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CMS Ends Certain COVID Waivers

The Centers for Medicare & Medicaid Services announced that they will be restoring training requirements for nurse aides who work at skilled nursing facilities as well as a host of other provisions affecting doctors, discharge requirements and the special use of rooms and buildings after waiving them during the COVID-19 public health emergency. The 16 waivers will lapse in distinct groups, 30 and 60 days from the issuance of today's memo. Blanket waivers for hospitals and certain other entities would remain in effect so those facilities can best manage surges in COVID infections, the agency said.

The waiver for nurse aide certifications had allowed SNFs and other nursing facilities employ aides for longer than four months without the necessary training and certification requirements during the pandemic.

“We remind states that all nurse aides, including those hired under the above blanket waiver must complete a state approved Nurse Aide Competency Evaluation Program to become a certified nurse aide,” CMS wrote. Some waivers will still be allowed, however, in cases where training and testing programs are over capacity. The agency first waived the nurse aide training and certification requirements in April 2020.

CMS also is rescinding numerous liberties related to doctors being able to relinquish some obligations to nurse practitioners or other non-physicians. It is also returning some requirements for in-person physician visits that had given way to telehealth capabilities.

In addition, the agency will end a waiver that allowed for a state-approved, non-SNF building to be temporarily certified and available for use by a SNF in the event there were needs for isolation processes for COVID-19 positive residents to ensure residents could still be treated.

The full list of affected waivers can be found in the CMS memo, which outlined numerous reasons and clarifications about conditions for the waivers' removal. Among the biggest worries are that a lack of in-person physician visits may have led to a lack of recognition of certain patient conditions. There is also a concern that facilities have not had enough fire- and life-safety inspections. MHCA has highlighted waivers affected below:

CMS will end specified waivers in two groups: 
  • 60 days from issuance of this memorandum - Monday, June 6, 2022 
    • Physical Environment
    • Training and Certification of Nurse Aides for SNF/NFs 
    • In-Service Training for LTC facilities
    • Paid Feeding Assistants for LTC facilities
    • Life Safety Code-Fire Drills & Temporary Construction
    • Outside Windows and Doors
    • Life Safety Code (LSC) and Health Care Facilities Code (HCFC) ITM
  • 30 days from issuance of this memorandum - Saturday, May 7, 2022 
    • Resident Groups  
    • Physician Delegation of Tasks in SNFs
    • Physician Visits
    • Physician Visits in Skilled Nursing Facilities/Nursing Facilities
    • Quality Assurance and Performance Improvement (QAPI)
    • Detailed Information Sharing for Discharge Planning for Long-Term Care (LTC) Facilities
    • Clinical Records  
The agency emphasized that long-term care providers should keep other measures firmly in place to guard against COVID-19 transmission. It especially promoted the pursuit of vaccinations. The agency also recommends that providers continue to adhere to CDC guidance regarding the potential spread of COVID-19 “especially during activities that may increase patient or resident contact.”

Staff Contact: dwatford@mehca.org

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