What to Consider with the End of the PHE

With the announcement from the Biden administration to end the COVID-19 Public Health Emergency (PHE) on May 11, PHCA wants to provide you with information and updates on waivers that are important to begin preparing for.


Three-Day Prior Hospitalization Waiver | End Date: May 11, 2023

Using the statutory flexibility under Section 1812(f) of the Social Security Act, CMS temporarily waived the requirement for a three-day prior hospitalization for coverage of a skilled nursing facility (SNF) stay. 

What this waiver provides: The three-day prior hospitalization waiver provides temporary emergency coverage of SNF services without a qualifying hospital stay. In addition, for certain beneficiaries who exhausted their SNF benefits, it authorizes a one-time renewed SNF coverage without first having to start and complete a 60-day “wellness period” (that is, the 60-day period of non-inpatient status that is normally required in order to end the current benefit period and renew SNF benefits). This waiver will apply only for those beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing the 60-day “wellness period” that would have occurred under normal circumstances. By contrast, if the patient has a continued skilled care need (such as a feeding tube) that is unrelated to the COVID-19 emergency, then the beneficiary cannot renew his or her SNF benefits under the Section 1812(f) waiver, as it is this continued skilled care in the SNF rather than the emergency that is preventing the beneficiary from beginning the 60-day “wellness period.”

How to prepare for the end of this waiver: Nursing facility providers should review pre-admission policies and procedures in preparation of the waiver expiration. This is also a good time to review policies and procedures with any recent hires in admission or business office roles. 


Pre-Admission Screening and Annual Resident Review Waiver | End Date: May 11, 2023

CMS has been allowing states and nursing homes to suspend PASARR assessments for new residents for 30 days. 

What this waiver provides: After 30 days, new patients admitted to nursing homes with a mental illness (MI) or intellectual disability (ID) should receive the assessment as soon as resources become available.

How to prepare for the end of this waiver: Nursing facility providers should review pre-admission policies and procedures to ensure assessments are included. This is also a good time to review policies and procedures with any recent hires in admission or business office roles.  


Required Facility Reporting | End Date: December 31, 2024 

Under §483.80(g), long-term care facilities are required to report COVID-19 cases in their facility to the CDC National Health Safety Network (NHSN) on a weekly basis.

Why this requirement is in place: The CDC and CMS uses information collected through the new NHSN Long-term Care COVID-19 Module to strengthen COVID-19 surveillance locally and nationally; monitor trends in infection rates; and help local, state, and federal health authorities get help to nursing homes faster. Nursing home reporting to the CDC is a critical component of the national COVID-19 surveillance system and to efforts to reopen America. The information is also posted online for the public to be aware of how the COVID-19 pandemic is affecting nursing homes. In COVID-19 Public Health Emergency Interim Final Rule #3 (CMS-3401-IFC), CMS is codifying enforcement actions for facilities noncompliance with this requirement. Failure to report results in the imposition of a civil money penalty for each occurrence of non-reporting as defined under § 488.447.

Facilities are also required to notify residents, their representatives, and families of residents in facilities of the status of COVID-19 in the facility, which includes any new cases of COVID-19 as they are identified. This action supports CMS’ commitment to transparency so that individuals know important information about their environment, or the environment of a loved one. 

Why is this requirement continuing through the end of the PHE: The 2022 CY Home Health PPS Rule extended this mandatory COVID-19 reporting requirements beyond the current COVID-19 PHE until December 31, 2024.

NOTE: Testing requirements end (outlined below), but reporting requirements and penalties for not reporting will continue.


Specific Life Safety Code (LSC) for Multiple Providers Waivers

CMS has been waiving and modifying particular waivers under 42 CFR §483.470(j) for ICF/IIDs and §483.90(a) for SNF/NFs. Specifically, CMS modified these requirements as follows:

  • Alcohol-based Hand-Rub (ABHR) Dispensers
    • What this waiver provides: CMS waived the prescriptive requirements for the placement of alcohol-based hand rub (ABHR) dispensers for use by staff and others due to the need for the increased use of ABHR in infection control. However, ABHRs contain ethyl alcohol, which is considered a flammable liquid, and there are restrictions on the storage and location of the containers. This includes restricting access by certain patient/resident population to prevent accidental ingestion. Due to the increased fire risk for bulk containers (over five gallons) those will still need to be stored in a protected hazardous materials area.Refer to: 2012 LSC, sections 18/ In addition, facilities should continue to protect ABHR dispensers against inappropriate use as required by 42 CFR §483.470(j)(5)(ii) for ICF/IIDs and §483.90(a)(4) for SNF/NFs.
    • How to prepare for the end of this waiver: Providers should evaluate and update any pertinent facility policies to ensure resident and staff safety. If unable to accommodate, they should request a waiver from PA DOH Life Safety if necessary. Providers can review the Life Safety Code regarding location and installation of ABHR dispensers by clicking here.
    • End Date: May 11, 2023
  • Established new requirements for Long Term Care Facilities to Conduct SARS-CoV-2 Testing for Staff and Residents
    • Why this requirement is in place: Under the new 483.80(h) CMS is requiring Long-Term Care (LTC) Facilities to test Staff and Residents. Specifically, facilities are required to test residents and staff, including individuals providing services under arrangement and volunteers, for COVID-19 based on parameters set forth by the Secretary. This rule will enhance efforts to keep COVID-19 from entering and spreading through nursing homes. These regulations are effective on September 2, 2020. Applicability date:
    • End Date: May 11, 2023, but reporting will continue until December 31, 2024.
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