On Thursday, April 7, CMS issued QSO-22-15-NH & NLTC & LSC – Update to COVID-19 Emergency Declaration Waivers for Specific Providers. The memo announced that CMS is ending some (not all) COVID-related 1135 waivers, including federal waivers which allowed for the creation of Emergency and Temporary Nurse Aide Training Programs here in Wisconsin. These employment and training flexibilities will end 60 days from the publication of QSO-22-15-NH & NLTC & LSC (PDF).

Please note: CMS’s announcement of certain 1135-waiver end dates does not impact the 3-Day Stay or Spell of Illness waivers. Those waivers remain in place nationwide for all hospitals, communities, and SNFs. This week, the federal PHE was renewed for an additional 90-day period, thus the current expectation is that remaining 1135 waivers (those not announced to be scheduled to end, see below) will be in place at least through mid-July, unless CMS issues a new announcement related to rescinding other 1135 waivers not listed below.

CMS announced it will end specified waivers in two groups:

On Saturday, May 7, CMS will end 1135 waivers related to:

• Resident Groups
• Physician Delegation of Tasks in SNFs
• Physician Visits
• Physician Visits in Skilled Nursing Facilities/Nursing Facilities
• Quality Assurance and Performance Improvement (QAPI)
• Detailed Information Sharing for Discharge Planning for Long-Term Care (LTC) Facilities

On Monday, June 6, CMS will end 1135 waivers related to:

• Physical Environment
• Life Safety Code (LSC) and Health Care Facilities Code (HCFC) ITM
• Outside Windows and Doors
• Life Safety Code-Fire Drills & Temporary Construction
• Paid Feeding Assistants for LTC facilities
• in-Service Training for LTC facilities
• Training and Certification of Nurse Aides for SNF/NFs
• Clinical Records

Of all waivers to be rescinded either on May 7 or June 6, likely the most impactful will be the elimination of 1135 waivers which allowed Wisconsin the flexibility to create Emergency Nurse Aide and Temporary Nurse Aide programs. If you haven’t already, it is critical that providers using either or both of these 1135-related nurse aide programs begin a transition process for these staff members. See the below timeline, and begin planning now to ensure your facility is positioned to place as many of these caregivers as possible on the Registry before time runs out:

On or before May 7:

• New Emergency Nurse Aide Training Programs must be approved prior to May 7 in order to begin a new training class of Emergency Nurse Aides.
• No new ETP training classes will be approved after May 7.

On or before June 6:

• Emergency Nurse Aide Training Programs must complete all training classes and submit checklists.
• DQA will rescind all waivers for Emergency Nurse Aide Training Programs
  • Please note: this does not apply to traditional, 75+ hour training nurse aide training programs. Previously approved permanent training programs may continue to train at the hours for which they are approved.
• The CMS-required 120-day period for all trained students to test and get on the Registry will be reinstated for both Emergency Nurse Aides and traditionally trained nurse aide students, meaning that Emergency Nurse Aides will have until October 4, 2022 to get on the Registry.
  • CMS has announced there will be a limited exception for those who are experiencing testing and/or training capacity issues and have received approval from their state official. It is not yet clear if Wisconsin DHS officials expect any significant testing/training capacity issues which may lead to an exception being granted.
• Temporary nurse aides, not on a path to the Wisconsin Nurse Aide Registry, must stop working as nurse aides unless they are employed full time and enrolled in an approved permanent nurse aide training program.
  • Out-of-state certified nurse aides who are not on the Wisconsin Nurse Aide Registry are considered temporary aides.
  • If you currently are utilizing Temporary Nurse Aides, NOW is the time to discuss with them future opportunities by either 1) enrolling in the Emergency Nurse Aide program, or 2) enrolling in a traditional 75+ hour nurse aide training program!

After receiving member inquiries, WHCA/WiCAL reached out to DHS to seek clarification on whether CMS’s announcement of rescinding the 1135 nurse aide waivers would affect DHS’s recent approvals of some NATCEP 2-year prohibition waivers (which are separate from 1135 waivers). DHS has informed WHCA/WiCAL that at this time, DHS does not have any plans to rescind those two-year NATCEP prohibition waivers as a response to the rescission of 1135 waivers.

If you have additional questions about the implications on the upcoming rescission of the above listed 1135 waivers, please reach out to Director of Government Relations and Regulatory Affairs, Jim Stoa.

WHCA/WiCAL will continue to share additional information as it becomes available.

AHCA is seeking additional clarifications from CMS, and in the meantime has outlined key takeaways and next steps facilities can take to prepare for the upcoming end of the 1135 waiver (please note: AHCA’s use of ‘TNA’ is similar to Wisconsin’s Emergency Nurse Aide).

DHS will host an informational webinar on April 20 from 10:30–11:30 a.m. for additional information regarding the ending of 1135 waivers related to Emergency and Temporary Nurse Aides.

To Join:

Join Zoom Meeting

Webinar ID: 161 563 4713

Passcode: 806871

Or by Phone: (669) 254-5252

To learn more about starting a nurse aide training program, please visit the DHS Nurse Aide Training and Registry information webpage (link)

Please contact Director of Government Relations and Regulatory Affairs Jim Stoa with any questions.