October 5, 2020
As we move into autumn and concerns regarding respiratory illness increase, it is vitally important that facilities make every attempt to obtain adequate PPE supplies to meet CDC conventional modalities of use. Documentation and records need to be maintained for interventions taken to obtain needed supplies as well as any issues or complications (cancelled orders, shipping delays, unavailability).

It has also been made clear from Washington’s Department of Labor and Industries (LNI) Division of Occupational Safety and Health (DOSH) that extended use of N95 masks beyond a shift (re-use) does not meet their worker safety requirements. Disposable respirators and procedural masks must be replaced daily at the beginning of each shift for every employee and immediately upon employee request when soiled or damaged during the shift. Multiple shift use of disposable respirators/masks is NOT allowed per LNI.

Employees who enter the room of a patient with a suspected or confirmed SARS-CoV-2 infection must follow Standard Precautions and use a NIOSH approved N95 or equivalent or higher-level respirator, gown, gloves, and eye protection. When an appropriate respirator is not available in the facility and cannot be reasonably obtained, a face shield and an approved face mask may be used by employees, but only if there has not been an aerosolization procedure performed within the last hour. Also, keep in mind that currently all aerosol generating procedures regardless of resident COVID status or diagnosis require the use of an N95 respirator at this time. If you have questions or need additional information, please contact the Division of Occupational Safety and Health (DOSH) at (800) 423-7233.

In emergency situations, local health jurisdictions are responsible for processing requests for emergency supplies, using the Guidelines for Prioritization of Allocation of PPEFor any facility outside of King County, use this form. To find out where your EMA is located, contact your local health jurisdiction

King County Providers, PPE is ordered from the King County Office of Emergency Management. Fill out this form and send your request to The weekly deadline to submit is each Wednesday at 12 noon. Questions about King County PPE requests should be sent to the same email address used for ordering.

As a backup, DSHS has limited supplies of PPE. You can order them on the online store, although, there is no guarantee that you will receive the items ordered.

AHCA/NCAL has vetted countless vendors and has compiled a list of vendors that have successfully delivered PPE to long term care providers during the pandemic.
NAR four-month rule proclamation
The Legislature has approved an extension for the Governor’s proclamation suspending certification requirements in nursing homes. The proclamation, which you can find here, is effective until the termination of the COVID-19 state of emergency or November 9, 2020, whichever occurs first. This means that a nursing assistant-registered can work in a nursing home past 120 days before obtaining a nursing assistant-certified credential.

Long-term care worker rules proclamation
The Legislature has approved an extension for the Governor’s proclamation suspending certification requirements in community-based settings (adult family homes, assisted living facilities, and home care agencies). The proclamation, which you can find here, is effective until the termination of the COVID-19 state of emergency or November 9, 2020, whichever occurs first. This means that a caregiver can work in a community-based setting past 200 days before obtaining a nursing assistant-certified or a certified home care aide credential.

Healthcare worker licensing proclamation
The Legislature has approved an extension for the Governor’s proclamation removing certain barriers for licensure. The proclamation, which you can find here, is effective until the termination of the COVID-19 state of emergency or November 9, 2020, whichever occurs first.

Barriers to continued and uninterrupted healthcare practice, including continuing education and other training requirements and license renewal deadlines
Licensed health profession rules requiring continuing education (CE), AIDS education, and training in suicide assessment, treatment, and management are waived. This includes the 8 hours of CE required to maintain the medication assistant endorsement and the requirement to demonstrate clinical skills to an instructor in a practice setting in nursing assistant training programs.

Barriers to the practice of health care provider volunteers
The requirement to verify that an NA has completed basic caregiver training and core delegation training before delegation, and the Washington state nursing care quality assurance commission community-based and in-home care setting delegation decision tree are waived.

Barriers to long-expired credential reissuance
The requirement to retake nursing assistant or nursing training and pass the competency examination prior to reissuance when a nursing assistant-certified credential has been expired for over three years is waived.

