The Centers for Medicare and Medicaid Services will phase out pandemic-related temporary waivers to nursing home regulations, the agency announced Thursday.
The changes are being made because COVID-19 vaccination rates for residents and employees are increasing and nursing homes are better able to handle outbreaks, the agency said in a news release.
"We've learned a lot from the pandemic over the last two years and are committed to using that knowledge to re-envision the next chapter of healthcare quality and patient safety and build a stronger healthcare system," CMS Administrator Chiquita Brooks-LaSure said in the news release.
In a memo sent to state regulators Thursday, CMS lists the temporary waivers that will end in 30 or 60 days. Those include:
- Allowing physicians to delegate tasks to physician assistants, nurse practitioners and clinical nurse specialists (30 days);
- Waiving requirements for residents to have access to in-person resident groups (30 days);
- Permitting physicians and other practitioners to perform telehealth visits for residents instead of in-person appointments (30 days);
- Waiving training requirements for nurse aides and paid feeding assistants (60 days);
- Allowing rooms not usually used for residents to be converted during surge periods (60 days).
Recent findings have shown fluctuations in residents' weight and increases in depression and pressure ulcers may be tied to a "lack of certain minimum standards," according to CMS.
"By ending some of the temporary waivers, CMS is helping nursing homes to redirect efforts back to meeting the regulatory requirements aimed at ensuring each resident's physical, mental and psychosocial needs are met," the agency said in the news release.
CMS will continue to offer state-based, county-based, or facility-based temporary waivers while the national public health emergency continues. For example, the agency will allow further flexibility to nursing homes that document capacity issues in training or testing for nurse aide certifications.
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The public health emergency is set to expire April 16 unless President Joe Biden renews it for another 90 days. But the Health and Human Services Department has committed to giving at least 60 days' notice, so it is unlikely to end before summer.
The pandemic isn't over, so CMS's actions are premature, said Holly Harmon, senior vice president of quality, regulatory and clinical services for the American Health Care Association, which represents nursing homes.
"State capacities are not sufficient to accommodate the training and testing needs for thousands of temporary nurse aides in this short time frame," Harmon wrote in an email. "These actions may further limit access to care for residents, as facilities may be forced to limit the number of residents they can serve due to staffing shortages."
Nursing homes lost 2,500 jobs in March and have experienced a downward trend in employment throughout the pandemic.
LeadingAge, an association of not-for-profit providers, also is concerned about a staffing crunch, said Janine Finck-Boyle, vice president of regulatory affairs.
"Although the waiver ends, workforce challenges have not. There is no current plan to help nursing homes with staffing," Finck-Boyle wrote in an email. "The reality is that we are looking for workers that, at the present time, don't exist," she wrote.
The CMS decision is "disappointing," said Nan Impink, a spokesperson for long-term care provider SavaSeniorCare Administrative and Consulting. We will have to regroup and determine next steps," she wrote in an email.
