Personnel with the Wisconsin Department of Health Services (DHS) Division of Quality Assurance (DQA) have notified WHCA/WiCAL that they are adopting a new approach to granting waivers from the two-year prohibition for nursing facilities hosting Nurse Aide Training and Competency Evaluation Programs.

In April, WHCA/WiCAL, the five other states making up the CMS-Chicago Region, and all state survey agencies within the Region met virtually with CMS-Chicago leadership. One issue for discussion was the difficulty that the two-year prohibition on nurse aide training was having on facilities in their quest to attract, train and retain qualified CNA staff. To the surprise of all on the call, CMS-Chicago leadership advised that states possess much broader discretion to approve waivers from the two-year prohibition than is currently being applied.

WHCA/WiCAL discussed the outcome of the Chicago Region meeting with personnel from the Wisconsin Department of Health Services (DHS) Division of Quality Assurance (DQA). As a result, DQA has since notified WHCA/WiCAL that they are accepting and adopting WHCA/WiCAL’s suggested approach to granting waivers from the two-year prohibition for nursing facilities hosting nurse aide training programs.

Previously, DQA’s position was that DHS did not have the authority to grant waivers of any kind under certain circumstances related to survey/enforcement results, including for extended surveys and for imposition of CMPs above $10,483 (adjusted for inflation).

However, DHS has changed its course, and will now make determinations for approval of waivers to the NATCEP two-year prohibition for waivers requesting the ability to provide nurse aide training in, but not by, the facility. Thus, the facility could serve as the site of the training, as long as there is a third-party trainer. Many providers already use this approach, for example working with a local technical college to provide the instruction.

DHS has said this new approach will be used in all cases requesting an “in but not by” waiver, no matter the reason for the imposition of the prohibition in the first place.

From DHS:

DHS is able to make this decision in all situations, including those with the CMP and the extended surveys.

DHS will still consider the three areas outlined by CMS for states to consider granting waivers:

(i) determines that there is no other such program offered within a reasonable distance of the facility,

(ii) assures, through an oversight effort, that an adequate environment exists for operating the program in the facility, and,

(iii) provides notice of such determination and assurances to the State long-term care ombudsman.

DHS has also notified WHCA/WiCAL that DHS will no longer rescind waivers when a high CMP is imposed, nor will DHS need approval from CMS. It will be much easier and smoother for everyone.

WHCA/WiCAL encourages providers who been notified that their facility has fallen under a NATCEP two-year prohibition to contact Jim Stoa to discuss opportunities to apply for a waiver of the prohibition.