CMS Provides Guidance on End of CNA Certification Waiver and TNA to CNA Transition

On Aug. 29, 2022, the Centers for Medicare and Medicaid Services (CMS) issued revisions to memorandum QSO-22-15-NH & NLTC & LSC that had provided guidance on the end of the 1135 waivers. The revised QSO specifically addresses the waiver of certified nurse aide (CNA) certification. Temporary nurse aides (TNAs) hired during the COVID-19 pandemic would have had to become CNAs by Oct. 6, 2022, when the waiver was due to expire.

In many states, including New York State, nursing homes have experienced delays in testing or a lack of available testing sites and have been unable to have TNAs become certified. In view of these problems, CMS is allowing both individual facility waivers as well as state/county waivers under certain circumstances and requiring documentation of efforts to obtain certification for nurse aides. The revised guidance states the following:

CMS will review waiver requests in the following manner:

1. Individual Facility waiver: When there are localized barriers to training/testing in a state or county not otherwise covered by a waiver, facilities may request a waiver by providing documentation of the barriers. The documentation must include information demonstrating that the aide(s) have attempted to become certified (e.g., enrollment in training or testing), but the NATCEP entity cannot accommodate the applicant(s) at this time.

• Documentation should include the date(s) and contact(s) that the communication occurred between.
• Documentation can be in the form of email, letters, or documentation of a phone call.
• Documentation must show timely contacts to state officials.
• Facilities should include the estimated date by which their aides will get certified.

2. State-wide or County waiver: When there are widespread barriers to training/testing that are statewide or in a particular county within a state, the state agency may submit a request for the waiver for the affected jurisdiction. The state agency must provide documentation of the status of their NATCEP program and a plan for remedying the situation.

1. Documentation: At minimum, documentation of the status must include information on the number of aides that need to be certified, a description of issue causing barriers to certification (e.g., training or testing capacity), and the available capacity to certify aides (e.g., describe the gap between the number of aides that need to be certified and capacity available, the number of aides to be certified on a monthly or weekly basis, etc.).
2. Plan: At minimum, the plan to remedy the situation must include the actions the state will take to improve the rate at which aides are certified and a target date for all aides to be certified.

Waivers are time-limited, and CMS expects state agencies to actively work towards resolution of barriers to certification. CMS may require that state agencies provide progress reports on the submitted action plan to maintain the waiver.

A state or facility cannot attain or retain a waiver longer than the declaration of a PHE. CMS will grant these waivers for a timeframe that is as short as possible, and CMS will only grant these waivers while the declaration of a COVID-19 public health emergency is still in effect. If the PHE ends during or before the granted period of waiver for a facility or a state or a county, the waiver also ends.

State agencies or facilities should use the following portal to submit a waiver request: https://cmsqualitysupport.servicenowservices.com/cms_1135

Contact: Elliott Frost, efrost@leadingageny.org, 518-441-8761