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What special federal waivers are available specific for skilled-nursing facilities (SNFs)?
Federal legislative and regulatory action has included several important provisions affecting SNFs. As the crisis continues and additional areas emerge, additional waivers may be forthcoming.
CARES Act: On March 26, President Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which includes measures of particular importance to hospitals, including SNFs.
- Infection control: The CARES Act provides $200 million to assist nursing homes with infection control and support states’ efforts to prevent the spread of coronavirus.
March 27 Blanket Waivers: In response to a request from CHA, the Centers for Medicare & Medicaid Services (CMS) issued several blanket 1135 Medicare waivers in addition to those previously issued.
- Staffing Data Submission: CMS is providing relief to long-term care facilities on the requirements for submitting staffing data through the Payroll Based Journal system.
- Pre-Admission Screening and Annual Resident Review (PASARR): CMS is waiving the following requirements related to PASARR for nursing home residents who may also have a mental illness or intellectual disability:
- Level I screens are not required for residents when they are being transferred between nursing facilities (inter-facility transfers) and staff cannot enter nursing facilities due to quarantine.
- Level II evaluations and determinations are also not required preadmission when residents are being transferred between nursing facilities. Residents who are transferred will receive a post admission review, which must be completed as resources become available.
- Physical Environment:Provided the state has approved the location as one that sufficiently addresses safety and comfort for patients and staff, CMS is waiving requirements to allow for non-SNF buildings to be temporarily certified as and available for use by a SNF in the event there are needs for isolation processes for COVID-19 positive residents, which may not be feasible in the existing SNF structure, to ensure care and services during treatment for COVID-19 is available while protecting other vulnerable adults. CMS will revise processes, as necessary, to facilitate certification and surveys of these sites under this waiver. Waives certain conditions of participation and certification requirements for opening a nursing facility if the state determines there is a need to quickly stand up a temporary COVID-19 isolation and treatment location.
- Resident Groups: CMS is waiving requirements that allow residents the right to participate in-person in resident groups.
- Training and Certification of Nurse Aids: CMS is waiving the requirements that a SNF not employ anyone for longer than four months unless they met specified training and certification requirements.
Additional information on the waivers noted above is available here.
March 13 Blanket Waivers: On March 13, President Trump declared a national emergency, which allows flexibility in requirements for health care providers. The Centers for Medicare & Medicaid Services (CMS) announced several blanket waivers. As with the March 27 blanket waivers, hospitals do not need to request an individual waiver to be relieved from compliance with these laws to the extent described in this list.
- Housing Acute Care Patients in Excluded Distinct-Part Units: CMS is waiving requirements to allow acute care hospitals to house acute care inpatients in excluded distinct-part units, where the distinct part unit’s beds are appropriate for acute care inpatient. The Inpatient Prospective Payment System (IPPS) hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute care inpatient being housed in the excluded unit because of capacity issues related to the disaster or emergency.
- Three-Day Qualifying Stay: CMS is waiving the requirement for a three-day prior hospitalization for coverage of a SNF stay, for people who need to be transferred as a result of the effect of a disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period.
- MDS Submission: CMS is providing relief on timeframe requirements for Minimum Data Sets and transmission.