CMS Provides More Information – Nurse Aide Training Competency and Evaluation Waiver Requirements

CMS Provides More Information – Nurse Aide Training Competency and Evaluation Waiver Requirements

The Centers for Medicare and Medicaid Services (CMS) has released Revised QSO-22-15-NH & NLTC & LSC memo.  In this memo, they have updated the section about NA waivers to include a process for asking for an extension of the 1135 waiver. Important to note:  Residential Care Services (RCS) requested a state-wide extension of the 1135 waiver in July and will submit additional documentation to CMS.  

RCS and the Department of Health (DOH) have been working with several Community and Technical Colleges to arrange for mass testing of Nursing Assistants in order to get the backlog tested and certified by the end of the 1135 waiver, October 6th.  LeadingAge WA has been sending out the dates and information on how to get the NARs in your buildings signed up for these test dates.  New dates are being released weekly; we will continue to send you this information.

After months of advocating for an extension of the 1135 waiver, along with our WHCA partner, including more recently with CMS Administrator Brooks-LaSure when we meet in Seattle to discuss workforce driven capacity problems in our health care system, this is a welcome acknowledgement of the need to extend the certification deadline. You can find the full letter to Administrator Brooks-LaSure here. It details the urgent need for an extension of the NAR certification deadline. The letter also goes over other imminent and long-term solutions needed to resolve our workforce shortage, including cautioning against mandatory staffing levels. 

Below are the major changes to the QSO memo-

CMS will review waiver requests in the following manner:  

  1. Individual Facility waiver:

When there are localized barriers to training/testing in a state or county not otherwise covered by a waiver, facilities may request a waiver by providing documentation of the barriers. The documentation must include information demonstrating that the aide(s) have attempted to become certified (e.g., enrollment in training or testing), but the NATCEP entity cannot accommodate the applicant(s) at this time.

  • Documentation should include the date(s) and contact(s) that the communication occurred between.
  • Documentation can be in the form of email, letters, or documentation of a phone call.
  • Documentation must show timely contacts to state officials.
  • Facilities should include the estimated date by which their aides will get certified.
  1. State-wide or County waiver:

When there are widespread barriers to training/testing that are statewide or in a particular county within a state, the state agency may submit a request for the waiver for the affected jurisdiction. The state agency must provide documentation of the status of their NATCEP program and a plan for remedying the situation.

  1. Documentation: At minimum, documentation of the status must include information on the number of aides that need to be certified, a description of issue causing barriers to certification (e.g., training or testing capacity), and the available capacity to certify aides (e.g., describe the gap between the number of aides that need to be certified and capacity available, the number of aides to be certified on a monthly or weekly basis, etc.).
  2. Plan: 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.

Waivers are time-limited, and CMS expects state agencies to actively work towards resolution of barriers to certification. CMS may require that state agencies provide progress reports on the submitted action plan to maintain the waiver.

A state or facility cannot attain or retain a waiver longer than the declaration of a PHE. 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.

We will continue to keep you updated of any additional changes from CMS.



Laura Hofmann, MSN, RN – Director of Clinical and Nursing Facility Regulatory Services
c: 425-231-4804

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August 30, 2022