The Centers for Medicare & Medicaid Services (CMS) (@CMSGov) is taking steps to continue to protect nursing home residents’ health and safety by announcing guidance that restores certain minimum standards for compliance with CMS requirements. Restoring these standards will be accomplished by phasing out some temporary emergency declaration waivers that have been in effect throughout the COVID-19 Public Health Emergency (PHE). These temporary emergency waivers were designed to provide facilities with the flexibilities needed to respond to the COVID-19 pandemic.
During the PHE, CMS used a combination of emergency waivers, regulations, and sub-regulatory guidance to offer health care providers the flexibility needed to respond to the pandemic. In certain cases, these flexibilities suspended requirements in order to address acute and extraordinary circumstances. CMS has consistently monitored data within nursing homes and has used these data to inform decision making.
With steadily increasing vaccination rates for nursing home residents and staff, and with overall improvements seen in nursing homes’ abilities to respond to COVID-19 outbreaks, CMS is taking steps to phase out certain flexibilities that are generally no longer needed to re-establish certain minimum standards while continuing to protect the health and safety of those residing in skilled nursing facilities/nursing facilities (SNFs/NFs). Similarly, some of the same waivers are also being terminated for inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end-stage renal disease (ESRD) facilities.
“Patient and resident health and safety are top priorities for CMS, and today’s actions are focused on ensuring every nursing home resident is cared for in a safe, high-quality environment,” said CMS Administrator Chiquita Brooks-LaSure. “We’ve learned a lot from the pandemic over the last two years and are committed to using that knowledge to re-envision the next chapter of health care quality and patient safety and build a stronger health care system.”
Recent onsite long-term care (LTC) survey findings have provided insight into issues with resident care that are unrelated to infection control, such as increases in residents’ weight-loss, depression, and pressure ulcers. The lack of certain minimum standards, such as training for nurse aides, may be contributing to these issues. By ending some of the temporary waivers, CMS is helping nursing homes to redirect efforts back to meeting the regulatory requirements aimed at ensuring each resident’s physical, mental, and psychosocial needs are met. In addition, CMS expects providers to have integrated practices to address any COVID-19 outbreaks into their normal operations.
CMS will maintain flexibility for certain requirements, such as making temporary waivers available for nurse aides’ certification if there are documented capacity issues in training or testing programs, and CMS will retain the ability until the expiration or termination of the national COVID-19 PHE to issue individual state-based, county-based, or facility-based waivers as needed. Centers for Disease Control & Prevention and CMS data, tracking trends in the number of COVID-19 cases in local communities and nursing homes, provide CMS with the ability to grant waivers in specific situations. For example, if there is a severe outbreak in a facility or geographically distinct group of facilities, CMS can quickly grant waivers to support the facilities’ response to COVID-19. If there is a nationwide surge of nursing home COVID-19 cases in the future, CMS can quickly re-issue national blanket waivers during the PHE.
CMS is ending specific waivers in two groups: one group of waivers will terminate 30 days from the issuance of this new guidance, and the other group will terminate 60 days from issuance. These timeframes give providers and state agencies time to adjust their operations to the reinstituted requirements.
Details can be found in the Quality, Safety, and Oversight (QSO) memo.