As the federal government edges closer to ending the PHE, CMS unveiled a “cross-cutting initiative” that will evaluate public health emergency blanket waivers and flexibilities – in hopes of preparing the health care industry for operation post-PHE.
The Centers for Medicare & Medicaid Services (CMS) issued a PHE roadmap of sorts on Thursday, reminding nursing home providers, among other health care sectors, of what waivers are still in place and which ones have been terminated already.
Currently, CMS is assessing the need for continuing certain blanket waivers and flexibilities, determining which ones would be most useful if the PHE needs to be implemented again and working with federal partners and industry leaders to make sure the health care system is prepared to address future emergencies.
One of the major waivers still in place for nursing homes – the three-day stay waiver – will be in effect until the end of the Covid-19 PHE, CMS said in its roadmap.
Suspension of the requirement allows Medicare patients to be discharged to a skilled nursing facility without having to stay at a hospital for at least three days.
Without the waiver, patients transferred from a hospital to a SNF in fewer than three days would have incurred out-of-pocket costs. The federal agency initially waived the requirement to free up hospital beds at the onset of the pandemic.
“Many of these waivers and broad flexibilities will terminate at the eventual end of the PHE, as they were intended to address the acute and extraordinary circumstances of a rapidly evolving pandemic and not replace existing requirements,” CMS officials said in a blog post.
There are some waivers CMS plans to keep in place even after the PHE ends in order to “promote innovation, maintain or improve quality, advance health equity and expand access to care.”
Nursing homes will be required to continue reporting resident and staff infections and deaths related to Covid-19 after the PHE ends, specifically through 2024; the requirement was baked into the SNF final rule.
Failure to report Covid-related infections and deaths will result in civil monetary penalties of $1,000 for the first occurence and $500 for each subsequent occurrence, CMS said.
Expanding telehealth is another major flexibility that will continue past the PHE, CMS said, through congressional change. The Consolidated Appropriations Act of 2021 expanded telehealth services for diagnosis, evaluation or treatment of mental health disorders.
Moving ahead, CMS’s strategic plan will ensure providers are more resilient and better prepared to adapt in the event of another health emergency, according to the agency.
Among the terminated waivers was one that allowed temporary nurse aides (TNAs) to work longer on the front lines prior to taking their certification exam. Another allowed a non-SNF building to be used temporarily by an operator for Covid isolation processes.
“Recent onsite LTC survey findings provided insight into issues with resident care that are unrelated to infection control, such as increases in residents’ weight-loss, depression, and incidence of pressure ulcers,” CMS officials noted. “As a result, it was determined that the lack of certain minimum standards, such as training for nurse aides, may be contributing to these issues.”
Two more terminated waivers related to data collection and submission – one allowed SNFs to ignore timeframe requirements for Minimum Data Set (MDS) assessments and transmission. Another delayed reporting staffing data to the Payroll-Based Journal (PBJ) system.
Federal government officials have promised to notify states and health care providers two months ahead of discontinuing the PHE.
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