CMS Provides Updates on Transition from Public Health Emergency
With the end of the COVID-19 public health emergency (PHE) approaching on May 11, 2023, the Centers for Medicare and Medicaid Services (CMS) has been disseminating information related to the status of regulatory waivers and new regulations implemented in response to the PHE. The waivers, which have offered flexibility to expand access to care and reduce administrative burdens during the pandemic, will generally expire on May 11th or within a specified period of time after May 11th. Some of those flexibilities were incorporated into law or regulation and will remain in effect. New health and safety standards implemented through interim final rules or federal guidance will generally remain in effect, either based on the expiration date of the regulation or as national standards of care and infection prevention.
CMS has made available information about specific waivers and regulations through a series of fact sheets on its Coronavirus Waivers & Flexibilities page and through stakeholder calls. The fact sheets include a general fact sheet that provides information to the general public and provider-specific fact sheets, including, among others:
An article about the implications of the end of the PHE for home health providers is available here.
General Fact Sheet
The recently released general fact sheet highlights the status of the following services and interventions after the PHE ends:
- COVID-19 vaccines, testing, and treatments;
- Telehealth services;
- Health Care Access: Continuing flexibilities for health care professionals; and
- Inpatient Hospital Care at Home: Expanded hospital capacity by providing inpatient care in a patient’s home.
It notes that Medicare beneficiaries will continue to have access to COVID-19 vaccinations without cost sharing after the PHE. Cost sharing for COVID-19 tests will continue to be waived for fee-for-service beneficiaries, but may be instituted by Medicare Advantage plans. The provision of free over-the-counter tests to Medicare beneficiaries will end with the PHE. State Medicaid programs will be required to cover vaccinations, testing, and treatment for COVID-19 without cost sharing through Sept. 30, 2024.
Many of the telehealth flexibilities granted during the PHE that allow Medicare beneficiaries to have broader access to telehealth services were incorporated in the Consolidated Appropriations Act of 2023 and will continue through Dec. 31, 2024.
Nursing Home Waivers and Requirements
The status of waivers pertaining to nursing homes have been detailed in the SNF fact sheet and a recent nursing home stakeholder call. CMS has noted that COVID-19-related requirements implemented through interim regulations will remain in effect until the expiration date identified in the regulation, or, if no expiration date is specified, the regulation will remain in effect for three years from the date of its publication. The following describes the status of key waivers and COVID-19-related requirements:
Temporary Nurse Aide Waiver
At the beginning of the pandemic, CMS waived the requirement that nurse aides in training be certified within four months of beginning to work in a nursing facility. That waiver expired in June 2022, and temporary nurse aides (TNAs) were initially required to be certified by October 2022. However, New York State received an extension until April 5, 2023 for TNAs to be certified, due to limited testing and training capacity. CMS has indicated that TNAs will have four months from the end of the State's extension waiver to get certified – that is, until Aug. 5, 2023.
In-Service Training
CMS modified the nurse aide in-service training requirement of at least 12 hours annually by postponing the deadline for completing it until the end of the first full quarter after the PHE concludes. Although this waiver terminated in June 2022, we have been informed by LeadingAge National that, because the in-service requirement is annual, facilities have until June 2023 to complete the required training.
Family Notification and NHSN Reporting
CMS adopted interim final rules requiring nursing homes to notify residents and families of COVID-19 infections and clusters of respiratory infections in facilities and to report data to the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN). Most of the notification and reporting requirements in those rules are in effect until Dec. 31, 2024. NHSN reporting of COVID-19 vaccination status continues through May 2024 or until CMS declares otherwise. Nursing homes should also be aware of the separate New York State requirement to include in their pandemic emergency plans provisions for family notification of pandemic infections consistent with these CMS regulations.
COVID-19 Testing
Interim final regulations require COVID-19 testing of residents and staff consistent with CMS guidance that has fleshed out the frequency and nature of testing, including during outbreaks, in response to the presentation of symptoms, and in response to exposures. The regulations expire with the PHE. However, CMS has stated in a nursing home stakeholder call that COVID-19 testing in accordance with CDC guidance is now considered a national standard for infection prevention and control that will be enforceable through the survey process.
Staff Vaccination Mandate
Nursing home staff in New York State are subject to both federal and state COVID-19 vaccination mandates. The federal mandate is incorporated in an interim final rule that will remain in effect until November 2024, unless other action is taken. It is anticipated that there may be some changes in the federal regulation, in light of the anticipated Food and Drug Administration (FDA) consideration of an annual COVID-19 vaccine. New York's health care staff vaccination mandate does not have an expiration date. Although a lower court recently enjoined enforcement of New York's vaccination mandate, that injunction was stayed by an appellate court pending resolution of the appeal.
Billing for COVID-19 Vaccines
The fact sheet provides additional details about payment and billing for COVID-19 vaccines after the end of the PHE. In particular, after June 30, 2023, immunizers, such as pharmacies, will no longer be able to bill Medicare directly for vaccines administered to individuals during a Part A stay. Beginning July 1st, typical SNF consolidated billing for vaccine administration will be in effect for COVID-19 vaccines.
Three-Day Prior Hospitalization and 60-Day Wellness Period
During the pandemic, CMS has waived the requirement of a three-day inpatient hospital stay to qualify for Medicare coverage of a Part A stay. It has also waived, under certain circumstances, the requirement of a 60-day break in SNF services in order to begin a new benefit period and renew SNF services. These waivers will terminate at the end of the PHE. CMS indicated on the nursing home stakeholder call that if a Part A stay begins on or before May 11th, no three-day stay will be required to qualify for Medicare coverage. If it begins after May 11th, there will be a three-day stay requirement. Similarly, if a resident’s SNF benefit is exhausted on or before May 11th, the resident will be eligible for renewed SNF coverage without a 60-day wellness period, but if the benefit is exhausted after May 11th, a 60-day wellness period will be required.
The status of a number of additional waivers are addressed in the SNF fact sheet, including those concerning resident grouping, Pre-Admission Screening and Resident Review (PASRR), and locations of alcohol-based hand rub dispensers. An article from LeadingAge National provides additional detail here.
LeadingAge NY will keep members informed of evolving policies related to the end of the PHE as more information becomes available.
Contact: Karen Lipson, klipson@leadingageny.org