CMS Announces Termination of COVID-19 Emergency Waivers

The Centers for Medicare and Medicaid Services (CMS) notified stakeholders last week that it will be terminating various 1135 COVID-19 emergency blanket waivers affecting nursing homes, inpatient hospices, intermediate care facilities, and end stage renal disease (ESRD) facilities. According to QSO 22-15, the waivers will be terminated in two batches, with the first batch terminating in 30 days from the issuance of the memorandum, on May 7, 2022, and the second batch terminating in 60 days from the issuance of the memorandum, on June 6, 2022. 

Termination of the Nurse Aide Training Waiver

The termination of the nurse aide training waiver, which allows nursing homes to employ individuals as temporary nurse aides (TNAs) for more than four months without completing the standard Nurse Aide Training Program (NATP) and passing the exam, is particularly noteworthy for nursing homes. That waiver will terminate on June 6, 2022. Once the waiver terminates, TNAs will have four months to complete their certification. The Department of Health (DOH) has approved an abbreviated 40-hour course that provides credit for up to 35 hours worked in a nursing home as a TNA. Individuals who have worked as a TNA for at least 30 days or 150 hours are eligible for the abbreviated course. TNAs who do not meet the minimum hours requirement must complete the standard in order to take the exam and obtain their certification. DOH has authorized a curriculum and process for the transition of qualifying TNAs. More information about the TNA transition course is available here. 

The new QSO recognizes that “there may be instances where the volume of aides that must complete a state approved NATCEP exceed the available capacity for enrollees in a training program or taking the exam . . . . If a facility or nurse aide has documentation that demonstrates their attempts to complete their training and testing (e.g., timely contacts to state officials, multiple attempts to enroll in a program or test), a waiver of these requirements (42 CFR §483.35(d)) is still available and the aide may continue to work in the facility while continuing to attempt to become certified as soon as possible.”

Termination of Other Waivers

CMS also announced the termination of more than a dozen other waivers. The following is a list of the waivers that will be terminated in each of the batches. Members are encouraged to read the CMS memo to learn more about the waivers that are ending.

• Waivers Terminating in 30 Days (May 7^th) for Skilled Nursing Facilities (SNFs)
  • Resident In-Person Groups: Residents must be allowed to resume meeting in groups.
  • Physician Delegation: Physicians may not delegate tasks when regulations specify that they must be performed personally.
  • Physician Visits: Physicians may not delegate required visits to mid-level professionals when regulations require the visit to be made by the physician personally. Physicians may not provide visits via telehealth when regulations require in-person visits. 
  • Quality Assurance and Performance Improvement (QAPI): QAPI requirements cannot be met solely by focusing on adverse events and infection control.
  • Discharge Planning: Detailed information sharing for discharge planning purposes will resume.
  • Clinical Records: Requirements to provide copies of records within two working days will resume.
• Waivers Terminating in 60 Days (June 6^th) for Various Providers
  • Physical Environment, Life Safety Code: Various physical environment, Life Safety Code, and Equipment Testing and Maintenance requirements will resume for SNFs, inpatient hospices, intermediate care facilities, and ESRD facilities. 
  • Paid Feeding Assistants: The reduction of required training for paid feeding assistants will terminate.
  • In-Service Training for Certified Nurse Aides (CNAs): CNAs will be required to receive 12 hours of in-service training annually.
  • Nurse Aide Training and Certification: See above.

More information on the termination of waivers affecting inpatient hospice is available from LeadingAge National here.

The CMS memo notes that: "States and individual facilities are still able to request regulatory waivers for issues unique to their facility or location (similar to actions taken in response to natural disasters) to provide flexibility." For additional information on individual waivers or flexibilities, the memo links to the Coronavirus waivers & flexibilities webpage.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838