On April 8, 2021, the Centers for Medicare & Medicaid Services (CMS) released a QSO Memo that outlines changes to some of the active blanket waivers in place for the COVID-19 Public Health Emergency (PHE). May is just around the corner, so here’s a reminder that several waivers will end on May 10, 2021.
Emergency Blanket Waiver re: Notifying Residents Before Transfer or Discharge or Room or Roommate Changes
What’s in the QSO Memo: The requirements for providing notice in advance to residents prior to transfer or discharge and prior to room/roommate change were waived to permit facilities to make transfers or room changes after they had occurred for cohorting purposes. CMS notes in the QSO Memo that it believes facilities can effectively cohort residents now and provide the required advance notice, so on May 10, 2021, the regulations will go back to normal.
CMS notes in the QSO Memo that it believes facilities can effectively cohort residents now and provide the required advance notice, so on May 10, 2021, the regulations will go back to normal.
This means that facilities must provide 30-day advance notice (or as soon as practicable under certain scenarios allowed by the regulations) before a resident is transferred or discharged and that residents must be provided with advance written notice before a room/roommate change in line with regulatory requirements. The related waivers that allow facilities to transfer or discharge and/or change rooms for the sole purpose of cohorting residents will remain in effect.
Per the list of Waivers (updated 4/8/2021):
- Resident Roommates and Grouping. CMS is waiving the requirements in 42 CFR 483.10(e ) (5), (6), (Terminated effective on 05- 10-2021) (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 action waives a facility’ s requirements, under 42 CFR 483.10, to provide for a resident to share a room with his or her roommate of choice in certain circumstances, to provide notice and rationale for changing a resident’s room, and to provide for a resident’s refusal a transfer to another room in the facility. This aligns with CDC guidance to preferably place residents in locations designed to care for COVID-19 residents, to prevent the transmission of COVID-19 to other residents. (Terminated §483.10 (e)(6) effective on 05-10-2021).
- Resident Transfer and Discharge. CMS is waiving requirements in 42 CFR 483.10(c)(5); 483.15(c)(3), (c)(4)(ii), (Terminated effective on 05- 10-2021) (c)(5)(i) and (iv), (c)(9), and (d); and § 483.21(a)(1)(i), (a)(2)(i), and (b) (2)(i) (Terminated effective on 05- 10-2021) (with some exceptions) to allow a long term care (LTC) facility to transfer or discharge residents to another LTC facility solely for the following cohorting purposes:
- Transferring residents with symptoms of a respiratory infection or confirmed diagnosis of COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents;
- Transferring residents without symptoms of a respiratory infection or confirmed to not have COVID-19 to another facility that agrees to accept each specific resident, and is dedicated to the care of such residents to prevent them from acquiring COVID-19; or
- Transferring residents without symptoms of a respiratory infection to another facility that agrees to accept each specific resident to observe for any signs or symptoms of a respiratory infection over 14 days.
- These requirements are only waived in cases where the transferring facility receives confirmation that the receiving facility agrees to accept the resident to be transferred or discharged. Confirmation may be in writing or verbal. If verbal, the transferring facility needs to document the date, time, and person that the receiving facility communicated agreement.
- In § 483.10, we are only waiving the requirement, under § 483.10(c)(5), that a facility provide advance notification of options relating to the transfer or discharge to another facility. Otherwise, all requirements related to § 483.10 are not waived. Similarly, in § 483.15, we are only waiving the requirement, under § 483.15(c)(3),
(c)(4)(ii)(Terminated effective on 05-10-2021), (c)(5)(i) and (iv), and (d), for the written notice of transfer or discharge to be provided before the transfer or discharge. This notice must be provided as soon as practicable. (Terminated §483.15(c) (4)(ii) effective on 05-10-2021)
- In § 483.21, we are only waiving the timeframes for certain care planning requirements
for residents who are transferred or discharged for the purposes explained in 1–3 above. Receiving facilities should complete the required care plans as soon as practicable, and we expect receiving facilities to review and use the care plans for residents from the transferring facility, and adjust as necessary to protect the health and safety of the residents the apply to.(Terminated effective 05-10-2021)
- These requirements are also waived when the transferring residents to another facility, such as a COVID-19 isolation and treatment location, with the provision of services “under arrangements,” as long as it is not inconsistent with a state’s emergency preparedness or pandemic plan, or as directed by the local or state health department. In these cases, the transferring LTC facility need not issue a formal discharge, as it is still considered the provider and should bill Medicare normally for each day of care. The transferring LTC facility is then responsible for reimbursing the other provider that accepted its resident(s) during the emergency period.
