COVID-19 PHE Ending – What Nursing Homes Need to Know re: Waivers & Regs

As noted on the CMSCG Blog in our post, “COVID-19 PHE Ending – Along with Waivers & Requirements for all Provider Types,” there are changes ahead for skilled nursing/long-term care providers due to the end of the COVID-19 Public Health Emergency (PHE).

Skilled Nursing/ Long Term Care Providers – What to Know

3-Day Prior Hospitalization – Changes May 12, 2023

The Medicare Part A 3-day qualifying hospital stay was waived as part of the PHE, but that all changes on May 12, 2023:

  • All new SNF stays beginning on or after May 12, 2023 will require a qualifying hospital stay before Medicare coverage.
  • For any new benefit period that begins on or after May 12, 2023, the beneficiary will need to have completed a 60-day wellness period.
Preadmission Screening and Annual Resident Review (PASARR) RequirementsResuming
  • The requirement for all nursing homes to admit new residents without a Level I or Level II Preadmission screening ends with the PHE.
  • Compliance with PASARR requirements is required for all admissions after May 11, 2023.

This means that residents with a mental illness (MI) or intellectual disability (ID) must have evidence in their medical records that PASARR Level I screening was completed prior to admission. If the Level I results in the need for a Level II, this must also be conducted prior to admission to the nursing home. States that allow the use of exceptions where a resident can remain in the facility for longer than 30 days must have evidence that these residents have a Level I screening and referral for a Level II – on or before the 30th day of admission.

Resident Roommates and Grouping for Illness – Ending

During the PHE, providers were allowed (and expected) to cohort residents solely related to COVID-19 status. As of May 11, 2023 when the PHE ends, this waiver also ends. The QSO Memo notes that a surveyor may need to consider whether a resident who was transferred due to COVID-19 related cohorting was allowed to return to his/her original room or to stay in the new room, based on room availability. This is to ensure compliance with the requirement that accommodation of room preference is not based on payment source.

Resident Transfer and Discharge Waivers – Ending

The waiver that allowed nursing homes to skip the usual advance notice requirements for transfer or discharge to another facility and/or provide written notice of transfer or discharge prior to the transfer/ discharge is also ending. As noted in the section above, surveyors are reminded about room changes and preferences.

Nurse Aide Training Competency and Evaluation Programs (NATCEP) – Resuming

During the PHE, many providers were able to take advantage of the waiver which allowed aides who had not met their training and certification requirements to be employed for more than four months. The need to ensure nurse aides are competent has been a focus of CMS, but the Agency also recognized that in many states, the number of approved training and testing programs (and their backlogs) was not sufficient to complete this timely. CMS is terminating all individual state and/or facility waivers at the end of the PHE (unless that waiver expires between now and May 11, 2023).

  • Uncertified nurse aides who are working in LTC facilities covered by a waiver have 4 months from the date the PHE ends (May 11, 2023) or from the termination date of the individual waiver, if earlier, to complete a state approved NATCEP program.
Alcohol-based Hand-Rub Dispensers (ABHR) Waiver – Ending

The waiver CMS allowed during the PHE related to ABHR dispensers ends at the termination of the PHE.

COVID-19 Specific Changes and Updates

Unfortunately, with the end of the COVID-19 Public Health Emergency, all things COVID-19 are not ending along with it. Here’s what you need to know.

Focused Infection Control (FIC) Surveys – Not Off the Table

State survey agencies are expected to conduct Focused Infection Control Surveys of 20% of providers in their states in 2023 per a standard set by CMS in an Administrative Memo.

For 2024, surveyors will not be required to conduct additional FIC surveys, but this survey type will remain available for States to use at their discretion. CMS notes that this survey type could be used to conduct a complaint survey when there are infection control concerns identified related to COVID-19.

COVID-19 Reporting Requirements – Changes Ahead

Any provider who hoped that COVID-19 reporting to NHSN and required notification to residents/ reps/ families would end with the PHE won’t be happy to hear that these requirements are not changing immediately.

  • The information reporting requirements related to NHSN are largely set to expire on December 31, 2024.
  • The requirement to provide COVID-19 reporting information to residents/ representatives/ families was supposed to be extended to December 31, 2024, but CMS has stated that it will not be enforcing the requirement at this time.
  • Reporting for staff and resident vaccination rates through NHSN remains permanently in place and will “continue indefinitely” unless rulemaking occurs to change this.
COVID-19 Testing Requirements – Changes Ahead
  • The requirement to perform routine testing of residents and staff for COVID-19 will expire at the end of the PHE.

Hooray, right? Nope. CMS notes in the QSO Memo that COVID-19 testing is still important to help identify and prevent the spread of COVID-19.

  • CMS still expects providers to conduct COVID-19 testing in accordance with accepted national standards, such as CDC recommendations.
CMSCG Survey Tip

COVID-19 testing is not going away entirely – facilities are expected to follow “accepted national standards” for testing. According to the new QSO Memo, non-compliance with this expectation will result in a citation at F880 Infection Prevention and Control. This testing is considered part of the requirement to implement and maintain an effective IPCP.

Accepted national standards include The Centers for Disease Control.

Education & Offering Residents & Staff the COVID-19 VaccineRemains in Place

  • An Interim Final Rule was issued on May 21, 2021, and the rule remains in effect for a 3-year period. That means that the requirement to educate about and offer both staff and residents the COVID-19 vaccine remains in effect until May 21, 2024, unless rulemaking occurs to change this.

For complete guidance, view the May 1, 2023 Centers for Medicare & Medicaid Services (CMS) QSO Memo, “Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE)” (QSO-23-13-ALL). Next up on the CMSCG Blog, we will review the contents of the QSO Memo impacting home health and hospice providers to highlight what you need to know.


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