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Regulatory Update
Enhanced Enforcement Infection Control Deficiencies I Renewal Deadline for CNA and CMA I Certification of Temporary Nurse Aides
April 3, 2023
CMS rescinds previous QSO-20-31-ALL, from 2020, and issues updated guidance
for Enhanced Enforcement for Infection Control Deficiencies
The Centers for Medicare and Medicaid Services (CMS) released QSO Memo QSO-23-10-NH, which updates the enhanced enforcement policy, which was implemented early in the pandemic. This update is related to changes that have occurred throughout the pandemic, including an interim final rule that established long term care facility vaccine immunization requirements, CMS noted the need to continue to evaluate guidance.
The biggest change, in enforcement, is that a CMP (Civil Money Penalty) would no longer apply for all infection control citations. Instead, a CMP would only apply if the scope and severity was cited at a G or higher. Furthermore, enhanced enforcement (Directed POC (point of care) and DDPNA), would only be enforced at Level 2 (D, E, & F) when BOTH F880-Infection Prevention & Control- and F887-COVID-19 Immunizations were cited. However, CMS did reduce the times to achieve substantial compliance. Compliance must be achieved in 30 days for a Level 2 (D, E, & F) deficiency and 15 days for a Level 3 (G, H, & I) or 4 (J, K, & L) deficiency.
Non-compliance with BOTH F880 and F887 (S/S Level 2- D, E, F)
Directed POC with the QIO (Quality Improvement Organizations) or another qualified consultant
DDPNA with 30-days to achieve substantial compliance
Non-compliance for F880 (S/S Level 3- G, H, I)
Directed POC with the QIO or hiring an IC Consultant
DDPNA with 15-days to achieve substantial compliance
CMP according to the CMP Analytical Tool with a 10% increase adjustment
Non-compliance for F880 (S/S Level 4- J, K, L)
Directed POC with the QIO or hiring an IC Consultant
DDPNA with 15-days to achieve substantial compliance
CMP according to the CMP Analytical Tool with a 20% increase adjustment
For survey cycles that began prior to the effective date of QSO-23-10-NH (March 30, 2023), facilities should continue to reference the previous memo.
Finally, the QIOs have been directed to focus their attention on assisting facilities with technical assistance to nursing homes with a history of infection control challenges.
CMS to End Blanket Waivers
Related to Texas Temporary Nurse Aides on May 11
The Centers for Medicare & Medicaid Services (CMS) has indicated that the blanket waiver (PDF), allowing temporary nurse aides to work for longer than four months without completing their Nurse Aide Training and Competency Evaluation Program (NATCEP) or Competency Evaluation Program (CEP), will end May 11, 2023. Previously, CMS had indicated that the temporary nurse aid waiver would end on April 5, 2023.
All nursing aide training emergency waivers for states and facilities will end at the end of the Public Health Emergency (PHE), which will end on May 11, 2023. This means that facilities will have until September 10, 2023, to have all nurse aides who are hired prior to the end of the PHE complete a state-approved NATCEP/CEP. Nurse aides hired after the end of the PHE will have up to four months from their date of hire to complete a state-approved NATCEP/CEP. Refer to PL 2023-05 (PDF) and PL 2021-19 (PDF) for additional information.
Renewal Deadline for CNA and CMA whose Certification Expires
on or before April 30, 2023
HHSC shared that there are approximately 56,000 CNA and Medication Aide certifications that will expire on April 30, 2023. Facilities must verify expiration dates and assist your aides, when necessary, to renew their certification immediately so that the renewal can be processed timely.
- A nurse aide whose certificate expired on or before April 30, 2023, must renew their certificate by April 30, 2023.
- A nurse aide whose certificate expires on or after May 1, 2023, must renew their certificate timely. A nurse aide’s certificate and listing of “active” in the nurse aide registry normally expires within 24 months of being issued or listed.
- A medication aide whose permit expired on or before April 30, 2023, must renew their certificate by April 30, 2023.
- A medication aide whose permit expires on or after May 1, 2023, must renew their permit timely. A medication aide’s permit normally expires within 12 months of being issued.
Deadlines for Temporary Nurse Aides to Become Certified
All TNAs have 4 months from 5/11/23 to become certified
- A nurse aide that began employment on or after 5/11/23 has 4 months from their hire date to become certified in Texas to continue working as a CNA.
- A nurse aide that began employment before 5/11/23 has 4 months from 5/11/2023 (which would be September 10, 2023) to become certified in Texas to continue working as a CNA.
- A nurse aide that began employment before 5/11/23 and has worked 4 months or more has 4 months from 5/11/2023 (which would be September 10, 2023) to become certified in Texas to continue working as a CNA.
Regards,
Dorothy Crawford
Director of Policy & Regulatory Analysis
Texas Health Care Association
