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).

UPDATE: Dates below have been updated based on DHS changes to compliance deadlines. Previous dates of June 6 and October 4, respectively, have been updated to June 7 and October 7. The June 7 date has passed and now the window has opened for the 120 days until the October 7 deadline.

See a previous CareConnection article, including a detailed overview of the 1135 waiver rescission announcement, along with which waivers will be rescinded and when.

This article focuses on steps facilities should take to best position yourself to retain current Emergency or Temporary Nurse Aides, and to ensure those caregivers are able to be timely trained, tested, and placed on the CNA registry.

On Tuesday, June 7, CMS ended 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:

By May 7, facilities that still wanted to apply to be an Emergency Nurse Aide training program had to submit an application. This deadline has passed, and any facility that does not currently have an Emergency Nurse Aide training program will not be able to apply to have such a program.

On or before June 7:

• 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 7, 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!

NEXT STEPS

WHCA/WiCAL is here to help member providers best situated to retain as many 1135-waiver related nurse aides as possible.

• For Emergency Nurse Aides:
  • Again, be aware that you must have all training and documentation for completion of ETP training complete and submitted by June 7. Note: This compliance deadline has now passed.
  • Emergency Nurse Aides who have completed their training by June 7 will be able to work in the facility for 120 days without having completed the exam and placed on the registry, which will be October 7. HOWEVER – we urge you not to wait until the weeks or days leading up to Oct 7 to take action, as there could be testing capacity issues.
    • Your facility can apply to serve as a NATCEP testing site. Relevant forms are available HERE and HERE.
• For Temporary Nurse Aides:
  • Be aware that after June 7, TNAs are not eligible to serve as nurse aides, unless they have been enrolled in a traditional 75+ hour training program (or if they had previously been transitioned to Emergency Nurse Aides, in which case refer to the ETP information directly above).

CONSIDERATIONS FOR RETURN TO TRADITIONAL NURSE AIDE TRAINING PROGRAMS

Along with the potential for nurse aide testing bottleneck/capacity issues, there is also a potential for a delay in processing/approving applications for new permanent 75+ hour training programs if DHS receives too many applications in short order. If your facility plans to apply for a traditional 75+ hour training program, we encourage you to begin that process now.

If your facility is not currently approved for a 75+ hour training program, visit this DHS website and navigate to the accordion menu section titled, “I am interested in applying to offer a nurse aide training program“.

If your facility has previously been approved to offer a traditional nurse aide training program above the state’s 75-hour minimum requirement, and you would like to adjust your training program’s hourly requirement down to the 75-hour standard, visit this DHS website and navigate to the accordion menu section titled, “I need to make a change to my currently approved training program“.

Note: prior to April 2020, Wisconsin had a 120-hour minimum nurse aide training requirement. That hourly requirement was reduced to 75 hours in April 2020. So, if you relied on a traditional nurse aide program prior to the availability of the 1135-related training programs, you may want to consider changing your program hours, following the steps on the website above.

DHS WEBINAR RECORDING ON 1135 WAIVER NURSE AIDE PROGRAMS AND TRANSITIONING TO A PERMANENT NURSE AIDE TRAINING PROGRAM

DHS held a webinar to discuss the rescission of 1135 waivers related to nurse aide training, along with next steps for providers. The webinar also included a Q&A section, where providers were able to ask additional questions. The webinar recording should soon be posted HERE.

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.