CMS' Temporary Nurse Aide Waiver Has Expired: What Happens Now

The blanket waiver expired on October 6 while there was still a backlog for CNA training and testing in numerous states, creating a barrier for temporary nurse aides to become certified.

Temporary nursing aides (TNA) lost their jobs on October 7 after the blanket employment waiver implemented by the Centers for Medicare & Medicaid expired on October 6.

The section of the initial 1135 waiver permitting TNAs' employment ended in June, with the agency giving TNAs four months to become certified nursing assistants (CNA), which would allow them to remain employed by their facilities. Yet, there were hinderances in their efforts to get certified by the October 6 deadline, with multiple states having a backlog for CNA training and testing.

"CMS received feedback from some nursing homes and states about barriers to getting nurse aides trained and tested," a spokesperson for the agency told HealthLeaders. "CMS has met with state survey agencies to ensure they understand how to submit requests for waivers of the Nurse Aide Training Competency and Evaluation requirements and the appropriate supporting documentation."

"Unfortunately, these workers were removed from or left their caregiving role unless states or their facilities were able to secure approval for a waiver," Holly Harmon, senior vice president of quality, regulatory, and clinical services for the American Health Care Association (AHCA), told HealthLeaders. "CMS is only allowing short-term exceptions to continue employing TNAs for individual states and facilities that were granted approval by the agency."

So far, CMS has granted waivers to 17 states: Rhode Island, Massachusetts, Washington, Indiana, Louisiana, Maryland, Minnesota, Oklahoma, Pennsylvania, Texas, Vermont, New York, Georgia, New Jersey, Tennessee, South Carolina, and Mississippi. Approximately 746 individual facilities have sent waiver requests, with 439 already covered under state waivers. Employment under these approved waivers will only last until the end of the public health emergency.

TNAs handle nonclinical tasks, such as serving as companions for nursing home residents.

Harmon said TNAs are still urged to get their CNA certification, adding that the AHCA supports the Building America's Health Care Workforce Act, which was recently introduced to Congress, and would give TNAs up to 24 months upon the end of the public health emergency to become certified.

"Temporary nurse aides are an important part of our long-term care workforce who make a positive impact every day," she said. "Losing these temporary nurse aides may further limit access to care for residents, as facilities may be forced to further limit the number of residents they can serve due to staffing shortages."

According to the AHCA, nursing homes have lost over 220,000 caregivers over the course of the pandemic—more than any other healthcare sector.

"It is evident that the temporary nurse aide role has been pivotal and beneficial to our nursing home residents nationwide, not on a case-by-case basis," Harmon said in a statement in October. "Federal data clearly shows that quality of care for residents remains high when temporary nurse aides are present. Our residents deserve continuity of care from caregivers they know, and these experienced aides deserve adequate time to build a permanent career in long-term care."

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