The Centers for Medicare and Medicaid Services (CMS) released a policy memo Thursday, April 8, announcing the termination of several 1135 waivers related to resident transfers, care plans, and assessments. These waivers, implemented as a result of the COVID-19 public health emergency, will end on May 10, 2021. Additionally, CMS has offered details on how states may assist individuals currently employed under the nurse aide training waiver to transition to certified nurse aides. Details of these waivers and related compliance are discussed below. We note that the 3-day stay waiver has not been terminated and remains in effect at this time.

Notice of Transfer and Discharge

CMS is terminating the waiver at §483.15(c)(4)(ii) regarding notice of transfer of discharge. With the termination of this waiver, nursing homes must resume compliance with the requirement to provide notice to a resident and resident representative at least 30 days or as soon as practicable prior to transfer or discharge.

Resident Roommates and Grouping

CMS is terminating the waiver at §483.10(e)(6) regarding notice of roommate change. With the termination of this waiver, nursing homes must resume compliance with the requirement to provide notice to residents prior to change of room or roommate.

Timely Completion of Care Plans

CMS is terminating waivers at §483.21(a)(1)(i), (a)(2)(i), and (b)(1)(i) regarding timely completion of baseline and comprehensive care plans following admission. With the termination of this waiver, nursing homes must resume compliance with the requirement to complete baseline care plans within 48 hours of admission and comprehensive care plans within 7 days of completion of the comprehensive assessment.

Reporting Minimum Data Set (MDS)

CMS is terminating the waiver at §483.20 related to submission of the resident assessment, the Minimum Data Set (MDS). With the termination of this waiver, nursing homes must resume compliance with timely completion and submission of all required MDS assessments.

Training and Certification of Nurse Aides

CMS will not be terminating at this time the waivers at §483.35(d) related to training and certification of nurse aides. However, CMS has offered in this memo information on how to work with these staff in preparation of the eventual end of this waiver.

First, CMS recommends that states evaluate current requirements of state approved Nurse Aide Training and Competency Evaluation Programs (NATCEP) to determine if hours worked in the nursing home can be used to satisfy any of the state-approved NATCEP training requirements, including the federal 75-hour training requirement. CMS reminds states that required areas of training must be addressed and any areas that are not fulfilled through hours spent on-site at the nursing home must be fulfilled through supplemental training. CMS additionally reminds states that all nurse aides must pass the state’s competency exam.

Lastly, CMS clarifies that while the current waiver at §483.35(d) allows a nursing home to employ as a nurse aide for longer than 4 months an individual who has not completed a state-approved NATCEP, nursing homes should be working with these individuals now to create a plan for completing required training. Individuals currently working under this waiver will have 4 months from the date of the expiration of this waiver to complete all required training and certification requirements.

Important Notes

The waivers listed above are the only waivers being terminated at this time. All other federal blanket waivers, including the 3-day stay (Qualifying Hospital Stay) waiver as noted above, remain in effect. Federal blanket waivers will end with the expiration of the national public health emergency (PHE). The PHE is currently set to expire in April; however, the Biden Administration has expressed intent to continue to extend the PHE. Each extension covers 90 days and we anticipate that the PHE will be extended on or before its April expiration. More information on federal blanket waivers can be found here.