The COVID-19 situation is rapidly evolving. You can monitor the following sources for updates: 
Supported by the federal Agency for Healthcare Research and Quality (AHRQ), and in collaboration with the Institute for Healthcare Improvement (IHI), Project ECHO is launching a National Nursing Home COVID-19 Action Network. Introductory webinars will take place over the course of the next two weeks.

The ECHO model of telementoring and collaborative practice has expanded treatment to underserved areas and helped countless people who otherwise would have suffered without medical care. In 2020, Project ECHO created a COVID-19 Collaborative and hosted numerous telementoring sessions to share best practices and information with public health officials, medical experts, and frontline providers to help them coordinate COVID-19 response strategies.

Currently, Project ECHO is actively recruiting nursing homes and training centers around the country to join this interactive community of practice to collaboratively advance improvements in COVID-19 preparedness, safety and infection control.

The Network will operate as a 16-week interactive virtual community of practice utilizing the ECHO model. The model is based on the idea that to learn complex ideas, guided mentorship is needed in an “all teach, all learn” environment. The weekly Network sessions are designed to create space to hear directly from nursing home staff about the challenges they are facing through discussion of real cases. All participants are encouraged to share best practices and learn from their peers – while benefiting from the guidance of nursing home and quality improvement experts. Each Network session will include a short didactic combined with case-based presentations and discussion.

Here is a link to the October 1 session between ECHO-IHI and the state affiliates from AHCA and LeadingAge. Providers can sign up to participate here. Provider questions can be emailed to ECHO Institute.

Currently, the ECHO Project is working on a set of FAQ that we will forward when received and an outline of curriculum that we will send to you when completed.
Last week several questions and concerns were raised from Piece County and Tacoma facilities as a result of communication with the Tacoma-Pierce County Health Department. These concerns were centered around miscommunication received applying the LTC Safe Start Plan criteria for visitation to admissions and discharges. These concerns were communicated to DSHS, DOH, and NWHRN. As a result, the following email clarification was received from the Tacoma-Pierce County Health Department:

“Hello All,

We acknowledge that there was some confusion with an email that was sent yesterday and are writing to clarify. We have been working with the DOH to determine the best guidelines for facilities in active outbreaks to admit new patients. There is no current statewide guidance. We will evaluate each facility on a case by case basis to determine a safe timeline for new admissions. The following considerations will be taken into account:
  • Ideally a facility with an active outbreak should be 14 days without a new positive test result.
  • The facility must have a plan in place to safely manage all admissions that is in alignment with DOH and CDC recommendations.
  • The facility must have an adequate supply of PPE.

Again, we truly apologize for the confusion. We value our partnerships with our long-term care facilities and appreciate your hard work and efforts during this stressful time.”

Please continue to reach out to your local health jurisdiction for clarification and questions regarding outbreak management.
Providers can begin applying for Phase 3 General Distribution funds today, Monday, October 5, and HHS recommends that providers apply early. You can find additional details below.

Apply for Funding
All applicants must submit their TIN and financial information to the Provider Relief Fund Application and Attestation Portal. Applicants who submit by Friday, November 6, 2020, at 11:59 p.m. ET will be considered for funding.

Providers are encouraged to submit their applications as soon as possible to expedite the calculation and distribution of payments. Providers should apply if they have lost revenues and/or increased expenses attributable to COVID-19 that have not been reimbursed by other sources.

Required documentation:
  • Most recent federal income tax return for 2017, 2018, or 2019, unless exempt
  • Revenue worksheet (if required by Field 15)
  • Operating revenues and expenses from patient care

Note: Providers will need to submit a new application, even if they previously submitted revenue details for a prior PRF distribution; the application has been updated to include some additional data entries in order to calculate payment based on financial impact of COVID-19.
The Department of Health and Human Services (HHS) Secretary Alex Azar announced today that the Trump Administration will renew the Public Health Emergency declaration effective October 23, 2020. The declaration will extend the availability of waivers and funding that are available under the Public Health Emergency. The new declaration will expire in January 2021.

