Schools utilizing CICH labor support should inquire with CICH about allowable activities for their staff. Email your L2R Program Manager to initiate this conversation.

• Parental/guardian consent does not allow for POC testing by anyone other than an RN, RN-delegated staff member, or RN-directed licensed practical nurse (LPN). 
• For schools to provide POC testing onsite, these conditions must be met: 
• An RN, RN-delegated staff member, or RN-directed LPN must administer or supervise the self-administration of the POC test;
• The school must have an active MTS license (CLIA waiver);
• The school must have signed consent by parents or guardians to perform the POC test.

• For schools that do not have an RN, the best option may be to transition to an over the counter (OTC) testing model and sunset POC testing. Here are some tips about transitioning to an OTC-only model.
• The Nursing Care Quality Assurance Commission (NCQAC) has recently issued a letter to clarify registered nursing practice authority as it applies to the administration and delegation of COVID-19 testing. 
• If your school has a licensed RN, please review this letter with your leadership team and the steps needed to support nurse delegation of activities to unlicensed assistive personnel (UAP) to support continued onsite testing. 
• For schools that do not have a licensed RN, continue to distribute OTC take-home tests or provide information on where to access testing. 

RNs interested in delegating POC testing to unlicensed personnel should follow guidance in the Nursing Care Quality Assurance Commission (NCQAC) Advisory Opinion 15.01: Registered Nurse Delegation in School Settings: K-12 Grades, Public and Private.

Delegation:

• Only an RN can delegate POC testing to other, unlicensed staff members. If there is an RN affiliated with your school/s in some way, it will be up to them to determine if RN delegation is an option.
• The Nursing Care Quality Assurance Commission (NCQAC) has recently issued a letter to clarify registered nursing practice authority as it applies to the administration and delegation of COVID-19 testing. 
• If your school has a licensed RN, please review this letter with your leadership team and the steps needed to support nurse delegation of activities to unlicensed assistive personnel (UAP) to support continued onsite testing. 
• For schools that do not have a licensed RN, continue to distribute self-tests or provide information on where to access testing.
• RNs interested in delegating POC testing to non-medical staff should follow guidance in the Nursing Care Quality Assurance Commission (NCQAC) Advisory Opinion 15.01: Registered Nurse Delegation in School Settings: K-12 Grades, Public and Private.
• Questions about RN delegation should be sent to the Nursing Commission at NursingPractice@doh.wa.gov.

Parental/guardian consent:

• Parental/guardian consent does not allow for POC testing by anyone other than an RN, RN-delegated staff member, or RN-directed licensed practical nurse (LPN).
• For schools to provide POC testing onsite, these conditions must be met: 
• An RN, RN-delegated staff member, or RN-directed LPN must administer or supervise the self-administration of the POC test;
• The school must have an active MTS license (CLIA waiver);
• The school must have signed consent by parents or guardians to perform the POC test.

Individuals should refer to the instructions for use that are included with each testing kit and consult with staff onsite to determine the competency of each individual to self-administer an OTC test.

• There has been a change in policy about POC testing in schools. When the federal public health emergency expired on May 11, 2023, so did the Washington state standing order that authorized the administration of POC testing by non-medical staff. 
• That means that, moving forward, only registered nurses (RNs), RN-delegated staff, or RN-directed licensed practical nurses (LPNs) are permitted under state law to perform POC tests onsite.

• RNs can delegate the administration of POC testing to non-medical school staff.
• The Nursing Care Quality Assurance Commission (NCQAC) has released a letter that provides clarification around nursing practice authority in school settings for delegation and administration of COVID-19 tests:  Authority of Registered Nurses to Administer and Delegate COVID-19 CLIA-Waived Tests in School Settings.
• RNs interested in delegating POC testing to non-medical staff should follow guidance in the NCQAC Advisory Opinion 15.01: Registered Nurse Delegation in School Settings: K-12 Grades, Public and Private.
• Questions about RN delegation should be sent to the NCQAC at NursingPractice@doh.wa.gov. 
• Under state law, RNs can direct (not “delegate”) an LPN to perform CLIA-waived tests that RNs can order independently. Direction is not the same as delegation. LPNs are individually accountable and responsible for the care they provide whereas RNs retain responsibility for “delegated” tasks.  LPNs do not have the legal authority to administer tests without direction from a RN or without a provider’s order. RNs don’t need to be on premise but may supervise indirectly when an LPN provides POC testing.

