The Centers for Medicare & Medicaid Services is restoring training requirements for nurse aides who work at skilled nursing facilities after waiving them early during the COVID-19 crisis. 

The agency on Thursday announced that it’s ending those waivers and a host of other provisions affecting doctors, discharge requirements and the special use of rooms and buildings after easing up on them due to the public health emergency. 

The 16 waivers will lapse in distinct groups, 30 and 60 days from the issuance of today’s memo, which was signed by David Wright, director of CMS’s Survey and Operations Group Management.

Blanket waivers for hospitals and certain other entities would remain in effect so those facilities can best manage surges in COVID infections, the agency said.

The waiver for nurse aide certifications lets SNFs and other nursing facilities employ aides for longer than four months without the necessary training and certification requirements during the pandemic. 

“We remind states that all nurse aides, including those hired under the above blanket waiver must complete a state approved Nurse Aide Competency Evaluation Program to become a certified nurse aide,” CMS wrote. Some waivers will still be allowed, however, in cases where training and testing programs are over capacity.

“State approved NATCEPs must have a curriculum that includes training in the areas defined [under the requirement[, such as respecting residents’ rights, basic nursing skills, personal care skills, and caring of cognitively impaired residents,” the agency added. 

CMS added that nurse aides must also pass a written or oral exam and demonstrate skills learned. 

The agency first waived the nurse aide training and certification requirements in April 2020. 

CMS also is rescinding numerous liberties related to doctors being able to relinquish some obligations to nurse practitioners or other non-physicians. It is also returning some requirements for in-person physician visits that had given way to telehealth capabilities.

In addition, the agency will end a waiver that allowed for a state-approved, non-SNF building to be temporarily certified and available for use by a SNF in the event there were needs for isolation processes for COVID-19 positive residents to ensure residents could still be treated. 

The full list of affected waivers can be found in the CMS memo, which outlined numerous reasons and clarifications about conditions for the waivers’ removal. Among the biggest worries are that a lack of in-person physician visits may have led to a lack of recognition of certain patient conditions. There is also a concern that facilities have not had enough fire- and life-safety inspections.

CMS said it is rescinding the waivers because findings from onsite surveys have revealed “significant concerns with resident care that are unrelated to infection control (e.g., abuse, weight-loss, depression, pressure ulcers, etc.). We are concerned that the waiver of certain regulatory requirements has contributed to these outcomes and raises the risk of other issues.”

The agency emphasized that long-term care providers should keep other measures firmly in place to guard against COVID-19 transmission. It especially promoted the pursuit of vaccinations.

“We expect providers to continue to implement actions to reduce the likelihood of COVID-19 transmission and follow all existing requirements,” the memo said. “Facilities should use all available resources to support their residents and staff in getting vaccinated, and in doing so, adhere to the requirements for educating residents and staff regarding the benefits and potential side effects associated with the COVID-19 vaccine, and offering the vaccine.”

The agency also recommends that providers continue to adhere to CDC guidance regarding the potential spread of COVID-19 “especially during activities that may increase patient or resident contact.”

More information on individual waivers or flexibilities providers can apply for can be found at the agency’s Coronavirus waivers & flexibilities webpage.

This is a developing story. Please check back for additional updates.