WSR 20-10-061

DEPARTMENT OF HEALTH

[Filed May 1, 2020, 10:57 a.m.]

WASHINGTON STATE DEPARTMENT OF HEALTH GUIDANCE and EXEMPTIONS FROM CERTAIN IN-PERSON AND ON-SITE REQUIREMENTS FOR HOME CARE, HOME HEALTH, AND HOSPICE AGENCIES and WASHINGTON STATE PATROL FINGERPRINT BACKGROUND CHECKS

I. INTRODUCTION AND PURPOSE: Washington State Governor Jay Inslee has issued Proclamation 20-05, subsequently amended, proclaiming a statewide state of emergency due to an outbreak of coronavirus disease 2019 (COVID-19) in the United States and community spread of COVID-19 in Washington state.

Exemptions from in-person requirements in chapter 246-335 WAC are necessary to provide home care, home health, and hospice agencies with regulatory flexibilities as they implement federal and state COVID-19 restrictions and guidelines. The exemptions listed in section IV focus on in-person/on-site rules, task documentation rules, and fingerprint background check rules where the intent of the rules can be accomplished in alternative ways. Allowing these flexibilities will reduce unnecessary exposure between agency staff and clients/patients and allow agencies to focus on providing critical services.

At the federal level, the Centers for Medicare and Medicaid Services has issued blanket 1135 waivers, with a retroactive date of March 1, 2020, through the end of President Trump's emergency declaration: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf.

II. AUTHORITY: The department of health (department) grants these exemptions of administrative requirements set out in WAC in accordance with WAC 246-335-355(5).

III. SCOPE AND DURATION: These exemptions are in effect retroactive to March 1, 2020, and will remain in effect until withdrawn by the department or until the governor issues a proclamation declaring the termination of the state of emergency declared by Proclamation 20-05, as amended by any subsequent amendatory proclamations, whichever is earlier.

IV. EXEMPTED LICENSING REQUIREMENTS: The purpose of the following exemptions is to give agencies regulatory flexibility while trying to implement federal and state COVID-19 guidelines. The department is not granting exemptions from the entirety of the requirements. The department grants exemptions from the following rules only to the extent the rules require certain activities to be conducted in person. See further guidance at the end of this section.

In Home Services general:

WAC 246-335-320 (2)(d)(ii) initial background checks through Washington State Patrol (WSP).

WAC 246-335-325(4) WSP background checks during licensing renewals.

Home Care Agency rules:

WAC 246-335-425 (6)(a), (c) initial and 2-year background checks through WSP.

WAC 246-335-425(9) in-person orientation to current agency policies and procedures.

WAC 246-335-425(13) on-site annual observation/evaluation of staff providing care.

WAC 246-335-430(6) evidence of initial and subsequent background checks in employee record.

WAC 246-335-440 (1), (2) on-site plan of care development.

WAC 246-335-440 (3)(f) types and frequency of on-site services to be provided.

WAC 246-335-440 (4)(a), (b) on-site plan of care updating.

WAC 246-335-450 (3)(e) client signed and dated notes documenting services provided during each client contact. Paper notes/log are transported back and forth between client and caregiver's homes.

Home Health Agency rules:

WAC 246-335-525 (6)(a), (c) initial and 2-year background checks through WSP.

WAC 246-335-525(9) in-person orientation to agency policies and procedures.

WAC 246-335-525(14) in-person demonstration of CPR skills.

WAC 246-335-525(16) on-site annual observation/evaluation of staff providing care.

WAC 246-335-530(7) evidence of initial and subsequent background checks in employee record.

WAC 246-335-545 (6)(b) on-site monthly supervision visit.

WAC 246-335-550 (3)(f) Patient signed and dated notes documenting services provided during each patient visit. Paper notes/log are transported back and forth between patient and caregiver's homes.

Hospice Agency rules:

WAC 246-335-625 (6)(a), (c) initial and 2-year background checks through WSP.

WAC 246-335-625(9) in-person orientation to agency policies and procedures.

WAC 246-335-625(13) in-person demonstration of CPR skills.

WAC 246-335-625(15) on-site annual observation/evaluation of staff providing care.

WAC 246-335-630(6) evidence of initial and subsequent background checks in employee record.

WAC 246-335-645 (6)(b) on-site monthly supervision visit.

WAC 246-335-650 (3)(f) Patient signed and dated notes documenting services provided during each patient contact. Paper notes/log are transported back and forth between patient and caregiver's homes.

Guidance on above exemptions:


•	Washington state name and date of birth criminal background checks through WSP WATCH must still occur but the fingerprint requirement for administrators, supervisors, and directors as well as agency personnel who are new to Washington in the last three years is temporarily exempted. When Governor Inslee's declared state of emergency has ended and the Washington state patrol resumes conducting fingerprint background checks, agencies must initiate fingerprint background checks for any administrator, supervisor, or director as well as agency personnel who had been temporarily exempted of this requirement.
•	Orientation to agency policies must still occur but can be done remotely (instead of in-person) using various electronic resources.
•	Annual performance evaluations of all personnel, including observation of care and skills, must still occur but can be done remotely (instead of on-site) using various electronic resources.
•	Initial client/patient plan of care development and necessary updating must still occur but can be done remotely (instead of on-site) using various electronic resources.
•	Types and frequency of services to be provided must still be listed on the plan of care but agencies can provide certain reminding and housework tasks remotely or separate from the client/patient. Examples: Calling a client to remind them to take medications, and cleaning a portion of the home while the client sits in another closed off section of the home.
•	Dated notes documenting services provided must still occur but wet ink client/patient signatures are not required. Agencies that do not utilize electronic notes/records should require direct care staff to document daily services provided and retain paper documentation in the client/patient's home or the trunk of their vehicle until they can safely be incorporated into the client/patient record at the agency's administrative office.
•	Necessary staff supervision must still occur but can be done remotely (instead of in-person) using various electronic resources.
•	In general, to the extent agencies have provided oversight of their employees' work, while federal and state COVID-19 restrictions are in effect, licensees should limit the number of staff in clients/patients' homes except when absolutely necessary to protect safety and well-being for the client/patient.

Guidance related to home health and hospice plan of care patient assessments: WAC 246-335-540 (1) and (2) and 246-335-640 (1) and (2) require the plan of care to be developed based on a patient assessment. Patient assessments are generally understood to be conducted in-person. These WAC do not explicitly specify "in-person" so the department acknowledges that agencies have the flexibility of conducting initial and subsequent patient assessments remotely (instead of in-person) using various electronic resources.

V. Signature

Dated: April 30, 2020

John Wiesman, DrPH, MPH

Secretary