Federal Waivers on Transfer Notices, Care Planning, and MDS Assessments to Expire on May 10, 2021

On April 8, 2021, the federal Centers for Medicare & Medicaid Services (CMS) issued QSO 21-17, announcing that it will end the following federal emergency blanket waivers for nursing facilities as of May 10, 2021:

• Transfer and Discharge Notification Requirements (42 CFR §483.15(e)(4)(ii));
• Resident Room or Roommate Changes (42 CFR §483.10(e)(6));
• Care Planning Requirements (§483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i)); and
• Minimum Data Set Timeframe Requirements (42 CFR §483.20).

CMS also provided clarification regarding the training and certification of Certified Nurse Aides (CNA), without ending the waiver that allows individuals to perform CNA tasks for more than four (4) months (but no more than eight (8) months as required under the state waiver), as outlined in more detail below.

As of May 10, the corresponding state waivers for nursing faclities will no longer be applicable.  IHCA/INCAL expects the Indiana Department of Health (IDH) to discontinue the corresponding residential care facility waivers that are addressed in this article at that time as well but will continue to keep you updated.

Notifying Residents before Transfer, Discharge, or Room or Roommate Change

The emergency blanket waivers that allowed notice to occur after a transfer, discharge, or room or roomate change will expire as of May 10.  At that time, nursing facilities will be required to resume providing 30 days advanced notice, or notice as soon as practicable, before the transfer or discharge of a resident and/or before a room or roommate change occurs.  Importantly, if 30 days’ notice cannot be provided as a result of swift cohorting action, notice must just be provided before the transfer, discharge, or change, and as soon as practicable.

QSO 21-17 also makes clear that CMS is still permitting transfers, discharge, and room or roommate changes for cohorting purposes; notice must just resume occurring 30 days in advance or as soon as practicable.

Care Planning Requirements

The emergency blanket waiver that waived the requirement that a baseline care plan must be created within 48 hours of admission and that a comprehensive care plan be created within seven (7) days of admission will expire as of May 10 as well, and such care plans will be required to established within those timeframes once again.

Minimum Data Set Timeframe Requirements

The emergency blanket waiver that waived the timeframe requirements for Minimum Data Set (MDS) assessments will also expire as of May 10, requiring the MDS assessments to be submitted within the applicable timeframes under federal regulation.  In QSO 20-17, CMS notes that the majority of nursing facilities are already submitting the MDS assessments within the normal timeframes.

Importantly, CMS is not ending the waiver at 42 CFR §483.20(k) related to the Pre-Admission Screening and Annual Resident Review (PASARR) at this time.  The PASARR waiver states that after 30 days, such assessments should take place “as soon as resources are available.”

Training and Certification of Nurse Aides

CMS also provided clarification regarding the training and certification of Certified Nurse Aides (CNA), without ending the waiver that allows individuals to perform CNA tasks for more than four (4) months (but no more than eight (8) months as required under the state waiver)(if individuals/facilities run into the eight (8) month limit under state wavier, some flexibility may be obtained.  Contact Nancy Adams at nadams1@isdh.in.gov).  QSO 20-17 states that when the emergency blanket waiver that allows an individual to perform CNA tasks for more than four (4) months eventually ends, individuals who are not certified at that time will have four (4) months from the date that the emergency blanket waiver ends to become certified.  In other words, those individuals will not have to be certified the day the emergency blanket waiver ends but will have four (4) months from that date to do so.

For more information on IDH’s pathways for individuals to become CNAs during the public health emergency, please click here.