CMS Officials Confirm End of PHE Nursing Home Waivers, Barring Congressional Action

The Centers for Medicare & Medicaid Services (CMS) on Wednesday outlined the biggest waivers tied to the public health emergency – including those linked to the three-day inpatient stay requirement and temporary nurse aides – would indeed be ending on May 11.

Any sort of permanent implementation of these waivers, would need to be carried out through Congress, officials said during a nursing home stakeholder call, one of many prior to the end of the PHE in three months.

“The best answer I can give you is to contact your congressman because this is a statutory requirement, this is not something that we are able to exercise our authority to waive permanently,” said John Kane, technical advisor and SNF payment team lead for CMS, referring to the suspension of the three-day hospital stay.


Medicare patients usually need to stay at a hospital for at least three days before they can be discharged to a SNF and not incur out-of-pocket costs.

Nursing home advocates sent letters to Congressional leaders earlier this month, urging lawmakers to end the requirement, especially amid the ongoing staffing crisis.

The Improving Access to Medicare Coverage Act was introduced in the Senate in June 2021, but no movement has been seen since.


The agency is allowing SNFs to use the waiver right down to the last day. If a Medicare patient begins a Part A stay on or before May 11, and they meet all other criteria necessary for a Part A stay, that person would fall under the waiver, Kane said.

If their benefits expire on May 12 or after, the waiver wouldn’t be available to them.

Providers can expect another update “today or tomorrow” to the CMS roadmap first issued in August, offering guidance for those in the industry after the end of the PHE, Jean Moody-Williams said during the call. Moody-Williams serves as deputy director of the Center for Clinical Standards and Quality.

“We will have to unwind all that information in the CMS emergencies page. We intend to issue more formal communication about the disposition of those waivers and requirements,” added Evan Shulman, director for the division of nursing homes with CMS.

As of publication, Skilled Nursing News didn’t see an update to guidance from the agency.

Clock’s ticking on TNA certification

Turning to the temporary nurse aide waiver, officials said any extensions would end with the PHE.

The original TNA waiver allowed trainees to continue working at facilities past four months without certification. CMS ended the waiver as of June 2022, but granted exemptions to certain facilities and states that “demonstrated exceptional barriers to having aides trained and certified,” said Shulman.

All TNA waivers, including these exceptions, will end on May 11, he said.

That means facilities will have until September 10 to get their TNAs trained and certified.

Shulman spent some time reviewing new requirements started as part of the PHE along with waivers, including staff vaccination requirements, requirements to offer and educate individuals on the vaccine, testing requirements, and reporting through the [National Healthcare Safety Network] NHSN.

Such requirements – or interim final rules – remain in effect until 2024, unless CMS takes further regulatory action, Shulman said. That’s Nov. 5 2024 for vaccine requirements, May 2024 to offer and educate on the vaccine, and Dec. 31 2024 for NHSN reporting.

CMS officials essentially want these requirements to become part of everyday operations.

“While the public health emergency is ending, the need to protect ourselves and nursing home residents from COVID-19 does not,” said Shulman. “It’s just not an emergency situation. Rather, it’s part of our normal operations.”

CMS said nursing homes should after three years be familiar with best practices to help reduce the spread of Covid-19. The agency expects those in the industry to continue employing those practices.

Future ownership disclosures

Adam Rubin, technical advisor in the Center for Program Integrity, took some time on Wednesday to outline the latest ownership reporting requirements for nursing homes announced on Feb. 13.

The biggest change relates to disclosure of persons or entities who provide financial management services or clinical consulting services to nursing homes. They will need to be listed in ownership data to CMS, Rubin said.

This information would need to be reported as part of a change in ownership as well.

CMS would also define private equity and real estate investment trusts (REITs) via the updated nursing home enrollment application due to be released in the summer of 2023.

Nursing home ownership and additional disclosable party data will be made available to the public within one year of the final rules publication, Rubin said.

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