This week CMS announced blanket Coronavirus waivers and flexibilities impacting multiple provider types including nursing facilities and a 221-page Interim Final Rule adjusting a wide range of Medicare and Medicaid regulations to give providers additional flexibility to respond to the COVID-19 pandemic.  The waivers are retroactive to March 1 and will be effective through the duration of the declared national public health emergency.

Updates for LTC/SNF:

  • Training and Certification of Nurse Aides:  To assist with staffing shortages, CMS is waiving the requirements which prohibit a SNF from employing a Nurse Aide for longer than four months unless they met the training and certification requirements under §483.35(d).  The waiver allows temporary employment of persons who have completed alternative training programs, so long as they demonstrate competence in providing nursing-related services.

Note: AHCA/NCAL has made available an 8-hour web-based Temporary Nurse Aide training module which is FREE to all providers once state licensing and regulatory requirements are received. Access the training here.

  • Physician Visits in SNF (certification and re-certification visits–30/60/90 day): CMS is waiving the requirement for physicians and non-physician practitioners to perform in-person visits for nursing home residents and will allow visits to be conducted, as appropriate, via telehealth options.
  • Payroll-Based Journal (PBJ) Submissions: CMS will provide relief to SNFs on the requirements for submitting staffing data through the Payroll-Based Journal system.
  • Resident roommates: Requirements providing for residents to share a room with the roommate of choice, to provide notice/rationale for room changes, and providing for refusal of a resident to transfer to a different room in the facility have been waived
  • Physical Environment Updates, Patient Transfers and other Updates Related to Surge Preparation: CMS will allow a SNF to move residents within a facility, or transfer resident(s) to another SNF solely for the purposes of cohorting and separating residents with and without COVID-19.
        • Non-SNF Building Temporary Conversion-With State prior approval of the location, CMS will allow non-SNF buildings to be temporarily certified as and available for use by a SNF in the event there are needs for isolation processes for COVID-19 positive residents which may not be feasible in the existing SNF structure to facilitate care for COVID-19 patients while protecting other residents.  [Note-This waiver would assist campuses who may want to utilize other resident spaces like assisted living and independent living to provide more space for isolation of residents subject to state approval.]
        • Temporary New SNF –CMS will waive certain conditions of participation and certification requirements for opening a SNF if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location.
        • Non-Resident Room Space for Surge Capacity-To assist with isolation needs, CMS will temporarily allow rooms in SNF not normally used as a resident’s room (e.g. conference rooms) to be used as resident rooms to facilitate surge capacity as long as residents can be kept safe, comfortable, and other applicable requirements for participation are met. Facilities must ensure implementation is consistent with state emergency preparedness or pandemic plan, or as directed by the local or state health department.
  • CMS Facility without Walls (Temporary Expansion Sites):  A SNF can temporarily transfer its COVID-19 positive resident(s) to another facility, such as a COVID-19 isolation and treatment location, with the provision of services “under arrangements.” The rule details how the transfer and billing will work in these situations.  Under arrangement, the transferring facility is responsible for reimbursing the other provider that has accepted the resident during the emergency period.  This measure supports CDC guidance to place COVID-19 positive patients into facilities equipped to care for them while protecting other vulnerable nursing residents.
  • Resident Transfer and Discharge: Some of the requirements related to transfer and discharge of residents to other facilities for the purpose of cohorting have been updated; note: there are several exceptions for these waivers (see pg. 11 of the CMS document)
  • Waive Pre-Admission Screening and Annual Resident Review (PASRR): CMS is allowing states and nursing homes to suspend these assessments for new residents for 30 days (review state-specific guidance.)
  • Resident Groups: CMS is temporarily waiving the requirement regarding resident participation in in-person resident groups in order to comply with social distancing guidelines.
  • Provider Enrollment: CMS has established toll-free hotlines for all providers to enroll and receive temporary Medicare billing privileges. CMS is also waiving certain screening requirements, postponing all revalidation actions, and expediting all pending and new applications.
  • Cost Reporting: While MACs had previously made a decision on cost reporting deadline extensions, CMS is delaying the filing deadline of certain cost report due dates as part of the blanket waiver.  As such, the FYI 10/31/2019 cost report previously due 3/31/2020 is now due 6/30/2020
  • 3 Day hospitalization and Spell of Illness waivers: CMS reiterated the national, blanket waiver regarding waiving the requirement for a 3-day prior hospitalization for SNF coverage as announced 3/13/2020. This waiver provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who experience dislocations or are otherwise affected by this emergency. In addition, for certain beneficiaries who exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period and waived timeframe requirements for Minimum Data Set assessments and transmission.  Note: on the 3/31/2020 CMS call, CMS stated that the entire nation is under an emergency declaration and that a resident does not have to be impacted directly by COVID-19 for this waiver to apply. The goal of the waiver is to assist hospitals in managing surge capacity nationally and all communities are considered impacted by the pandemic. Medicare criteria for determining medical necessity and skill need have not changed and must be applied to all decisions for skilled services.