Declaration of Blanket Waivers for SNFs

On 7th April 2022, in response to the COVID-19 PHE and under section 1135 of the Social Security Act, CMS passed several temporary emergency declaration blanket waivers which were intended to provide health care providers with extra flexibilities required to respond to the COVID-19 pandemic. While the waivers of regulatory requirements have provided flexibility in how nursing homes may operate, they have also removed the minimum standards for quality that help ensure residents’ health and safety are protected. 

Declaration of Blanket Waivers

Recently, CMS conducted some surveys that revealed significant concerns with resident care that are unrelated to infection control (e.g., abuse, weight loss, depression, pressure ulcers, etc.). Waiver of certain regulatory requirements may have contributed to these outcomes and raised the risk of other issues. For example, by waiving requirements for training, nurse aides and paid feeding assistants may not have received the necessary training to help identify and prevent weight loss. Similarly, CMS waived requirements for physicians and practitioners to perform in-person assessments, which may have prevented these individuals from performing an accurate assessment of the resident’s clinical needs, contributing to depression or pressure ulcers. As a result, CMS has terminated certain waivers.

Terminated Waivers

CMS is ending the specific emergency declaration blanket waivers for SNFs/NFs, inpatient hospices, ICF/IIDs, and ESRD facilities. The termination of these blanket waivers will have no effect on other blanket waivers that remain in places such as those for hospitals and CAHs. Providers are expected to take immediate steps so that they may return to compliance with the reinstated requirements according to the mentioned timeframes. 

Waivers Ending in 30 Days

  • CMS waived the requirements which ensure residents can participate in-person in resident groups. This waiver permitted the facility to restrict in-person meetings during the COVID-19 PHE.
  • CMS waived the requirement that prevents a physician from delegating a task when the regulations specify that the physician must perform it personally. 
  • CMS waived the requirement that all required physician visits must be made by the physician personally. 
  • CMS waived the requirement for physicians and non-physician practitioners to perform in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth options. 
  • CMS modified certain requirements which require long-term care facilities to develop, implement, evaluate, and maintain an effective, comprehensive, data-driven QAPI program. 
  • CMS waived the discharge planning requirement which requires LTC facilities to assist residents and their representatives in selecting a post-acute care provider using data, such as standardized patient assessment data, quality measures, and resource use. 
  • CMS modified the requirement which requires long-term care (LTC) facilities to provide a resident a copy of their records within two working days (when requested by the resident).

Waivers Ending in 60 Days

  • CMS waived requirements to allow for a non-SNF building to be temporarily certified and available for use by an SNF in the event there were needs for isolation processes for COVID-19 positive residents, which may not be feasible in the existing SNF structure to ensure care and services during treatment for COVID19, provided that the state has approved the location as one that sufficiently addresses safety and comfort for patients and staff.
  • CMS waived the requirement for on-time preventive maintenance of dialysis machines and ancillary dialysis equipment. Additionally, CMS waived the requirements for ESRD facilities to conduct on-time fire inspections.
  • CMS waived ITM requirements for facility and medical equipment to reduce the disruption of patient care and potential exposure/transmission of COVID-19.
  • CMS modified the nurse aide training requirements for SNFs and NFs, which required the nursing assistant to receive at least 12 hours of in-service training annually.
  • CMS waived the requirements which require that an SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements.

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Reference: Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers