COVID-19 Update #256
Pfizer Consent Form and Fit Test Information

  • As you know, the Maryland National Guard tactical teams are administering the vaccine to residents, patients, and staff in nursing homes in the short-term. They are continuing to contact centers 72 hours in advance of their visit. Given the pause in the J&J vaccine, please ensure that you fill out the Pfizer consent form for any individual who will be receiving vaccination. It is critical that consent forms for employees, residents, and staff are signed and ready before the teams arrive. Vaccinations will not be administered without the consent form.

Updates from AHCA/NCAL
CDC and FDA Pause Johnson and Johnson COVID-19 Vaccine

This week, the CDC and FDA announced a pause to the Johnson and Johnson (J&J) COVID-19 vaccine after six cases of a rare type of blood clot developed in individuals who received the vaccine. The CDC discovered these six cases through the Vaccine Adverse Events Reporting System (VAERS), showing the importance and effectiveness of these national surveillance systems and that COVID-19 vaccine safety is a top priority. They are recommending this pause to prepare the health care system to recognize and treat patients appropriately, and to report severe events they may be seeing in people who have received the J&J vaccine. 

The CDC will convene a meeting of the Advisory Committee on Immunization Practices on Wednesday, April 14, to further review these cases and assess their potential significance. It is important to note that these events are extremely rare and have only been reported in six individuals of the 6.85 million doses administered. 

This is important to long term care because the J&J vaccine was the primary vaccine being allocated to long term care pharmacies enrolled in the CDC's Federal Retail Pharmacy Program. While many states are providing allocations of their own to long term care pharmacies, this was the only vaccine available through the federal program. AHCA/NCAL is calling on the Biden Administration to promptly allocate Pfizer and Moderna vaccines to these settings in order to fill the gap caused by the J&J pause.

Careers in Aging Week (CIAW) starts on Sunday, April 18!

Join us in celebrating all week by bringing awareness to the numerous career opportunities available in long term care and aging services. CIAW is also an opportunity to celebrate current caregivers in the industry for their heroic efforts. Along with the Gerontological Society of America, Argentum, and LeadingAge, we will be spreading the word about careers in aging and celebrating our members’ current employees. Join us in promoting these rewarding careers on social media using the hashtag #CareersinAging.

Visit the Careers in Aging Week webpage for resources and stories of health care heroes.
CMS Issues FY 2022 SNF Proposed Payment Rule  

The Centers for Medicare & Medicaid Services (CMS) recently issued the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) fiscal year (FY) 2022 update. 

The proposed rule includes a net market basket increase of 1.3 percent. CMS estimates that the net market basket update would increase Medicare SNF payments by approximately $444 million in FY 2022. The 1.3 percent net market basket is the result of statutorily-mandated adjustments (a prior version of this email had an incorrect number identified).

Additionally, CMS discusses proposals to rebase and revise the Market Basket weights (a regularly scheduled update), solicits comments on possible adjustments/recalibration to the Patient-Driven Payment Model (PDPM), and solicits delete budget proposes a new Consolidated Billing exclusion.

The team at AHCA team has developed a summary of the proposed rule, which includes an overview of the payment updates, the SNF value-based purchasing (VBP) program, and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act quality reporting additions.
Upcoming Webinar:

Wednesday, April 21 at 2:30 PM Eastern
Hosted by AHCA/NCAL
CMS Announces Changes to 1135 Waivers

Last week, CMS issued a memo announcing it is ending four of the 1135 waivers issued in response to the COVID-19 Public Health Emergency (PHE). These changes are effective May 10, 2021. The four waivers that will be ending relate to prior notification of room and roommate change, prior notice of transfer/discharge, certain care planning requirements and MDS submission. 

CMS also provides clarification and recommendations for Nurse Aide Training and Competency Evaluation Programs (NATCEPs). Currently, CMS is keeping the current nurse aide waiver. 

