 30 through October 16. Renewals and payments must still be submitted today.

Since renewal processing delays may occur in October, due to a high volume of renewals being submitted at the end of September. Users of Provider Credential Search are cautioned about using the Last Issue and Expiration dates reflected on the website until processing can be completed.

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 up for renewal between April 1, 2020, and September 30, 2020. All late fees were waived during this period.

What is the deadline to submit?
The deadline to submit is TODAY. If you took advantage of this extension, and you haven’t renewed your license yet, you must do one of the following:
  • Postmark your renewal fee no later than Wednesday, September 30, 2020. Mail applicable renewal fees (check or money order accepted) to: Department of Health, PO Box 1099, Olympia, WA 98507-1099
  • Use a Department of Health approved courier service, or personally submit your renewal fee, in our Town Center 2 drop box prior to our office opening on Thursday, October 1, 2020. Please note: In-person customer service is currently not available, but our drop box is checked daily.

It is important to note that renewal processing delays may occur due to a high volume of renewals being submitted. Users of Provider Credential Search are cautioned about using the last issue and expiration dates reflected on the DOH site until about October 16, 2020.
ASSISTED LIVING COVID-19 BINAXNOW ABBOTT TESTING AND REPORTING
Many Washington State assisted living facilities with CLIA waivers have received or will receive Binax Abbott rapid antigen test cards from the Department of Health and Human Services. These antigen tests were originally approved for point-of-care testing for individuals who are experiencing symptoms of COVID-19. Recently the FDA provided an emergency approval for asymptomatic and presymptomatic testing purposes. All tests continue to require a practitioner’s order.

There is currently no direction from the federal or state government, nor the local health jurisdictions, on when and for whom these tests should be used. It is important to note, however, that there are several requirements for facilities to report the test results, both positive and negative, to HHS and the CDC. Additional emergency rules written specifically for COVID-19 provides additional directions on exactly what must be reported to the local health jurisdiction, and the timelines for reporting.

At this time, it is believed that assisted living communities utilizing these tests onsite would be required to report all results for all tests conducted in conjunction with the laboratory reporting guidelines. Further information and clarification have been sought. Reporting requirements encompass 18 data points for each test conducted regardless of positive or negative result and must be documented and reported within 24 hours of the test results.

The state currently does not have a mechanism to report; it is recommended, then, that the facility maintain a complete log with all necessary items included. The CDC has guidance and data on testing and specifics regarding what must be reported. Several facilities that have been using antigen testing have reported false negative results when using these types of tests on individuals who have no symptoms; these false negatives have the potential of causing silent spread of the infection until the next testing is conducted. Similarly, several facilities have discovered false positive test results; these have prompted uninfected residents being moved to COVID-19 units and/or staff being quarantined at home unnecessarily.

Please note that using these tests is optional; there are no orders directing assisted living facilities to use antigen tests. If you choose to use the antigen tests delivered to your facility, you should refer to the CDC algorithm on methods for interpreting antigen test results. We will continue sharing any additional information on these test and associated reporting mechanisms as we learn more.
CMS VISITATION GUIDANCE – ADDITIONAL INFORMATION FOR SNFs
The CMS Guidance released on September 17, 2020, in QSO 20-39 includes a myriad of information. The CMS guidance outlined the expectations and requirements for skilled nursing facilities related to core principles of infection control in regards to indoor and outdoor visitation, compassionate care visits, required visits, resident access to the ombudsman, visitor testing, federal disability rights laws and Protection and Advocacy (A&P) programs, entry of health care workers (HCW) and other providers of service, and communal dining and activities.

WHCA continues to encourage all skilled nursing providers to read and understand the guidance. As communicated previously, discussions continue with regulatory bodies including DSHS, DOH, and CMS regarding the need for clarification related to CMS’s release of QSO 20-39 and the conflicts with our Washington State LTC Reopening Plan. Most other states have similar conflicts and AHCA continues to address the concerns on our behalf to CMS.

As more information becomes available, WHCA will ensure you are made aware. Please keep in mind, RCS and CMS Seattle have agreed that providers and regulators need additional time to digest the implications of CMS’s revision. Accordingly, because portions of Washington’s phased reopening/visitation plan are more stringent than CMS’s revisions, Washington SNF providers will continue to follow Washington’s phased reopening/visitation plan until RCS is able to provide further guidance.

Survey Considerations
CMS has clearly stated the following F-tags should be considered for compliance related to the visitation guidelines.
  • For concerns related to resident communication with and access to persons and services inside and outside the facility, surveyors should investigate for non-compliance at 42 CFR 483.10(b), F550.
  • For concerns related to a facility limiting visitors without a reasonable clinical and safety cause, surveyors should investigate for non-compliance at 42 CFR 483.10(f)(4), F563.
  • For concerns related to ombudsman access to the resident and the resident’s medical record, surveyors should investigate for non-compliance at 42 CFR 483.10(f)(4)(i)(C), F562 and 483.10(h)(3)(ii), F583.
  • For concerns related to lack of adherence to infection control practices, surveyors should investigate for non-compliance at 42 CFR 483.80(a), F880.

Use of CMP Funds to Aid in Visitation
In order to facilitate and support visitation, CMS has previously approved the use of CMP funds (See QSO-20-28-NH) to purchase communicative devices, such as tablets or webcams, to increase the ability of facilities to help residents stay connected with their loved ones. CMS has also outlined the following guidelines related to the use/access of CMP funds.
  • To ensure a balanced distribution of funds, facilities are limited to purchase one communicative device per 7–10 residents, up to a maximum of $3,000 per facility.
  • Additionally, facilities may apply to use CMP funds to help facilitate in-person visits. CMS will now approve the use of CMP funds to purchase tents for outdoor visitation and/or clear dividers (e.g., Plexiglas or similar product) to create a physical barrier to reduce the risk of transmission during in-person visits. Funding for tents and clear dividers is also limited to a maximum of $3,000 per facility.

NOTE: When installing tents, facilities need to ensure appropriate life safety code requirements found at 42 CFR 483.90 are met, unless waived under the PHE declaration. Information on how to apply to receive CMP funds for communicative devices, tents, or clear dividers is provided in the Residential Care Services (RCS) Dear Provider letter dated September 23, 2020. If you have questions, please email Melissa Lawton, CMP Grant Program Specialist, or call her at (360) 725-3204.
NURSING ASSISTANT CERTIFICATION TESTING
Candidates are now able to register to take the written test for nursing assistant certification at Pearson’s third-party computer-based test sites. Candidates can register for the test through their Pearson VUE account. When they select the written exam for registration, they will be able to enter their address and search for the test sites that are closest to them. They will then be able to choose a date and time that works best.

As a reminder, candidates will take their written exam at one of Pearson VUE’s third-party computer testing centers. They will continue to take their skills exam in an RTS or INF location. If a candidate encounters issues with scheduling for their written exam, they can call (888) 252-8712 and the scheduling team will assist.
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.