QSO-22-15-NH leave many scratching their heads

Last week CMS released CMS QSO-22-15-NH & NLTC & LSC which rolled back several pandemic waivers and changed the way nursing homes are able to employ Temporary Nurse Aides (TNAs). Currently, AHCA is seeking some clarifications from CMS which we expect to receive next week. In the meantime, below are some key takeaways and next steps facilities can take to prepare for the upcoming end of the 1135 waiver.

Please note: The waiver end dates does not impact the 3-Day Stay or the Spell of Illness waivers. Those waivers remain in force nationwide for all hospitals, communities, and SNFs.

What training do TNAs need to complete to become CNAs?
  • Per CMS QSO, Temporary Nurse aides (TNAs) who were hired during the blanket waiver period must complete a state approved Nurse Aide Training and Competency Evaluation Program (NATCEP) to become a certified nurse aide (CNA). If your state has approved a transition or bridge program from TNA to CNA, follow your state approved program.
What do I do if my state has backlogs in training and/or testing which is delaying the TNAs in my facility?
  • Have written documentation demonstrating all attempts made to have TNAs complete their training and testing. This can include documentation from both the facility and the TNAs to training programs and testing sites in multiple locations. 
  • Have frequent communication to state officials (may include CNA registry, survey agency, Board of Nursing, Department of Education) regarding the delays and backlogs in training and/or testing and outline the facility's attempts to enroll TNAs into training/testing programs. Document those communications.
  • Enroll TNAs into training and/or testing centers as soon as possible, even if the only option is a waitlist.
  • Keep all communications to and from state agency overseeing nurse aide programs. Maintain a log showing ongoing and multiple attempts.
  • Keep all communications to and from training and/or testing centers. Maintain a log showing ongoing and multiple attempts.
  • In states that do not have a backlog or delay in training and/or testing sites, facilities should be actively seeking to transition all TNAs into CNAs as soon as possible. As noted above, maintain documentation for each TNA and their progress towards CNA to ensure it is timely according to allowed timeframes.
How long can TNAs still work as nurse aides in training after the 1135 waiver ends?
  • The waiver is set to end on June 6, 2022. The traditional four months' time per CMS requirement to get nurse aides in training to become certified, will begin on June 6, 2022. To this end, facilities will need to have TNAs become certified before October 6, 2022, to continue working as a nurse aide. If a TNA is not certified by the end of the four months post-waiver termination, the TNA cannot continue working as a nurse aide in training, except for those who are experiencing testing and/or training capacity issues and have received approval from their state official.
MHCA is working with the State of Maine DHHS to determine appropriate pathways for TNA to CNA; as well as workforce recruitment and retention. AHCA will continue to advocate for innovative approaches to resident care and services and seek new ways for enhancing the workforce to support members in providing quality care to residents. 

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