What’s new: CMS released QSO-23-13-ALL entitled “Guidance for Expiration of the COVID-19 Public Health Emergency (PHE) on May 11, 2023”, which is applicable to Long Term Care (LTC) and other provider types.

• The memo outlines each waiver CMS put into place during COVID-19 and how the end of the PHE will affect those waivers.
• The memo outlines timelines for certain regulatory requirements issued through the PHE.

Reporting to Residents, Representatives, and Families on COVID-19

Per the memo, CMS will exercise enforcement discretion for the requirement to report to residents, their representatives, and families and not expect providers to meet this requirement at this time.

• AHCA received confirmation from CMS that the requirement at §483.80(g)(3) to notify all residents and their representatives about COVID-19 cases ended Monday, May 1, 2023, when the QSO was issued.
• This pertains to the requirement associated with F885-Resident and Family Notifications.
• Facilities are no longer required to notify all residents and their representatives when there is a positive COVID case in the facility, or if there have been three more residents with new onset of respiratory symptoms occurring within 72 hours of each other.
• Notification of changes in condition for residents will still apply as referenced in F580 at §483.10(g)(14).

Staff COVID-19 Vaccine Requirements

CMS will soon end the interim final rule issued on November 5, 2021 that required all healthcare staff to be fully vaccinated for COVID-19. This is related to F888-Staff Vaccination Requirements.

• CMS will provide more information on this at the anticipated end of the PHE.
• CMS urges everyone to stay up-to –date on their COVID-19 vaccine.

Requirements for Educating about and Offering Residents and Staff the COVID-19 Vaccine

Facilities need to continue to educate and offer residents and staff the COVID-19 vaccine until the interim final rule expires on May 21, 2024. 

Requirements for Reporting Related to COVID-19

The requirement to report via NHSN will end on December 31, 2024.

• Reporting requirements will continue until then as a requirement to support national efforts to control the spread of COVID-19.  

CMS notes that some reporting, such as COVID-19 vaccine status of residents and staff through NHSN is permanent and will continue indefinitely unless additional regulatory action is taken. 

Providers should also be aware that the SNF Quality Reporting Program (QRP) will require reporting of two COVID-19 vaccine related measures: 

• COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date (FY24)
• COVID-19 Vaccination Coverage among Healthcare Personnel 

Emergency Preparedness

During the PHE, facilities were not required to complete full-scale emergency drills.

• This allowance will expire at the end of the PHE.

3-Day Stay Prior Hospitalization and Spell of Illness

The 3-Day Stay waiver will terminate immediately with the expiration of the COVID-19 PHE on May 11, 2023.

• Beginning May 12, 2023, SNF stays will require a qualifying hospital stay before Medicare coverage.
• With the end of the Spell of Illness waiver, residents will be required to have a 60-day wellness break to begin a new benefit period.
• Read this VHCA-VCAL blog post, WYNTK: 3-Day Stay Waiver Ending May 11 for more info.

Nurse Aide Training Competency and Evaluation Programs (NATCEP)

All individual waivers granted to states and individual facilities will terminate at the conclusion of the PHE, unless a facility or state has been granted a waiver that expires prior to the end of PHE.

• The Virginia Board of Nursing did not apply for a statewide waiver.

Uncertified nurse aides working in a LTC facility covered by a waiver granted to an individual facility will have four months from the date the PHE ends (or from the termination date of the facility’s or state’s waiver, if earlier) to complete a state-approved NATCEP program.

• This includes those LTC facilities or facilities in states that were granted an extension of the waiver after October 6, 2022.

Preadmission Screening and Annual Resident Review (PASARR)

CMS will begin requiring residents to have a PASARR prior to admitting to facilities when the PHE expires.

• This will affect all admissions taking place after May 11, 2023.

Resident Roommates and Grouping

CMS waived the requirements in 42 CFR 483.10(e)(5) and (7) solely for the purposes of grouping or cohorting residents with respiratory illnesses.

• The requirements of this waiver will end with the conclusion of the PHE.

Requirements for COVID-19 Testing

The COVID-19 testing requirements will expire with the end of the PHE.

• However, COVID-19 testing remains important and is a nationally recognized standard to help identify and prevent the spread of COVID-19.
• Facilities should continue to follow CDC guidelines for when to test residents and staff.

Focused Infection Control (FIC) Surveys

Through September 30, 2023 states are still required to survey 20 percent of their nursing homes utilizing FIC surveys.

• Beginning October 1, 2023, states will no longer be required to conduct additional FIC surveys.