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What is Next for 1135 Waivers?

With almost 90 days since the last formal extension of the CMS 1135 waivers, many are asking the status of these waivers as they offer providers a much-needed opportunity to leverage the advantages of waivers related to the 3-day hospital stay requirement, skilling in place and the 60-day wellness break (Please see HealthPRO Heritage’s prior communication here for details.)  While the industry interpreted the extension of the waivers as welcomed news, that same announcement also indicated there could be a termination of the PHE (and therefore an end to the full use of the 1135 waivers) at any time with 60 days notification.
In an open letter from the Director Quality, Safety & Oversight Group to State Survey Agency Directors, the group states that skilled nursing facilities have adapted to the PHE by creating policies and instituting other practices that now mitigate the need for several of the actions covered under Emergency Regulatory Waivers. Select portions of the blanket waiver intended to assist providers in responding to the public emergency will be terminated effective May 10, 2021. The following relaxed guidance under the waiver will no longer be available as an emergency waiver:
  • The notification requirement of resident room/roommate changes and transfers/discharges.
  • Certain care planning requirements for residents transferred/discharged for cohorting purposes. Please note the letter states: “Federal regulations require that nursing homes complete a baseline care plan and comprehensive care plan within 48 hours and seven days of admission to the facility, respectively.” It is important to be aware that the comprehensive care plan rules did not change; the comprehensive care plan is due no later than 7 days after completion of the comprehensive MDS.
  • Timeframe requirements for completing/transmitting resident assessment information Minimum Data Set (MDS). CMS’s statement RE: this change is provided below for further clarification:
“CMS waived the MDS timeframe requirements for assessments to allow providers flexibility in completing and transmitting assessments. This action was intended to allow facilities to prioritize infection control efforts in response to the PHE. However, the majority of facilities have been completing and transmitting assessments timely, therefore we believe all providers should be able to complete and transmit MDS assessments as required at 42 CFR §483.20. Also, CMS believes nursing homes should have developed practices for completing these assessments timely, which are critical for resident care planning. As a result, CMS is ending the emergency blanket waiver for 42 CFR §483.20.” 
Alert: This letter does NOT terminate use of the waiver for skilling without a 3-day prior hospitalization or end the ability for beneficiaries to access/renew Medicare Part A benefits for SNF coverage without a 60-day break.
Fortunately, waivers that allow for direct admissions, skilling in place, and initiating skilled level of care without completing the 60-day wellness break remain unchanged.
Our team of experts is available to discuss the remaining access to the Waivers with your team. Contact us by clicking, here.
Stay tuned for further information related to the fate of the 1135 waivers, as HealthPRO Heritage will continue to keep our partners and industry peers updated!

Tags: COVID-19