Prepare for the Upcoming to 1135 Waivers


In a memo (QSO-21-17-NH) issued to State Survey Agencies dated April 8, 2021, the Centers for Medicare and Medicaid Services (CMS) updated the status of several Long-Term Care Emergency Regulatory Waivers that will end effective May 10, 2021. These waivers have been in place in response to the COVID-19 pandemic, allowing flexibility for nursing home providers respective to specific requirements. Learn more about these updates below:


Q: What four Emergency Regulatory Waivers are ending on May 10, 2021?

A: The following waivers ending are:

  • Notifying residents prior to transfer or discharge (relates to F622 Transfer and Discharge)
  • Notifying residents of room or roommate change (relates to F580 Notification of Changes)
  • Care Planning requirements – the timing of care plans (relates to F655 Comprehensive Person-Centered Care Planning and Baseline Care Plans)
  • Timeframe for completing and transmitting MDS (relates to F636 Resident Assessment and F640 Automated Data Processing Requirements)


Q: Could you provide key information regarding the waivers related to F622-Transfer and Discharge and F580 Notification of Changes?

A: Absolutely. Below are a few key points:

  • During the waiver period, the requirements for 30-day advance notice to residents of discharge or 7-day advance notice of change in room or roommate were allowed to be provided after the change to allow facilities to quickly move residents for safety and care related to COVID-19.
  • Cohorting requires swift action once symptoms are identified and test results are received. Facilities are expected to move residents to appropriate locations within the facility to meet their transmission-based precautions needs.
  • At the beginning of the COVID-19 pandemic, some facilities were unable to care for COVID-positive residents due to a lack of appropriate space, equipment, supplies or staff. Those residents were sent to the hospital or a centralized regional facility once their COVID-positive status was identified.
  • CMS believes that facilities have now developed systems and processes that would allow advance notice to the resident before planned discharges, room changes or roommate changes.

The memo states the facilities are now required to resume providing notice as required in the regulations:

  • With 30-day advanced notice, or as soon as practicable before the transfer or discharge of a resident; and
  • Before a room or roommate change.

It does not reinstate the prior timing requirements, nor does it address the timing of the notification of planned discharges to the Ombudsmen. The related waivers, which continue to allow facilities to transfer or discharge, and change rooms for the sole purposes of cohorting remain in effect.


Q: What details are important to know regarding the waiver related to F655 Comprehensive Person-Centered Care Planning and Baseline Care Plans?

A: Providers should consider the following:

The emergency waiver suspended the required timing for completion of the baseline care plan within forty-eight hours of admission and the comprehensive care plan within seven days of the admission MDS completion when transferring COVID-19 residents to another facility or cohorting new admissions.

CMS believes that facilities should now have developed processes for timely completion of care plans. The original timing requirements will become effective May 10, 2021.

The regulations require Baseline Care Plans to be complete within 48-hours of the resident’s admission with a copy or summary provided to the resident before the comprehensive care plan is completed. The comprehensive care plan is due for completion within seven days of the completion of the admission assessment (MDS and Care Area Assessments).


Q: The last waiver impacted is for Timeframe for completing and transmitting MDS, related to F636 Resident Assessment and F640 Automated Data Processing Requirements. Can you please provide a little more insight into this change and any recommendations?

A: CMS waived the timeframe requirements for completion and transmission of MDS assessments during the public health emergency to allow facilities to focus on COVID-19 infection mitigation. CMS states in the memo that the majority of facilities are completing and submitting assessments on time.

CMS believes that nursing homes should have developed practices for timely completion and submission of assessments as they are critical for resident care planning. Therefore, the timeframe requirement waiver will expire on May 9, 2021.

I recommend completing the following:

  • Follow the MDS 3.0 manual schedules for MDS completion and submission. The schedules can be found here.
  • View each submission validation report to confirm MDS is complete and submitted timely.


Q: What pertinent Emergency Waivers are not impacted?

A: CMS is not ending the waivers related to the following:

  • Pre-admission Screening and Annual Resident Review (PASARR) (related to F644 Coordination). The timing requirements for PASARR completion will continue to be waived until further notice.
  • Nurse Aide training.
  • CMS provided a blanket waiver during the pandemic for the timing of training and certification for nurse aides. Facilities are not required under the waiver to employ nurse aides who have attended a state-approved training program and passed a standardized certification test within four months of hire.
  • The memo clarifies how federal regulations can be applied to nurse aides working under the waiver.
  • The memo further indicates that states are recommended to evaluate the method of training accepted for certification to include on-the-job training provided to uncertified nurse aides by the facility during orientation and competency training.
  • States should maintain the required areas of training and ensure that any gaps are covered by supplemental training prior to a nurse aide taking a certification exam.
  • CMS advises stakeholders that the four-month timeframe will eventually be reinstated. The memo tells us that nurse aides would have four months from the end of the waiver to complete their required training and certification.


Q: What are a few key next steps providers should consider?

A: Now is the time to prepare by completing the following:

  • Review the current Emergency Blanket Waiver as outlined in the memo, your responsibilities as a provider, as well as the overall requirements outlined by your individual state.
  • Review the topics covered by new employee orientation for nurse aides and any additional training provided during the waiver. Compare the topics to the requirements of the nurse aide training program in your state.
  • Plan for the potential ending of this Emergency Waiver and review the supplemental education needed for those staff members who will need to complete all the training and certification requirements for a certified nursing assistant in your state.
  • It is important to review the memo in detail with your team and prepare now for the May 10, 2021 changes.

Pathway Health’s reimbursement professionals are available to support your reimbursement optimization journey. Contact us for details on the affordable Reimbursement Snapshot review which outlines areas of opportunity. 


Karolee Alexander, RN, RACT-CT
Director of Reimbursement and Clinical Consulting