The Centers for Medicare & Medicaid Services has revised guidance for a temporary nurse aide training program whose pending Oct. 7 end date has threatened many individuals’ ability to comply with staffing rules. 

The agency said it now will issue waivers that may be statewide, county-wide or at the individual facility level when “localized barriers” training or testing exist.

The waiver program was put into place during the pandemic to enable a better flow of aides coming into nursing homes beleaguered by lasting staffing shortages. CMS, however, announced in April, that all aides would have to meet normal compliance standards by the first week of October. Stakeholders said immediately that might not be attainable in certain areas given testing backlogs.

In issuing earlier official communications this year, CMS officials indicated flexibility would be granted and that providers and individuals should keep careful records of attempts to complete certification to avert compliance problems. Monday’s revised memo to state survey agency directors adds further detail to those instructions.

CMS reiterated that training waivers would only be granted through the end of the public health emergency, and “for a timeframe that is as short as possible.”

“Waivers are time-limited, and CMS expects state agencies to actively work towards resolution of barriers to certification,” the agency said in a memo. “CMS may require that state agencies provide progress reports on the submitted action plan to maintain the waiver.” 

If the PHE ends during or before the granted period of waiver for a facility or a state or a county, any granted waivers will also end, CMS said.

Providers had been pushing for more flexibility for months and expressed gratitude for the revised rules, according to Bloomberg Law, which first reported on them early Tuesday. But they still expressed concern that nurse aides would be coming into the pipeline too slowly.

“We appreciate CMS recognizing that temporary nurse aides should have a more realistic opportunity to get certified as a next step on their long-term care career path,” Holly Harmon, senior vice president of Quality, Regulatory & Clinical Services at AHCA/NCAL said Tuesday. “However, the concern remains that nationwide training and testing backlogs could extend well beyond the public health emergency — perhaps even for years —which ultimately, will restrict professional advancement opportunities for these heroic caregivers.”

She added that an eventual end of the temporary nurse aide program while the labor shortage continues “will cause care disruptions for the frail seniors we serve.”

Janine Finck-Boyle, vice president of health policy for LeadingAge said her members will be “relieved to get the information from CMS.”

 “LeadingAge has been pushing for these details for months as the October deadline nears. Many of our members tell us of barriers and extensive wait times for the CNAs using the waiver to take the training exam.  So this is one step forward,” she said Tuesday. “At the same time, so much more is needed. Chronic underinvestment in and longstanding disregard for aging services — and primarily the valuable workers who are its core — created an opportunity for COVID to wreak havoc. That must not continue. Our country must repair, rebuild and reinvigorate this sector.”

To ensure better care for residents, the Biden administration reinstated full training requirements effective June 7. Uncertified temporary nursing aides have until Oct. 7 to complete 75 hours of training and pass a state certification test. Those hired after June 7 had four months from their date of hire to complete the training.

An estimated 300,000 aides had taken advantage of the waiver and were being hustled through the process.

After CMS announced it would sunset its initial waiver, many states announced backlogs at testing centers that certify nurse aides after their training is complete. In Pennsylvania, would-be CNAs were reportedly “walking away” after being scheduled for test early next year.

The issue of testing backlogs was raised as recently as yesterday during a national listening session for stakeholders regarding CMS’ study of staffing minimums for nursing homes.

CMS’s nursing home division director Evan Shulman acknowledged that the entire nurse-aide training issue would be tricky to unfold this year. But more rigid requirements were needed due to what he called troubling field reports about caregiving outcomes.

“This is a very, very delicate balance, folks, I’m going to be completely candid,” Shulman said during an address to the crowd at the NADONA annual meeting in June. “On one hand, we do not want to create barriers for facilities to retain staff. On the other hand, we are seeing significant issues related to staff not being trained and certified. We want to be very careful about how we proceed here. We’re going to try to thread that needle the best we can.”

Concerns about lagging quality of care were repeated in Monday’s CMS memo.