Summary of Removed Waivers 

CMS is making the following changes to blanket 1135 waivers, effective May 10, 2021. CMS’ rationale for removing these waivers is that facilities have developed processes for completing these requirements at this point. 

  • ​Resident roommates and grouping: ​
  • ​Ending: waiver of notification prior to Resident Room or Roommate Change at 42 CFR §483.10(e)(6). 
  • Keeping: related waivers at 42 CFR 483.10(e)(5) and (7) when change of rooms is done solely for purposes of cohorting due to COVID-19. 
  • Impact: You must provide notice before a room or roommate change except when the change is solely for COVID-19 cohorting. 

  • Resident transfer and discharge:
  • ​​​Ending: waiver of notification prior to Transfer and Discharge at 42 CFR §483.15(c)(4)(ii) 
  • ​Keeping: related waivers at 42 CFR 483.10(c)(5) as well as 483.15(c)(3), (c)(5)(i) and (iv) and (c)(9), and (d) that allow providers to transfer or discharge residents to another long term care facility solely for cohorting purposes without prior written notice. 
  • Note: It is important to read​ the details of these waivers to ensure you are applying them correctly and provide notice as soon as possible when transferring or discharging residents for cohorting purposes. 
  • Impact: You must provide written notice of transfer or discharge at least 30 days in advance, or as soon as practicable in certain situations, before the transfer or discharge.

  • ​Care planning requirements: 
  • ​Ending: waiver of certain care planning requirements at §483.21(a)(1)(i), (a)(2)(i), and (b)(2)(i) for residents transferred or discharged for cohorting purposes. 
  • Impact: You must complete baseline care plans within 48 hours of admission and comprehensive care plans within seven days of completion of the comprehensive assessment, according to current regulations. 

  • ​Minimum Data Set (MDS): 
  • ​Ending: waiver of timeframe requirements for completing and transmitting resident assessment information at 42 CFR §483.20. 
  • Keeping: waiver at 42 CFR §483.20(k) related to the Pre-Admission Screening and Annual Resident Review (PASARR). 
  • Impact: You must complete and transmit MDS assessments according to current regulations. 

Additional NATCEP Information 

AHCA/NCAL is pleased that CMS has recognized that time worked by the nurse aides during the PHE may count towards meeting the federal 75-hour training requirement and is encouraging states to evaluate their NATCEP to consider time worked during the PHE to help temporary nurse aides become certified nurse aides (CNA). CMS has also clarified that the four-month regulatory timeframe for completing the nurse aide training and competency evaluation requirements after hire will be reinstated when the blanket waiver ends and will start at that time. Nurse aides will have the full four-month period starting from the end of the blanket waiver to successfully complete the required training and certification, regardless of the amount of time worked during the time the waiver was in effect. Federal requirements do not specify whether training must be delivered in a classroom versus a nursing home setting, and CMS acknowledges that training on many of the required topics can be obtained in a nursing home setting while working as a nurse aide under the waiver and through onsite experience and observation. 

Currently, it is expected that HHS will renew its declaration of public health emergency through the end of 2021 and will provide 60 days’ notice prior to ending it. As long as the PHE is in place, CMS may retain its 1135 waivers. However, CMS could decide to phase out other waivers prior to the end of the PHE if it determines they are no longer needed. CMS will continue to monitor the emergency blanket waivers and may provide future updates. 

You can access more information regarding these changes and current waivers that remain in place. For questions, please contact
The 2021 HFAM Conference “Together We Re-Imagine” will be held in person October 4 – 7, 2021 at the Maryland Live Hotel and Casino in Hanover, Maryland. Hundreds of long-term care leaders will connect, share best practices and discuss actionable insights on how we can reflect, reform, rebuild, and revolutionize quality care. You and your teams will not want to miss this opportunity as we come together again.

Visit the conference website to learn more and register.
Thank you to our current sponsors!
Did you miss an update?

Visit our website to view all previous HFAM alerts, as well as guidance
from our federal and state partners.
Health Facilities Association of Maryland WW.HFAM.ORG