- If the LTC facility does not intend to provide services under arrangement, the COVID-19 isolation and treatment facility is the responsible entity for Medicare billing purposes. The LTC facility should follow the procedures described in 40.3.4 of the Medicare Claims Processing Manual (https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/Downloads/clm104c06.pdf) to submit a discharge bill to Medicare. The COVID-19 isolation and treatment facility should then bill Medicare appropriately for the type of care it is providing for the beneficiary. If the COVID-19 isolation and treatment facility is not yet an enrolled provider, the facility should enroll through the provider enrollment hotline for the Medicare Administrative Contractor that services their geographic area to establish temporary Medicare billing privileges.
Emergency Blanket Waiver for Certain Care Planning Requirements
What’s in the QSO Memo: CMS waived the requirements for completion of a Baseline Care Plan within 48 hours of admission to the facility and Comprehensive Care Plan within 7 days of admission.
These waivers will expire on May 10, 2021 as well, so it’s time to ensure your processes for timely completion of the Baseline Care Plan and the initial CCP are back in action if you are not already doing this. CMS states in the QSO Memo that it believes most facilities have implemented processes for completion of these care planning requirements.
It’s time to ensure your processes for timely completion of the Baseline Care Plan and the initial CCP are back in action if you are not already doing this.
Per the Ftag Waiver Guide:
CMS is waiving 483.21(a)(1)(i), (a)(2)(i). In § 483.21, we are only waiving the timeframes for certain care planning requirements for residents who are transferred or discharged for the purposes for cohorting purpose. Receiving facilities should complete the required care plans as soon as practicable, and we expect receiving facilities to review and use the care plans for residents from the transferring facility, and adjust as necessary to protect the health and safety of the residents the apply to.
Emergency Blanket Waiver of MDS Timeframe Requirements
What’s in the QSO Memo: Completion and submission of MDS assessments within required timeframes had been waived so facilities could focus on infection control during the COVID-19 PHE. Per the QSO Memo, most facilities are completing and submitting within expected timeframes, so CMS feels this waiver can be terminated with the others on May 10, 2021.
Per the list of blanket waivers (4/8/2021):
Reporting Minimum Data Set. CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission. (Terminated effective 05- 10-2021)
Other Areas to be Aware of:
FYI re: Pre-Admission Screening and Annual Resident Review
What’s in the QSO Memo: CMS notes in the QSO Memo that the blanket waiver for PASARR is not being terminated at this time.
Per the Ftag Waiver Guide:
Per blanket 1135 waiver, CMS is waiving 42 CFR 483.20(k), allowing nursing homes to admit new residents who have not received Level 1 or Level 2 Preadmission Screening. Level 1 assessments may be performed post-admission. On or before the 30th day of admission, new patients admitted to nursing homes with a mental illness (MI) or intellectual disability (ID) should be referred promptly by the nursing home to State PASARR program for Level 2 Resident Review.
FYI re: Blanket Waiver for Nurse Aide Training and Certification
What’s in the QSO Memo: An emergency waiver permitting nurse aides to work longer than 4 months without having completed the required training has been in place to assist with staffing shortages throughout the COVID-19 PHE. This waiver will remain in place, however, CMS states that it is advising facilities that when the blanket waiver ends, the 4-month regulatory timeframe will be reinstated. At that time, nurse aides will have the full 4 months to successfully complete their training and become certified, regardless of how many months they worked during the PHE.
CMS recommends in the QSO Memo that States evaluate their Nurse Aide Training and Competency Evaluation Programs (NATCEP) to help enable more individuals to become CNAs. This is because many of the training topics that are required for the NATCEP could be obtained through on-site observation and working as a nurse aide throughout the PHE as part of the waiver. CMS is recommending that states consider allowing some of the time that nurse aides have worked during the PHE to be counted towards their training requirement but is not requiring states to do this.
Current Waivers List
The list of current waivers, for your reference, is located on the CMS Current Emergencies Webpage and is updated regularly. The current version is dated 4/9/2021. The Ftag Waiver Guide can be found in the CMS Survey Resources folder on this webpage.
For more information, view the April 8, 2021 QSO Memo, “Updates to Long-Term Care (LTC) Emergency Regulatory Waivers issued in response to COVID-19” (Ref: QSO-21-17-NH).