A CLOSER LOOK: waivers for healthcare providers during COVID-19

A Closer Look

Nursing home rule changes during the pandemic

Photo courtesy Breanne Ahearn.

ARKANSAS (KNWA/KFTA) — COVID-19 is the reason for relaxed enforcement at nursing homes across the state — and nationally, according to a summary by National Consumer Voice for Quality Long-Term Care.

On March 28, 2020 (retroactive to March 1, 2020), and again updated on April 21, 2020, the Centers for Medicare and Medicaid Services (CMS) announced waivers of federal regulations that are now in effect. The waivers will be active until the end of the emergency declaration.

These are “blanket” waivers, which means that no request or notification of CMS is required.

COVID-19 EMERGENCY DECLARATION BLANKET WAIVERS FOR HEALTH CARE PROVIDERS

TRANSFERS/DISCHARGES/BED HOLD

  • Transfer and discharge between facilities for purposes of separating residents who are COVID positive/negative/uncertain status may be done as soon possible instead of before the transfer/discharge. It is urged for providers to give as much advance notice as possible.
  • Transferring facilities do not have to give a resident notice before moving them to another room in the facility. A resident cannot refuse a transfer. This waiver only applies to transfers for those with COVID-19 or symptoms and separate them from those who have no symptoms.
  • A bed hold notice may be given as soon as possible instead of before and at the time of transfer. Prior to COVID-19, a notice of bed hold rights had to be provided twice: in advance of hospitalization and at the time of transfer to a hospital, according to Consumer Voice for Quality Long-Term Care.
  • As of April 21, Long Term Care facilities do not have to assist the resident and their representatives in selecting a post-acute care provider using standardized patient assessment data, quality measures, and resource use. CMS says the reason for this waiver is so facilities may quickly discharge and move residents among care settings.

TRAINING AND CERTIFICATION OF NURSE AIDES

  • Individuals working as nurse aides for more than four months do not have to meet the mandated training and certification requirements. They may continue on the job IF the facility finds them to be competent to provide nursing services. This waiver was created to help facilities should there be staff shortages.
  • As of April 21, The requirement for certified nursing assistants to complete at least 12 hours of in-service training annually is waived until the end of the first full quarter after the pandemic concludes.

RESIDENT ROOMMATES, GROUP AND RESIDENT GROUPS

  • The facility may place residents in rooms without honoring resident choice or roommate. For resident grouping, the facility does not have to give a notice or rationale for changing a roommate or moving them to another room in the facility.
  • Residents cannot refuse to move to another room (but only if the move is COVID-19 related).
  • Resident groups (councils) cannot meet in-person, however, there are creative ways to keep a resident council going, according to CMS, but none was listed on the summary report.

CARE PLANNING

  • Baseline care plans and comprehensive care plans must be developed as soon a possible.
  • Prior to the waiver, the time frame of completion for a baseline care plan was within 48 hours of admission and seven days for a comprehensive care plan.
  • If facilities choose to use the comprehensive care plan as the baseline care plan, the time frame of completion within 48 hours of admission is waived for residents transferred for COVID-related reasons.

PHYSICAL ENVIRONMENT

  • A skilled nursing facility (SNF) can use a non-SNF building for purposes of isolating residents who are COVID-positive. The building will be temporarily certified. The buildings would serve as COVID-19 isolation and treatment locations. CMS will also waive other requirements for opening a facility.

3-DAY HOSPITALIZATION

  • A 3-day hospital stay is not required for Medicare SNF coverage for someone affected by COVID-19. This waiver allows for increased access to skilled nursing facility care for Medicare beneficiaries needing COVID-related care.

DATA SUBMISSION

  • The time frames for completion and submission of Minimum Data Set (MDS) have been waived/relaxed, but must still be completed and submitted.
  • Facilities do not have to submit staffing data through the Payroll-Based Journal during the pandemic.
  • Facilities must still post nurse staffing data on a daily basis at the beginning of each shift.
  • MDS assessments are usually completed every three months on nearly all residents of nursing homes in the U.S.

PHYSICIAN VISITS AND SERVICES

  • Physicians can visit using telehealth instead of in-person. Staff is encouraged to make sure accommodations are made for residents who are hard of hearing, visually-impaired, cognitively-impaired, or have other conditions that may make video conferencing challenging.
  • As of April 21, a physician can delegate conducting visits and other tasks to a nurse practitioner, physician assistant, or clinical nurse specialist who is not an employee of the facility.
  • The requirements for frequency of physician visits are not waived.
  • A physician must still supervise the resident’s medical care and must continue to be available 24 hours a day in case of an emergency.

PRE-ADMISSION SCREENING AND ANNUAL RESIDENT REVIEW

  • Screenings do not have to be done prior to admission or within the first 30 days. This frees up hospital beds since individuals will not have to wait for the screening to be completed before they are admitted to a nursing home, according to CMS.

QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT

  • The scope of the Quality Assurance and Performance Improvement program will be narrowed to focus exclusively on adverse events and infection control, this waiver was put into place on April 21. This allows facilities to concentrate on aspects of care delivery associated most closely with COVID-19, according to the CMS summary.

CLINICAL RECORDS

  • Long Term Care facilities will have 10 working days to provide a resident a copy of their records upon request, rather than two working days.
  • This waiver applies to a resident’s request to obtain a copy of their records. It does not apply to a resident’s right to access their records, which still must be provided upon request or within 24 hours under certain, limited circumstances.
  • It will take longer for a resident representative to obtain records. If a resident representative is having difficulty learning about the resident’s status, they may contact the long-term care ombudsman for assistance.

Arkansas has 227 nursing homes. As of July 7, there are 117 nursing home residents with COVID-19, according to Governor Asa Hutchinson’s daily pandemic briefing. There are 111 nursing home deaths, and more than 300 health care workers are positive with the virus, according to the Arkansas Department of Health’s report from July 6.

Resources/information about COVID-19 for more information about this report.

A CLOSER LOOK: COVID-19 nursing home deaths; visitor reopening plan

For more feature stories like this visit KNWA/FOX24 homepage, A CLOSER LOOK

Copyright 2020 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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