A stressed nurse
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The first set of COVID waivers have officially been put to rest and nursing home providers expect the changes will create “some very real challenges” with care access for residents. 

“Nursing homes are still facing this pandemic, and now is not the time to let crucial supports and flexibilities necessary to combat the virus end,” the American Health Care Association/National Center for Assisted Living told McKnight’s Long-Term Care News on Thursday. 

“We are especially concerned to see these waivers ending while the sector continues to struggle with a historic workforce crisis,” the association added. 

The Centers for Medicare & Medicaid Services first announced in an April 7 memo that it was eliminating 16 COVID-related waivers, some in 30 days and some in 60 of the issuance of the memo. The first set of COVID waivers will be retired Saturday and the second, June 7.

Liberties related to doctors being able to relinquish some obligations to nurse practitioners or other non-physicians are among the rescinded COVID waivers expiring this weekend. CMS is also returning some requirements for in-person physician visits that have given way to telehealth capabilities.

The termination of physician visits and physician delegation of tasks to a physician assistant, nurse practitioner, or clinical nurse specialist creates significant challenges, a LeadingAge spokeswoman told McKnight’s Thursday. 

“Eliminating telehealth, which can provide cost-effective, relatively time-efficient access to care, may result in an unintended consequence of delay in care,” the spokeswoman said. 

Most nursing homes do not have full-time physicians on staff and the waiver (and subsequent use of telehealth) has permitted one physician to visit more residents in different places. This has been particularly beneficial in areas where physicians must drive double-digit miles between nursing homes, she argued. 

Similarly, with the termination of the waiver that permits delegation of physician tasks, residents may now have to wait to receive care from a physician who may be logging more driving hours. 

“A capable nurse practitioner, physician assistant, or clinical nurse specialist could have provided the care under supervision of the physician in a more timely manner,” the spokeswoman observed.

LeadingAge also reminded that nursing home providers must often arrange for and manage the appointment process, including transportation expenses. They are navigating operational issues including staffing challenges, as well as insufficient reimbursement that doesn’t cover costs.

“Ending telehealth, without providing needed resources, such as access to additional doctors or other staffing support or funds to cover travel, for instance, may well limit access to needed help,” the spokeswoman said. 

The group has called for CMS and other federal health agencies to address long-term care workforce needs with an all-government approach, and draw on resources from other departments.