In an August 9, 2022 letter, the American Health Care Association asked HHS Secretary Xavier Becerra to reinstate the 1135 waiver on nursing aide training requirements for nursing homes that expired more than two months ago. The Center for Medicare Advocacy strongly opposes this request and urges the Centers for Medicare & Medicaid Services (CMS) to firmly and quickly say no.
In March 2020, at the beginning of the COVID-19 pandemic, CMS waived the federal statutory requirement that facilities not use individuals as nurse aides for more than four months unless they had completed a nurse aide training program. However, CMS did not waive the statutory requirement that aides pass their state’s competency evaluation program.
AHCA immediately created a free eight-hour on-line training program for a new staff position, which it called temporary nurse aides (TNAs). Many states accepted TNAs, with limited training, as workers during the pandemic.
In April 2021, CMS advised that when it lifted the waiver of nurse aide training requirements, aides would have four months to complete their states’ required training. However, CMS simultaneously suggested that “states evaluate their NATCEP [nurse aide training and competency evaluation program] and consider allowing some of the time worked by the nurse aides during the PHE to count toward the 75-hour training requirement.” The Center expressed concern at the time that CMS was signaling that states were free to undermine longstanding statutory nurse aide training requirements, in anticipation of the end of the public health emergency. This gratuitous offer to states and nursing homes was especially troubling when CMS did not know how many people were working as TNAs and what proportion of the aide workforce they actually represent, what kind of training and how much training they received, who provided the training, where they work, and which specific CNA tasks they perform and how well (or inadequately) they perform those assignments.
CMS finally lifted the nurse aide training waiver on April 7, 2022, effective in 60 days. The waiver is no longer in effect. The Center for Medicare Advocacy urges CMS not to reinstate it.
August 18, 2022 – T. Edelman
 Letter from AHCA President and CEO Mark Parkinson to HHS Secretary Xavier Becerra, https://www.ahcancal.org/News-and-Communications/Fact-Sheets/Letters/AHCA-NCAL-Letter-HHS-Aug2022.pdf
 42 U.S.C. §§1395i-3(f)(2), 1396r(f)(2), Medicare and Medicaid, respectively (federal rules). States’ programs must comply with these federal standards, 42 U.S.C. §§1395i-3(e)(1), 1396r(e)(1)
 AHCA, Temporary Nurse Aide Training & Competency Checklist (website no longer available to the public)
 See “Who’s Providing Care for Nursing Home Residents? Nurse Aide Training Requirements during the Coronavirus Pandemic” (CMA Report, Jul. 23, 2020), https://medicareadvocacy.org/wp-content/uploads/2020/07/Report-Nurse-Aide-Training.pdf
 CMS, “Updates to Long-Term Care (LTC) Emergency Regulatory Waivers issued in response to COVID-19,” QSO-21-17-NH (Apr. 8, 2021), https://www.cms.gov/files/document/qso-21-17-nh.pdf
 See “Who Provides Care for Nursing Home Residents? An Update on Temporary Nurse Aides” (CMA Alert, Sep. 15, 2021), https://medicareadvocacy.org/special-report-update-on-tnas, and (CMA Report, Sep. 15, 2021), https://medicareadvocacy.org/wp-content/uploads/2021/09/SNF-TNA-Report-09-2021.pdf
 CMS, “Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers,” QSO-22-15-NH & NLTC & LSC (Apr. 7, 2022), effective in 60 days from Apr. 7, https://www.cms.gov/files/document/qso-22-15-nh-nltc-lsc.pdf