In response to the COVID-19 PHE and under section 1135 of the Social Security Act, CMS issued several temporary emergency SNFs Blanket Waivers Declaration on April 7, 2022. It aimed at providing healthcare providers with the extra flexibility required to respond to the COVID-19 pandemic. While waivers of regulatory requirements have offered nursing homes more flexibility in how they operate, they have also removed the minimum quality standards that help ensure residents’ health and safety.
Declaration of Blanket Waivers
CMS recently conducted some surveys that disclosed significant issues with resident care that were unrelated to infection control (e.g., abuse, weight loss, depression, pressure ulcers, etc.). Waiver of certain regulatory requirements may have contributed to these outcomes while also increasing the risk of other problems. Nurse aides and paid feeding assistants, for example, may not have received the necessary training to help identify and prevent weight loss because training requirements were waived. Similarly, CMS waived the requirement for physicians and practitioners to conduct in-person assessments, which may have prevented these individuals from performing an accurate assessment of the resident’s clinical needs, contributing significantly to depression or pressure ulcers. As a result, the CMS has terminated certain waivers.
Terminated Waivers
CMS is discontinuing blanket waivers for specific emergency declarations for SNFs/NFs, inpatient hospices, ICF/IIDs, and ESRD facilities. The termination of these blanket waivers will not affect existing blanket waivers, such as those for hospitals and CAHs. Providers are expected to take immediate action to return to compliance with the reinstated requirements within the timeframes specifically mentioned.
The blanket waivers are terminated in two groups, 30 days and 60 days from the date of the memorandum (May 7 or June 6). Within these timeframes, CMS instructed SNFs and other affected providers to “take immediate steps to return to compliance with the reinstated requirements.” The blanket waivers ending are as follows:
Waivers Ending in 30 Days
- CMS waived the requirements that ensure residents can participate in-person in resident groups. This waiver permitted the facility to restrict in-person meetings during the COVID-19 PHE.
- CMS waived the requirement that prevents a physician from delegating a task when the regulations specify that the physician must perform it personally.
- CMS 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 options.
- CMS waived the requirement that all required physician visits must be made by the physician personally.
- CMS modified certain requirements which require long-term care facilities to develop, implement, evaluate, and maintain an effective, comprehensive, data-driven QAPI program.
- CMS waived the discharge planning requirement which requires 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 modified the requirement which requires long-term care (LTC) facilities to provide a resident a copy of their records within two working days (when requested by the resident).
Waivers Ending in 60 Days
- CMS waived requirements to allow a non-SNF building to be temporarily certified and available for use by an SNF if isolation processes for COVID-19 positive residents were required, which may not be feasible in the existing SNF structure to ensure care and services during COVID19 treatment, provided the state approved the location as one that adequately addresses patient and staff safety and comfort.
- CMS waived ITM requirements for facility and medical equipment to reduce the disruption of patient care and potential exposure/transmission of COVID-19.
- CMS waived the requirement for on-time preventive maintenance of dialysis machines and ancillary dialysis equipment. Additionally, CMS waived the requirements for ESRD facilities to conduct on-time fire inspections.
- CMS 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.
- CMS waived the requirements which require that an SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements.
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