For more information about LPN scope of practice, please follow the guidance in the NCQAC Advisory Opinion 13.02 Registered Nurse and Licensed Practical Nurse Scope of Practice (wa.gov).

• If you have an active MTS license, you should have received a renewal notice in the mail in late April or early May 2023. Instructions for how to make a renewal payment are included in your renewal notice. If you did not receive the renewal notice, contact hsqafc@doh.wa.gov for assistance before June 30.
• Schools with an active MTS/CLIA waiver license should not need to submit a new application, just pay the renewal fee ($260). Schools seeking a new license should complete the Certificate of Waiver Medical Test Site (MTS) Application Packet. 
• If your school is renewing a license and has paid the fee before June 30, there will be no gap in the coverage of the license. If the facility is concerned about the renewal, please contact hsqafc@doh.wa.gov at least 2 weeks after the payment is processed (i.e., check is cashed) to check on the status. There is also a website where you can search to check for the processed renewal confirmation: https://fortress.wa.gov/doh/facilitysearch/
• MTS/CLIA waivers are valid for 2 years. Once renewed, it will expire on June 30, 2025.

• No, you do not need an MTS license if you are only distributing OTC tests for use away from school grounds. 
• You only need an MTS license if you plan on having a registered nurse (RN), RN-delegated staff member, or RN-directed LPN administer POC tests on school grounds.

Schools may add glucose testing to their MTS license as long as it is a CLIA waived test.

• First, check if the test is CLIA waived by visiting CLIA – Clinical Laboratory Improvement Amendments and typing “glucose” into the Test System / Manufacturer field or selecting “Glucose” from the dropdown menu for the Analyte Name field.
• Find your test in the list that populates. If the test is listed a “WAIVED” under the column labeled “Complexity,” it is considered a CLIA waived test.
• Notify DOH Laboratory Quality Assurance (LQA) that you are adding glucose testing by completing the Test Menu Change Form 505-089 and return it to hsqafc@doh.wa.gov.
• Questions on licensing can be submitted to LQA@doh.wa.gov.

Schools may add glucose testing to their MTS license as long as it is a CLIA waived test.

• First, check if the test is CLIA waived by visiting CLIA – Clinical Laboratory Improvement Amendments and typing “glucose” into the Test System / Manufacturer field or selecting “Glucose” from the dropdown menu for the Analyte Name field.
• Find your test in the list that populates. If the test is listed a “WAIVED” under the column labeled “Complexity,” it is considered a CLIA waived test.
• Notify DOH Laboratory Quality Assurance (LQA) that you are adding glucose testing by completing the Test Menu Change Form 505-089 and return it to hsqafc@doh.wa.gov.
• Questions on licensing can be submitted to LQA@doh.wa.gov.

• Any test you receive from DOH will either be within the printed expiration date on the box or, if this date has passed, will be within the extension period granted by the FDA and DOH.

• You can order free OTC tests from DOH at any time via the DOH Order Form. DOH recommends ordering 1-2 months worth of supply with each order. 

Tests may continue to receive new expiration date extensions as additional performance data is available. Even if a test has an updated expiration date that is now in the past, per DOH, you can still use the test if it passes quality control. Be sure to check out this guidance for more information.

Yes. Countermeasures like diagnostic testing for COVID-19 that received emergency use authorization (EUA) are still covered by the federal PREP Act due to a recent amendment that authorizes their use until December 2024.  

