This week, CMS
issued a memo announcing it is ending four of the 1135 waivers issued in response to the COVID-19 Public Health Emergency (PHE). These changes are effective May 10, 2021. The four waivers that will be ending relate to prior notification of room and roommate change, prior notice of transfer/discharge, certain care planning requirements and MDS submission.
CMS also provides clarification and recommendations for Nurse Aide Training and Competency Evaluation Programs (NATCEPs). Currently, CMS is keeping the current nurse aide waiver.
Summary of Removed Waivers
CMS is making the following changes to blanket 1135 waivers, effective May 10, 2021. CMS’ rationale for removing these waivers is that facilities have developed processes for completing these requirements at this point.
- Resident roommates and grouping:
- Ending: waiver of notification prior to Resident Room or Roommate Change at 42 CFR §483.10(e)(6).
- Keeping: related waivers at 42 CFR 483.10(e)(5) and (7) when change of rooms is done solely for purposes of cohorting due to COVID-19.
- Impact: You must provide notice before a room or roommate change except when the change is solely for COVID-19 cohorting.
- Resident transfer and discharge:
- Ending: waiver of notification prior to Transfer and Discharge at 42 CFR §483.15(c)(4)(ii)
- Keeping: related waivers at 42 CFR 483.10(c)(5) as well as 483.15(c)(3), (c)(5)(i) and (iv) and (c)(9), and (d) that allow providers to transfer or discharge residents to another long term care facility solely for cohorting purposes without prior written notice.
- Note: It is important to read the details of these waivers to ensure you are applying them correctly and provide notice as soon as possible when transferring or discharging residents for cohorting purposes.
- Impact: You must provide written notice of transfer or discharge at least 30 days in advance, or as soon as practicable in certain situations, before the transfer or discharge.
- Care planning requirements:
- Ending: waiver of certain care planning requirements at §483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i) for residents transferred or discharged for cohorting purposes.
- Impact: You must complete baseline care plans within 48 hours of admission and comprehensive care plans within seven days of completion of the comprehensive assessment, according to current regulations.
- Minimum Data Set (MDS):
- Ending: waiver of timeframe requirements for completing and transmitting resident assessment information at 42 CFR §483.20.
- Keeping: waiver at 42 CFR §483.20(k) related to the Pre-Admission Screening and Annual Resident Review (PASARR).
- Impact: You must complete and transmit MDS assessments according to current regulations.
Additional NATCEP Information
AHCA/NCAL is pleased that CMS has recognized that time worked by the nurse aides during the PHE may count towards meeting the federal 75-hour training requirement and is encouraging states to evaluate their NATCEP to consider time worked during the PHE to help temporary nurse aides become certified nurse aides (CNA). CMS has also clarified that the four-month regulatory timeframe for completing the nurse aide training and competency evaluation requirements after hire will be reinstated when the blanket waiver ends and will start at that time. Nurse aides will have the full four-month period starting from the end of the blanket waiver to successfully complete the required training and certification, regardless of the amount of time worked during the time the waiver was in effect. Federal requirements do not specify whether training must be delivered in a classroom versus a nursing home setting, and CMS acknowledges that training on many of the required topics can be obtained in a nursing home setting while working as a nurse aide under the waiver and through onsite experience and observation.
AHCA/NCAL strongly encourages states, providers and temporary nurse aides to explore ways to complete the nurse aide training and certification requirements as soon as possible to retain the thousands of individuals who have provided vital care and support to residents throughout the pandemic. The process of transitioning from a temporary nurse aide to a CNA takes time and these pathways vary depending on the state. We encourage you to contact your state licensing agency, state affiliate or AHCA/NCAL at
educate@ahca.org with any questions. States must ensure that all of the required areas of training per 42 CFR §483.152(b) are addressed, and any gaps in onsite training that are identified are fulfilled through supplemental training. Nurse aides must still successfully pass the state’s competency exam per 42 CFR §483.154.
Currently, it is
expected that HHS will renew its declaration of public health emergency through the end of 2021 and will provide 60 days’ notice prior to ending it. As long as the PHE is in place, CMS may retain its 1135 waivers. However, CMS could decide to phase out other waivers prior to the end of the PHE if it determines they are no longer needed. CMS will continue to monitor the emergency blanket waivers and may provide future updates.