On May 1, 2023, the Center for Clinical Standards and Quality/Quality, Safety & Oversight Group issued Guidance to State Survey Agency Directors. This guidance covers multiple settings, including Long Term Care Facilities (Skilled Nursing Facilities (SNFs) and/or Nursing Facilities (NFs)) starting on Page 3. Below is the information all SNFs need to be made aware of:
- 3-Day Prior Hospitalization Waiver Expires: all new SNF stays beginning on or after May 12th will require a qualifying hospital stay before Medicare coverage.
- 60-Day Wellness Period Waiver Expires: For any new benefit period that begins on or after May 12th, the beneficiary will need to have completed a 60-day wellness period.
- Alcohol-based Hand-Rub (ABHR) Dispensers Waiver Expires: CMS waived the requirement for ABHR dispensers for SNF/NFs at 42 CFR 483.90(a) during the PHE because of the need for the sudden increased use by staff and others of ABHR in infection control. The waiver of this requirement ends with the conclusion of the PHE.
- Preadmission Screening and Annual Resident Review: (PASARR) Waiver Expires: CMS allowed nursing homes to admit new residents who have not received a Level I or Level II Preadmission Screening. CMS expects all providers to be in compliance with the requirements for PASARR with all admissions taking place after May 11, 2023.
- Resident Roommates and Grouping Waiver Expires: CMS waived the requirements in 42 CFR 483.10(e)(5) and (7) solely for the purposes of grouping or cohorting residents with respiratory illness symptoms and/or residents with a confirmed diagnosis of COVID-19 and separating them from residents who are asymptomatic or tested negative for COVID-19. This waiver of these requirements ends with the conclusion of the PHE (note that Section (e)(6) was terminated on 05/10/2021 per QSO-21-17-NH).
- Resident Transfer and Discharge Waiver Expires: CMS waived requirements of facility to provide advance notification of options relating to the transfer/discharge to another facility; the written notice of transfer or discharge to be provided before the transfer or discharge. This notice must be provided as soon as practicable (with some exceptions); to allow a long-term care (LTC) facility to transfer or discharge residents to another LTC facility solely for cohorting purposes. This waiver of these requirements ends with the conclusion of the PHE. (note that 483.10 (e)(3) was terminated on 05/10/2021 per QSO-21-17-NH).
- Nurse Aide Training Competency and Evaluation Programs (NATCEP) Waiver Expires: CMS waived the requirements which require that a SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements. CMS provided additional guidance for this waiver with the release of QSO-21-17-NH. CMS memorandum QSO-22-15-NH & NLTC & LSC terminated this blanket waiver, however, individual states and facilities could apply for a separate time-limited waiver of these requirements for instances where the volume of nurse aides that must complete a state-approved NATCEP exceeded the availability of approved training and testing programs. All individual waivers granted to states and individual facilities will terminate at the conclusion of the PHE, unless a facility or state has been granted a waiver that expires prior to the end of PHE. Uncertified nurse aides working in a Long Term Care facility covered by a waiver granted to a state or individual facility will have 4 months from the date the PHE ends (or from the termination date of the facility’s or state’s waiver, if earlier) to complete a state-approved NATCEP program. This includes those LTC care facilities, or facilities in states that were granted an extension of the waiver after October 6, 2022.
- Requirements for Reporting related to COVID-19: Not all of these requirements expire. CMS is exercising enforcement discretion and will not expect providers to meet the requirements at 42 CFR 483.80(g)(3) at this time. All other reporting requirements referenced remain in effect until December 31, 2024.
- 42 CFR 483.80(g)(3): Inform residents, their representatives, and families of those residing in facilities by 5 p.m. the next calendar day following the occurrence of either a single confirmed infection of COVID–19 or three or more residents or staff with new-onset of respiratory symptoms occurring within 72 hours of each other.
- Requirements for COVID-19 Testing Expires: Testing regulation will expire with the end of the PHE, as noted in the IFC CMS-3414-IFC.
Source Document: Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE) (cms.gov)