The End of the Federal Public Health Emergency: What Will It Mean for Nursing Homes?

At the beginning of the federal COVID-19 Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) used emergency waiver authorities and various regulatory authorities to enable flexibilities so that providers could rapidly respond to individuals impacted by COVID-19. CMS has developed a cross-cutting initiative to use a comprehensive, streamlined approach to reestablish certain health and safety standards and other financial and program requirements at the end of the PHE, recently announced by the Biden administration to be May 11, 2023.

With the end of the PHE, the following nursing home waivers are expected to lapse:

• Three-Day Prior Hospitalization: Using the statutory flexibility under §1812(f) of the Social Security Act, CMS temporarily waived the requirement for a three-day prior hospitalization for coverage of a nursing home stay. This waiver provides temporary emergency coverage of nursing home services without a qualifying hospital stay.
• Pre-Admission Screening and Annual Resident Review (PASRR): CMS has been allowing states and nursing homes to suspend these assessments for new residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness or intellectual disability should receive the assessment as soon as resources become available.
• Required Facility Reporting: Under §483.80(g), long term care facilities are required to report COVID-19 cases in their facility to the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) on a weekly basis. Facilities are also required to notify residents, their representatives, and families of residents in facilities of the status of COVID-19 in the facility, which includes any new cases of COVID-19 as they are identified. The Calendar Year (CY) 2022 Home Health Prospective Payment System (PPS) Rule extended these mandatory COVID-19 reporting requirements beyond the current PHE until Dec. 31, 2024.
• New Requirements for Long Term Care Facilities to Conduct SARS-CoV-2 Testing for Staff and Residents: Under the new §483.80(h), CMS is requiring long term care facilities to test staff and residents. These regulations are applicable for the duration of the PHE. Note that §488.447 is applicable one year beyond the expiration of the PHE.

The CMS outline of waivers that will continue through the end of the PHE, as well as waivers that have already expired, can be accessed here.

Contact: Amy Nelson, anelson@leadingageny.org, 518-867-8383 ext. 146