The public health emergency (PHE) is issued by the Department of Health and Human Services Secretary in 90-day increments. Effective October 2, Secretary Azar extended the PHE for another 90 days through January 2, 2021. There are several important implications. Read more.
The CDC updated its information about how COVID-19 spreads, including the potential for airborne transmission of the virus. It acknowledges airborne transmission occurs uncommonly, but data still supports close contact as a major mode of transmission. Read more.
An updated version of the SNF COVID-19 PR Tip Sheet that was posted on September 8, 2020, is now available. The purpose of this Tip Sheet is to help providers understand CMS’ public reporting strategy for the PAC QRP in the midst of the COVID-19 public health emergency (PHE). This Tip Sheet explains the CMS strategy to account for CMS quality data which were exempted from public reporting due to COVID-19, and the impact on CMS’ Skilled Nursing Facility Quality Reporting Program (QRP) data on the Nursing Home Compare website refreshes. The updated Tip Sheet is available under the Downloads section of the SNF Quality Reporting Training webpage.
AHCA/NCAL will be hosting a follow-up “office hour” webinar on the Families First Coronavirus Response Act (FFCRA) and How it Impacts Long Term Care on Wednesday, October 7 at 12:00 PM EST.

On this webinar, AHCA/NCAL Department of Labor consultants from Jackson Lewis,
Craig S. Roberts, Principal, and Henry Shapiro, Associate will answer questions from our first webinar and additional questions as time allows, on the FFCRA impacting long term care. If you missed the first webinar you can find the recording and slides on the AHCA/NCAL website. Please note, this is not meant to take the place of guidance from your legal counsel.  

No pre-registration is required but you will need to log in using your computer or WebEx app as questions will be accepted using the chat function. All lines will be muted. Click here to join the meeting. The meeting credentials are below:

Meeting number: 172 281 2053
Password: QExXPBc5b36

Or, you can join via audio only by dialing (415) 655-0003 and entering the meeting number above when prompted.
On October 1, President Trump signed into law H.R.8337: Continuing Appropriations Act, 2021 and Other Extensions Act. The Senate passed the bill last night by a vote of 84-10 and the House passed the same measure last week by a vote of 359-57-1. 
This continuing resolution (CR) provides continued FY2021 appropriations to federal agencies through December 11, 2020, and extends several programs. Of particular interest to our sector, this bill modifies the Accelerated and Advance Payment Programs under Medicare parts A and B during the COVID-19 pandemic. Below are specific details of the modifications.
Congress changed the terms of loan repayment in the following ways: 
  • Subsection C of the bill makes clear that Part A providers, in addition to hospitals, now have an extension from 120 days of the loan to 29 months from the date of the first payment. 
  • One year delay – Repayments for both Part A and Part B providers will not begin until at least a year from the date of the original payment from CMS. 
  • Staggered recoupment – Rather than seizing the entire amount of claims until that is repaid, CMS would put limits on the total amount deducted from new claims during the recoupment period: 
  • During the first 11 months in which any such payment offsets are made, 25% of the amount is due. 
  • During the succeeding six months, 50% of the amount is due. 
  • Longer recoupment period – Providers would have 29 months from the date of the first Advance/Accelerated payment to repay funds before a bill is sent for the balance, including interest. 
  • Lower interest rate – The legislation would lower the interest rate for payments due after the recoupment period from 10% to 4%. Read more.
Accurate reporting to National Healthcare Safety Network (NHSN) is crucial. The White House hosted a provider call on October 2, 2020. During the call, CMS Administrator Seema Verma announced that the information being submitted to the NHSN has been extremely helpful in identifying the areas hardest hit by supply shortages. Through the NHSN reporting module for supplies, the Federal Government can deploy tangible onsite resources to assist centers. Read more.
Long term care facility users who wish to gain full access to the NHSN surveillance modules, various analytic tools, and data reports must complete the enhanced security clearance known as Secure Access Management Services (SAMS) Level 3. Centers who are only reporting to the COVID-19 module in NHSN likely only have a Level 1 security clearance. 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.