Our therapy contract company recently notified us that their therapy staff will no longer be able to help cover nurse aide / CNA responsibilities. We don’t agree with this. The regulation did not change and there hasn’t been recent activity with waiver updates. Please help.


We have seen some fairly recent updates (April 7, 2022) in waivers that we’ll see come to full fruition early October. Early on in the pandemic, CMS waived the requirements at 42 CFR §483.35(d) (Nursing Services), which required that a SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements. CMS had waived these requirements to assist in potential staffing shortages seen with the COVID-19 pandemic. However, On April 7, 2022, CMS issued guidance (CMS QSO-22-15-NH & NLTC & LSC) announcing it was ending specific emergency declaration blanket waivers, this specific wavier being one of them. Based on this CMS guidance, effective June 6, 2022, no one would be allowed to enter employment under the blanket waiver exception, and facility staff assisting with nurse aide duties would have to become fully certified by October 6, 2022.

Further, there is a non-permanent employee clause (d)(2) that has caused some therapy contractors to implement updated policies related to assisting direct care tasks in the facility. If providers continue to rely on therapy staff assistance to cover the floor, I suggest engaging in discussion to determine possible responsibilities in which they can assist that may be carried out by non-direct caregivers as well (e.g., restorative and functional maintenance programs, resident feeding assist, meal pass, etc.).


Stacy Baker, OTR/L, CHC, RAC-CT
Director of Audit Services

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