HHS Secretary Xavier Becerra Monday extended the COVID-19 related Public Health Emergency, allowing the continuance of several healthcare waivers the skilled nursing sector has come to rely upon since the coronavirus began spreading last March.
The PHE notably ensures vaccines can continue to be administered under emergency use authorization, providers can access emergency funding, and states can request use of federal resources including the military and supply stockpiles for another 90 days.
At least for now, it also adds time to waivers granted by the Centers for Medicare & Medicaid Services’ governing hiring, admissions and assessment practices. But as the agency has already shown once this year, it has the authority to revoke those Section 1135 waivers before the emergency officially ends.
A temporary waiver of nurse aide training rules may be one exemption the agency is eager to move away from, LeadingAge has warned members repeatedly over the last several weeks.
“Will CMS terminate this waiver early?” Jodi Eyigor, director of nursing home quality and policy, asked during a recent COVID-19 webinar. “We do not know. We do know that CMS is continuing to evaluate which waivers are necessary, which should remain in effect and which can be terminated.”
In guidance issued May 10, CMS said states needed to determine how many nurse training hours delivered through temporary, hands-on programs could be used to fulfill the typical federally required 75 hours of classroom training. It also reiterated that training must cover certain topic areas without spelling out completely how those two requirements might overlap.
That’s been a concern in Pennsylvania, where an estimated 1,000 temporary nurse aides have been hired (and continue to be hired) under the waiver. Those workers receive eight hours of educational training online, followed by an assessment and then a quick transition to 80 hours of supervised, on-the-floor training.
“These individuals are working right alongside people who have gone through the whole training program, and we have not heard, to our knowledge, any changes in outcomes,” Anne Henry, senior vice president and chief government affairs officer for LeadingAge PA told McKnight’s Long-Term Care News Tuesday. “We’re just at this point holding out hope that we get CMS to really recognize what these individuals have done for us during the pandemic.”
State education officials are slated to meet with CMS nursing home leaders later this week.
Valuable workers at risk?
CMS reiterated in its memo that nurse aides will have four months after the waiver’s end to successfully complete any additional required training and certification.
But in Pennsylvania, which has a dearth of RN instructors and training programs, “that’s not a lot of time,” Henry said. She fears losing valuable workers who don’t want to repeat training. In some cases, it simply may be too inconvenient: A provider in rural Western Pennsylvania recently told Henry the closest in-person nurse aide training program was an hour from her facility.
Eyigor, however, has noted that some states are already creating bridge programs to help nurse aides become full-fledged certified nursing assistants, making any extra education worthwhile.
In Florida, the legislature amended an early pandemic-era bill to add eight more hours of education and ensure its temporary personal care attendant program would meet regular federal requirements. The program prepares nurse aides to sit for the CNA exam. Kristen Knapp, senior director of strategy and communications for the Florida Health Care Association, said it has been a critical recruitment tool with labor shortages caused by retirements, COVID-related burnout and an insufficient number of clinical training sites.
“The COVID-19 pandemic has magnified our staffing challenges — and similar to other healthcare sectors, the long term care profession is facing a legitimate crisis,” Knapp told McKnight’s. “Making the personal care attendant program permanent will help to strengthen our workforce, as more individuals now have a pathway to transition into more permanent long term caregiver roles …. It creates a valuable pipeline that we need, especially now when the supply of available workers is not keeping up with the high demand and growing elderly population.”