On Thursday, the Centers for Medicare and Medicaid (CMS) issued a memorandum to State Survey Agency Directors announcing that COVID-19 emergency declaration blanket waivers for specific providers will end in either 30 or 60 days. The agency is restoring training requirements for nurse aides in SNF, ending waivers and other provisions affecting doctors, discharge requirements, and the special use of rooms and buildings. Blanket waivers for hospitals and certain other entities will remain in effect to allow those facilities to best manage surges in COVID infections. The CMS memorandum, QSO-22-15-NH & NLTC & LSC, provides details regarding which of the waivers put in place in response to the COVID-19 national Public Health Emergency (PHE) will end in the near future.
SNF/NF Waivers Ending in 30 days – May 7th, 2022
Resident Groups – 42 CFR §483.10(f)(5) – CMS had waived the requirements ensuring residents can participate in-person in resident groups.
Physician Delegation of Tasks in SNFs – 42 CFR §483.30(e)(4) – CMS had waived the requirement preventing a physician from delegating a task to a physician assistant, nurse practitioner or clinical nurse specialist when regulations specify that the physician must perform it personally.
Physician Visits – 42 CFR §483.30(c)(3) – CMS had waived the requirement for all required physician visits (not already exempted in §483.30(c)(4) and (f)) to be made by the physician personally.
Physician Visits in Skilled Nursing Facilities/Nursing Facilities – 42 CFR §483.30 – CMS had waived the requirement for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth.
Quality Assurance and Performance Improvement (QAPI) – 42 CFR §483.75(b)–(d) & (e)(3) – CMS had modified certain requirements that facilities develop, implement, evaluate and maintain an effective, comprehensive, data-driven QAPI program.
Clinical Records – 42 CFR §483.10(g)(2)(ii) – CMS had modified the requirement for LTC facilities to provide a resident a copy of his/her records within two working days when requested by the resident.
Detailed Information Sharing for Discharge Planning for Long-Term Care (LTC) Facilities – 42 CFR §483.21(c)(1)(viii) – CMS had waived the discharge planning requirement for LTC facilities to assist residents and their representatives in selecting a post-acute care provider using data, such as standardized patient assessment data, quality measures and resource use. CMS had maintained all other discharge planning requirements.
Waivers for Various Provider Types Ending in 60 days – June 6th, 2022
Physical Environment for SNF/NFs – 42 CFR §483.90 – CMS had waived requirements to allow for a non-SNF building to be temporarily certified and available for use by a SNF for isolation processes for COVID-19 positive residents and other requirements related to the physical environment.
Facility and Medical Equipment Inspection, Testing & Maintenance (ITM) for Inpatient Hospice, ICF/IIDs and SNFs/NFs– 42 CFR §§418.110(c)(2)(iv), 483.470(j) & 483.90 – CMS had waived ITM requirements for facility and medical equipment to reduce disruption of patient care and potential exposure/transmission of COVID-19.
Life Safety Code (LSC) and Health Care Facilities Code (HCFC) ITM for Inpatient Hospice, ICF/IIDs and SNFs/NFs – 42 CFR §§ 418.110(d)(1)(i) & (e), 483.470(j)(1)(i) & (5)(v) & 483.90(a)(1)(i) & (b) – CMS had waived ITM required by the LSC and HCFC, with specified exceptions, which permitted facilities to adjust scheduled ITM frequencies and activities to the extent necessary.
Outside Windows and Doors for Inpatient Hospice, ICF/IIDs and SFNs/NFs – 42 CFR §§418.110(d)(6), 483.470(e)(1)(i) & 483.90(a)(7) – CMS had waived the requirement to have an outside window or outside door in every sleeping room.
Life Safety Code for Inpatient Hospice, ICF/IIDs, and SNFs/NFs – 42 CFR §§418.110(d), 483.470(j) & 483.90(a) – CMS had waived specific LSC provisions around fire drills and temporary construction.
Paid Feeding Assistants for LTC facilities – 42 CFR §§483.60(h)(1)(i) & 483.160(a) – CMS had modified the requirements regarding required training of paid feeding assistants to allow that training can be a minimum of one hour in length. CMS did not waive other requirements related to paid feeding assistants or required training content.
In-Service Training for LTC facilities – 42 CFR §483.95(g)(1) – CMS had modified the nurse aide training requirements for SNFs and NFs, which required the nursing assistant to receive at least 12 hours of in-service training annually.
Training and Certification of Nurse Aides for SNF/NFs – 42 CFR §483.35(d) (Modification & Conditional Termination) – CMS had waived the requirements that a SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements under §483.35(d). CMS previously provided information related to nurse aides working under this blanket waiver in CMS memorandum QSO-21-17-NH.
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