Waiver Status for the SNF

CMS is starting to phase 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. There were multiple emergency waivers issued that impacted the skilled nursing facility setting (SNF), including access to Medicare benefits, staffing, training and life safety.

CMS released a memorandum to State Survey Agency Directors on 4/7/22 with the subject line “Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers,” outlining the components that will expire in the next 30 or 60 days.

CMS is currently focusing on restoring the rules that impact quality care and ensure resident health and safety first.

Why?

CMS reports that findings from onsite surveys revealed significant concerns with resident care , including abuse, weight-loss, depression and pressure ulcers, to name a few. CMS relates the waiver of certain regulatory requirements for the extended period of time as contributing to these negative outcomes and seeks to restore the standards for quality care.

CMS updated the status of each waiver in red on a prior-released document. View the document HERE. SNF specific information can be found on pages 16-22.

Here are the highlights impacting SNF professionals directly from the document:

Waivers Set to Expire on May 7th (30 Days)

Resident Groups:

In-Person Physician Visits / Telehealth:

Physician Services:

Discharge Planning:

Medical Records:

QA/QAPI Rules:

• CMS modified certain requirements which require long-term care facilities to develop, implement, evaluate, and maintain an effective, comprehensive, data driven QAPI program. This waiver gave providers the ability to focus on adverse events and infection control, and those aspects of care delivery most closely associated with COVID-19 during the PHE.

Waivers Set to Expire June 6th (60 Days)

Nurse Aide Training and Certification:

Paid Feeding Assistants:

Physical Environment and Life Safety:

• Waivers for multiple requirements falling in the following categories for the SNF will also expire: Physical Environment, Facility and Medical Equipment Inspection, Testing & Maintenance (ITM), Life Safety Code (LSC) and Health Care Facilities Code (HCFC) ITM, Outside Windows and Doors, and Life Safety Codes. Specifics can be found on page 3 and 4 HERE

Waivers with No Set Expiration – Yet

SNF MDS and therapy professionals are on the look-out for status changes with the Qualifying Hospital Stay (QHS) and Benefit Period Waivers (BPW). As of yesterday’s memorandum, CMS has left these intact for now, as well as the PASARR requirements, both outlined here:

3-Day Qualifying Hospital Stay and 60-Day Benefit Period Waiver:

PASARR:

What Can Be Expected Next?

The next 30-60 days will be an adjustment for SNFs, as many of these waivers have been in place for 2 years, and overall staffing 2 years ago looked much more promising than it looks now, with documented significant national shortages in the SNF.

Along with these waiver changes, the declaration that a PHE exists nationwide, last renewed for the 8th time on January 14, 2022 by the Secretary of Health and Human Services (HHS), is set to expire on April 15th. The PHE will likely be renewed for the 9th time, as the Secretary of HHS indicated in previous communication to governors, that “when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination.”

The remaining pieces of the waiver, in particular, the Qualifying Hospital Stay and Benefit Period waivers, may or may not make it until the end of the PHE if renewed for another 90 days. We will need to wait to see if the PHE is renewed, and if it is, then keep an eye out for an early termination potentially at the 60-day mark.

Bookmark this HHS.gov page to keep an eye out for the PHE declarations.

Resources for waiver information and waiver status to date can be found here:

As always, thank you for all of your hard work and dedication to the geriatric population.

If you have any questions, send them in via the Just Ask Q&A  tab.

In Your Corner,

Dolores

Dolores Montero, PT, DPT, RAC-CT, RAC-CTA

SNF Therapy & MDS Resource Team