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Reminder to Nursing Homes: CMS 1135 Blanket COVID-19 Waivers Expiring

Nursing homes are reminded that several waivers of federal regulations implemented in response to the COVID-19 pandemic were terminated on May 7th, and additional waivers will be terminated on June 6th. The waiver of the three-day prior hospitalization requirement for Medicare coverage of a skilled nursing facility (SNF) stay remains in effect. More information on the three-day hospitalization waiver is available here, under "Nursing Home Updates."

As previously reported here, the Centers for Medicare and Medicaid Services (CMS) announced in QSO 22-15 last month the termination of several blanket waivers of federal nursing home regulations issued under Section 1135 of the Social Security Act. With the termination of these waivers, nursing homes must revert to pre-COVID-19 regulatory requirements. The following waivers terminated on May 7th:

  • 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.

A second set of waivers will terminate on June 6th:

  • Nurse Aide Training and Certification: Individuals employed as nurse aides must complete an approved training and competency evaluation program within four months of the expiration of the waiver. For individuals who have worked as a temporary nurse aide (TNA) for at least 30 days or 150 hours, an abbreviated 40-hour course has been approved by the Department of Health (DOH). TNAs who do not meet the minimum hours requirement must complete the standard course in order to take the exam and obtain their certification. More information about the TNA transition course is available here.
  • Physical Environment, Life Safety Code: Various physical environment; Life Safety Code; Equipment Inspection, Testing, and Maintenance; and Fire Drill requirements will resume for SNFs, inpatient hospices, intermediate care facilities, and end-stage renal disease (ESRD) facilities. A description of these waivers is available here at pp. 16-17 and 29-30.
  • 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.

Nursing homes are urged to begin planning for the transition of TNAs to certified status. Facilities that are experiencing challenges with scheduling Prometrics examinations are encouraged to contact DOH here. LeadingAge NY is also collecting information from members about Prometrics delays. Please contact Karen Lipson or Elliott Frost if you are experiencing difficulty with scheduling examinations.

Nursing homes are also urged to begin planning for the termination of the Life Safety Code waivers pertaining to facility and medical equipment inspection, testing, and maintenance by contacting vendors and scheduling services. In addition, facilities should be planning for the resumption of required fire drills.

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