CMS QSO 23-13-ALL: Ending of COVID Staff Vaccine Requirement, Other Protocols

On May 1, CMS released a new regulatory memo QSO-23-13-ALL​ entitled “Guidance for Expiration of the COVID-19 Public Health Emergency (PHE) on May 11, 2023.” The memo outlines each waiver CMS put into place during COVID-19 and how the end of the PHE will affect those waivers. Additionally, the memo outlined timelines for certain regulatory requirements issued through the PHE. This memo applies to Long Term Care (LTC), Intermediate Care Facilities (ICF), and other provider types.

Reporting to Residents, Representatives and Families on COVID-19

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. This pertains to the requirement associated with F885. AHCA has advocated for this relief and has confirmed that this change is effective May 1, 2023.​

Staff COVID-19 Vaccine Requirements

Related to the interim final rule issued November 5, 2021, CMS will soon end the interim final rule requiring all healthcare staff to be fully vaccinated for COVID-19. CMS will provide more information on this at the anticipated end of the PHE. CMS does continue to urge 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 will need to continue to educate and offer residents and staff the COVID-19 vaccine until the interim final rule expires, 3 years after issuance, which would be May 21, 2024.

Requirements for Reporting Related to COVID-19

The requirement to report via NHSN is set to terminate December 31, 2024. This will continue until that time as a requirement to support national efforts to control the spread of COVID-19.

CMS does note 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 Prior Hospitalization

As previously reported, the 3-Day waiver will terminate immediately with the expiration of the COVID-19 PHE. Meaning, beginning May 12, 2023, SNF stays will require a qualifying hospital stay before Medicare coverage. Additionally, residents will be required to have a 60-day wellness break to begin a new benefit period.

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. Uncertified nurse aides working in a LTC​ facility covered by a waiver granted to a State or individual facility will have 4 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 care facilities, or facilities in states that were granted an extension of the waiver after October 6, 2022.

Preadmission Screening and Annual Resident Review (PASARR)

As previously reported, 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

Beginning in Fiscal Year 24, states will no longer be required to conduct additional FIC surveys in their states. For Fiscal Year 23, states are still required to survey 20% of their nursing homes utilizing FIC surveys.

Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs)

CMS previously waived the requirement for clients to have the opportunity to participate in social, religious, and community group activities. The waiver of this requirement ends upon the conclusion of the PHE.

Additionally, requirements for routine training, that was waived for ICF/IIDs, during the pandemic, will resume when the PHE expires.

CMS waived the requirement that each client must receive a continuous active treatment program. This requirement will resume when the PHE expires.

CMS also waived the requirements for the facility to provide sufficient Direct Support Staff (DSS) so that Direct Care Staff could provide direct client care. AHCA is seeking more information on the impact to ICF/IID providers and will be in touch with more information.

Please reach out to Rick Abrams or Jim Stoa with any question related to the upcoming PHE termination.

Posted in COVID-19