June 8, 2023

By Tony Pugh
The Biden administration plans to provide extra breathing room for nursing homes that can’t get their uncertified nursing aides to complete mandatory federal training requirements by the Oct. 7 deadline.
The revised guidance, issued by the Centers for Medicare & Medicaid Services on Monday and obtained by Bloomberg Law, could give temporary nursing aides hired during the Covid-19 pandemic until the end of the public health emergency to complete a required 75 hours of training and pass a state certification test.
The agency said it will issue state- and county-wide waivers, as well as those for individual facilities. The public health emergency is scheduled to end Oct. 15, but Health and Human Services Secretary Xavier Becerra is likely to extend it another 90 days.
The industry, still reeling from a severe labor shortage, says the updated guidance will help it overcome a shortage of state training and testing slots, while allowing struggling facilities to keep their doors open and continue providing care.
“With so great a need for certified nursing aides, we are relieved to get the information from CMS,” said Janine Finck-Boyle, vice president for health policy at LeadingAge, which represents nonprofit aging services providers.
The organization has “been pushing for these details for months as the October deadline nears,” she said in a statement.
Holly Harmon, senior vice president of quality, regulatory and clinical services for the American Health Care Association and the National Center for Assisted Living, the industry’s leading trade group, said, “We appreciate CMS recognizing that temporary nurse aides should have a more realistic opportunity to get certified as a next step on their long term care career path.”
“However, the concern remains that nationwide training and testing backlogs could extend well beyond the public health emergency—perhaps even for years—which ultimately, will restrict professional advancement opportunities for these heroic caregivers,” she said in a statement.
But patient advocates say the waiver is too broad and endangers staff and resident safety by allowing undertrained workers to continue working with fragile patients.
“We know that caregiving staff are one of those professions where there are high rates of injuries among staff and if you’re not properly trained in how to transfer people and move them, and use the equipment, and interact with people of varying conditions, then it puts everybody at risk,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care.
More than 300,000 temporary nursing aides have received abbreviated training and most are seeking their full certification, Harmon said previously. But that has created a logjam for state agencies that provide the training and testing.
“We are aware that there may be instances where the volume of aides that must complete a state approved” Nurse Aide Training and Competency Evaluation Program “exceed the available capacity for enrollees in a training program or taking the exam. This may cause delays in nurse aides becoming certified,” the updated CMS guidance said.
While a “state or facility cannot attain or retain a waiver longer” than the declared public health emergency, the CMS “will grant these waivers for a timeframe that is as short as possible, and CMS will only grant these waivers while the declaration of a COVID-19 public health emergency is still in effect. If the PHE ends during or before the granted period of waiver for a facility or a state or a county, the waiver also ends,” the revised guidance said.
To maintain staffing levels at nursing homes early in the pandemic, the Trump administration waived a rule that limited employment for uncertified nursing aides to just four months. Under the waiver, some states required little additional training beyond an eight-hour online course, according to a report by the Center for Medicare Advocacy.
But to ensure better care for residents, the Biden administration reinstated the training requirement, effective June 7. Uncertified temporary nursing aides had until Oct. 7 to complete the 75-hour training and pass a state certification test. Those hired after June 7 had four months from their date of hire to complete the training.
Nursing aide training encompasses numerous areas, including: medication side effects, skin integrity, dementia care, how to respond to emergencies, infection control, basic nursing and personal care skills, and residents’ rights.
State agencies can request statewide or county waivers “when there are widespread barriers to training/testing that are statewide or in a particular county within a state,” the updated guidance said. The agency must document problems with the nursing aide training program and provide a “plan for remedying the situation.”
“At minimum, the plan to remedy the situation must include the actions the state will take to improve the rate at which aides are certified and a target date for all aides to be certified,” the guidance said.
Individual facility waivers can be requested when local barriers to training and testing occur in a state or county that’s not covered by a waiver. Facilities must document the aide or aides’ efforts to enroll, the obstacles they face, and the facility’s efforts to overcome those obstacles.
To contact the reporter on this story: Tony Pugh in Washington at tpugh@bloomberglaw.com
To contact the editor responsible for this story: Brent Bierman at bbierman@bloomberglaw.com
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