Earlier this week, CMS issued guidance setting forth the process through which individual facilities, and statewide and countywide survey agency waivers could be approved when barriers exist that prevent the training, testing and certification of temporary and emergency nurse aides by the public health emergency (PHE) waiver sunset deadline of October 7th. Notification from our national affiliate, American Health Care Association, and the revised CMS guidance, QSO-22-15, is set forth below. Importantly:

CMS will review waiver requests in the following manner:

• Individual Facility waiver: When there are localized barriers to training/testing in a state or county not otherwise covered by a waiver, facilities may request a waiver by providing documentation of the barriers. The documentation must include information demonstrating that the aide(s) have attempted to become certified (e.g., enrollment in training or testing), but the NATCEP entity cannot accommodate the applicant(s) at this time.
  • Documentation should include the date(s) and contact(s) that the communication occurred between.
  • Documentation can be in the form of email, letters, or documentation of a phone call.
  • Documentation must show timely contacts to state officials.
  • Facilities should include the estimated date by which their aides will get certified.
• State-wide or County waiver: When there are widespread barriers to training/testing that are statewide or in a particular county within a state, the state agency may submit a request for the waiver for the affected jurisdiction. The state agency must provide documentation of the status of their NATCEP program and a plan for remedying the situation.
  • Documentation: At minimum, documentation of the status must include information on the number of aides that need to be certified, a description of issue causing barriers to certification (e.g., training or testing capacity), and the available capacity to certify aides (e.g., describe the gap between the number of aides that need to be certified and capacity available, the number of aides to be certified on a monthly or weekly basis, etc.).
  • Plan: At minimum, the plan to remedy the situation must include the actions the state will take to improve the rate at which aides are certified and a target date for all aides to be certified.

Waivers are time-limited, and CMS expects state agencies to actively work toward resolution of barriers to certification. CMS may require that state agencies provide progress reports on the submitted action plan to maintain the waiver.

A state or facility cannot attain or retain a waiver longer than the declaration of the PHE. CMS will grant these waivers for a timeframe that is as short as possible, and CMS will only grant these waivers while the declaration of a COVID-19 public health emergency is still in effect. If the PHE ends during or before the granted period of waiver for a facility or a state or a county, the waiver also ends.