The ending of pandemic era waivers means what exactly?

The looming end to pandemic era waivers have sent many providers searching for answers on the implications to staffing patterns and direct care workers allowed to perform duties in our nursing homes. If you recall there were flexibilities allowable through the 1135 blanket waivers including the use of Temporary Nurse Aides (TNA) and Personal Support Specialists (PSS) in nursing homes and assisted housing. For purposes of the Maine nursing home licensing Rule, a PSS can still work in a nursing home and would continue to count as direct care staff for meeting the State of Maine licensing rule, provided they are not acting outside of the course of their training and education.

For purposes of CMS federal regulatory requirements, the ending of the CMS waiver does not prohibit a nursing home from hiring PSS staff (PSS staff with additional training and education may be used to fulfill the requirements under F741), but the regulations do not count PSS staff as fulfilling the sufficient nursing staff as they do not qualify as nurse aides under the CMS definition of a nurse aide.

The intent of the federal requirement is to ensure that the facility has sufficient staff members who possess the basic competencies and skills sets to meet the behavioral health needs of residents for whom the facility has assessed and developed care plans. The facility must consider the acuity of the population and its assessment in accordance with §483.70(e).

With regard to the use of TNAs the State of Maine rules allow for the continued use of ‘non-nursing personnel' as outlined in Chapter 8, section C.2-Non-Nursing Personnel:
“There shall be adequate numbers of non-nursing personnel to perform the necessary services and meet the needs of the residents and the facility. These persons shall not give resident care, unless staffing patterns, training, qualifications and job descriptions reflect the activities of such multi-purpose personnel.”

MHCA will continue to pursue answers to questions regarding staffing patterns and the end of the pandemic era waivers. We encourage members to reach out with any questions or need for clarity as we continue to adjust to these changes.
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