• Please see the DOH Expired COVID-19 Tests FAQ for more information on using expired testing supplies.
• According to the FAQ, “Manufacturers of COVID-19 tests are required to do studies that look at how long a test can be used. The FDA tracks this data to approve extended expiration dates. Shelf-life extensions for COVID-19 tests are normal as more data comes in about how long these tests last.” 
• Your COVID-19 test comes with instructions to ensure that the test is working reliably, also called “quality control”. Built-in quality controls within COVID-19 tests allows for individuals to validate if the test can function properly to provide an accurate result. According to CDC, internal controls evaluate whether “the test is working as it should, enough sample is added, the sample is moving through the test strip correctly, and/or the electronic functions of the instrument are working correctly”. For more information, see Ready? Set? Test! Patient Testing is Important. Get the right results.

The DOH statement from March 2022 approving the use of expired tests also notes, “Many COVID-19 testing supplies are set to expire quickly due to manufacturers performing under short study times on stability. Many of these tests have integrated quality control indicators, which can also be used to determine if an expired item can reliably be used.”

Current DOH Guidance to Prevent and Respond to COVID-19 in K-12 Schools and Child Care Settings recommends a minimum 5-day isolation period for anyone with COVID-19. This recommendation will remain the same in the updated version of the guidance.  

 Schools and child cares should develop protocols to ensure that individuals who have COVID-19 isolate away from others and do not attend in-person school or child care until they have completed isolation. Students, children, or staff who test positive for COVID-19 should stay home for at least 5 days. The DOH guidance on What to do if you test positive for COVID-19 has more information about testing to determine when to leave isolation and stop masking. The Isolation and Quarantine Calculator is a tool that can help an individual determine how long they need to isolate, when they should test, and when they can stop wearing a mask. 

 Individuals can return to school or child care after the end of their 5-day isolation period if they have not had a fever for 24 hours (without using fever-reducing medication) and their symptoms have improved. They should continue to wear a well-fitting and high-quality mask for an additional 5 days (day 6 through day 10) if they return to school or child care after their 5-day isolation. If they are unable to wear a well-fitting and high-quality mask, they should continue to isolate for a full 10 days or follow a test-based strategy as described in What to do if you test positive for COVID-19.

DOH currently recommends an isolation period of 5 days (see answer above). This recommendation will stay the same in the updated guidance. 

DOH will no longer require that K-12 schools report positive home test results or results from outside healthcare providers to their local health jurisdictions, effective when the guidance is updated. Schools will continue to be required to report test results from tests administered at the school, per the DOH COVID-19 Test Reporting for K-12 Schools Website.  LHJs have the ability to request additional COVID-19 test result reporting, per WAC 246-101-420.  DOH recommends contacting your local health jurisdiction with any questions requiring local COVID-19 reporting expectations. 

DOH changed from recommending exposure notifications for every individual COVID-19 case to recommending exposure notifications for COVID-19 outbreaks. We made this change because schools and child cares are not doing individual contact tracing, and often do not have visibility on all cases (for example, cases identified from home tests that are not reported to the school or child care), so individual notification is often not feasible.  

We continue to recommend exposure notifications when there are outbreaks in a school or child care setting, and schools or child cares may choose to continue to provide exposure notifications for individual cases if they have the capacity and see a benefit to their school or child care community. 

The webinar recording is available here, which includes the slide deck. Attendees received an email on May 19 with the recording, attached slide deck, and a brief survey to provide feedback to L2R.

DOH has not yet determined an end date for the COVID-19 Cases Among Children and Youth in Washington reports. The decision will be based on what is still useful for DOH stakeholders. DOH would appreciate feedback from schools on the usefulness of this report and/or suggestions for other data products that might be useful. Please send this feedback to lillian.manahan@doh.wa.gov.

• The Labor Fund will not be available for COVID-19 related activities next year.
• Although we cannot confirm, there may be support available through the Elementary and Secondary School Emergency Relief Fund.