Centers for Medicare & Medicaid Services Ending Certain COVID-19 Regulatory Waivers for Skilled Nursing Facilities

The Centers for Medicare & Medicaid Services (CMS) recently issued Memorandum QSO-22-15-NH & NLTC & LSC (Memorandum) announcing that certain staffing, treatment, and life safety regulatory waivers applicable to skilled nursing facilities (SNF) and in effect during the COVID-19 state of emergency would be coming to an end.

Previously, CMS waived various regulatory requirements to provide flexibility in SNF operations and to allow for a focus on COVID-19 prevention and treatment. Although COVID-19 transmissions continue, CMS will again require SNFs to comply with certain pre-pandemic regulations in order to address resident health and safety risks that may not be related to infection control. To this end, CMS has created two timeframes for the termination of COVID-related waivers:

By May 7, 2022, SNFs must ensure that:

  • Residents are permitted to participate in in-person resident groups / resident meetings .
  • Physicians do not delegate tasks that they are required to personally perform in accordance with federal or state regulations or the SNFs own policies
  • Physicians personally visit with residents at least once every 30 days for the first 90 days of a resident’s admission, and at least once every 60 days thereafter (unless otherwise exempted by other pre-COVID regulations)
  • Physician visits are not performed via tele-health
  • Residents receive copies of their medical records within 2 working days of the resident’s request
  • By June 6, 2022, SNFs must ensure that:

  • Rooms in the SNF that were not normally used as resident rooms pre-COVID are no longer used as resident rooms if they were during the COVID-19 state of emergency
  • Facility and medical equipment inspection, testing, and maintenance policies and procedures are re-instituted if paused during the COVID-19 state of emergency
  • Life Safety Code and Health Care Facility Code inspection, testing, and maintenance policies and procedures are re-instituted and re-adjusted if paused or modified during the COVID-19 state of emergency
  • Every resident sleeping room has an outside window or an outside door
  • Quarterly fire drills are conducted
  • Temporary walls or barriers between patients are removed (if constructed)
  • Nurse aides receive at least 12 hours of in-service training annually
  • Nurse aides employed by the SNF for more than 4 months complete all pre-state of emergency training and competency programs in accordance with federal and state laws and regulations
  • This is not an exhaustive list of the Memorandum’s requirements. With this in mind, we recommend that SNFs review CMS’ Memorandum with appropriate staff and begin to modify policies and procedures to ensure compliance with federal and state regulations that applied prior to the COVID-19 state of emergency. All staff should be notified of these upcoming changes, and SNFs should conduct in-service training as needed.

    For more information:

    If you have questions or concerns about compliance with the Memorandum and/or the impact of these regulatory changes on applicable state regulations or orders, please contact Sheri L. Pizzi or Greg Vanden-Eykel by email, or by calling 617-654-8200.