In the midst of the COVID-19 crisis, the government passed temporary measures to reduce the burden of healthcare workforce recruitment and training. One key measure was the relaxation of training timelines and certification for nurse aides. The Centers for Medicare & Medicaid Services (CMS) issued waivers, helping human resources departments find and keep desperately needed workers during a period of maximum strain on the system.
But what now? The demand for healthcare workers certainly hasn’t tapered off. Yet after the CMS waiver ended in June 2022, many workers struggle to fulfill training requirements by the deadline of October 7th. Backlogs in the training and testing systems make compliance extremely difficult for some and impossible for others.
In fact, some candidates have simply given up due to their inability to find an exam opening.
Both healthcare and government employees are trying to balance the dangers of lax standards with the dangers of insufficient staffing. The Building America’s Healthcare Workforce Act is one proposed solution. So what is it, and does it mean that facilities can finally relax?
What Is the Building America’s Healthcare Workforce Act?
Under the authority granted in section 1135 of the Social Security Act, the CMS issued multiple blanket waivers for providers (which are sometimes referred to as the 1135 waivers). Some of these covered the employment of temporary nurse aides in Medicare skilled nursing facilities (SNFs) and Medicaid nursing facilities (NFs).
Pre-pandemic, nursing facilities couldn’t hire aides for longer than four months unless they met the training and testing requirements to become certified nurse aides (CNAs). By relaxing these requirements, the CMS allowed SNFs and NFs to keep temporary nurse aides (TNAs) on the front lines. It was an important factor in the struggle to maintain adequate staffing.
Introduced in May, the Building America’s Healthcare Workforce Act extends the leeway CMS granted to new nurse aides during the pandemic. If the act passes, these flexibilities would be extended for at least two more years. The bill also proposes some modifications to training hours and competency testing that would make it easier for aides to fulfill these requirements.
How Would the Act Affect Workforce Recruitment and Training?
When it comes to job loss, long-term care is the worst impacted industry in the healthcare sector. Employment at assisted living facilities is down 3.9% since February 2020. At nursing homes, the number is worse: a whopping 14.1%. The time crunch created by the October 7th deadline threatens to add new pressure to an already bad situation.
The Building America’s Healthcare Workforce Act would give SNFs and NFs some breathing room. In addition to extending the waiver, the Act specifies that any hours worked during the emergency period count toward initial training hours. The bill also allows a TNA’s SNF or NF employer to administer their evaluation if the state doesn’t offer it at least once a week.
Who Supports the Resolution?
Support for the bill comes from different sectors and from both sides of the political aisle. It was introduced in May by House Representatives Madeleine Dean (D-PA), Brett Guthrie (R-KY), and David McKinley (R-WV). On September 9th, the three Congresspeople joined 11 others in a bipartisan letter to the administrator of CMS, asking her to put her own weight behind it.
In addition, both the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL) support the proposal. They followed the September 9th letter with their own statement, urging Congress to pass the bill and CMS to relax the requirements.
Both trainers and workers are frustrated. No one wants to lose a vital workforce or deny eager aides job opportunities. According to a survey issued to temporary nurse aides who completed the AHCA/NCAL training program, almost 80% were interested in making it a permanent career and becoming certified.
What’s the Opposing Argument?
CMS officials have raised concerns about falling standards of care. They’ve cited survey findings that linked the laxer standards to resident depression, weight loss, and pressure ulcers.
Nursing home division director Evan Shulman tried to walk a middle course during a June address. He voiced sympathy for facilities struggling to retain staff, but he also alluded to worrying field reports:
On the one hand, we do not want to create barriers for facilities to retain staff. On the other hand, we are seeing significant issues related to staff not being trained and certified.
Shulman has since repeated his concerns and his determination to find a balance between the two camps.
Is There Any Flexibility in Current CMS Training Regulations?
Yes. In situations where there are local obstacles to training or testing — such as the backlog of individuals needing tests — CMS will allow extensions at the level of the state, county, or facility. Providers that demonstrate need can receive short-term waivers.
However, these waivers are set to immediately expire when the COVID-19 Public Health Emergency Declaration does. Legislators expressed their concern that this simultaneous expiration will create a sudden disruption of important bedside care. A holding pattern may only delay the issue.
Already overburdened providers have also found the situation frustrating. Some even resent being left with the additional work of applying for waivers. This is particularly true in states such as Pennsylvania where the difficulty of scheduling tests is dramatic and widespread.
Other states significantly worried about converting TNAs to CNAs in time are Iowa, Maryland, Massachusetts, Oklahoma, Texas, and Virginia.
How Can Providers Manage Employees in Light of Emerging Legislation on Healthcare Staffing?
Healthcare human resources departments have a lot to handle these days. There are new reimbursement guidelines, sometimes confusing compliance issues, and the eternal need to maintain a staff of highly qualified nurses and aides.
Whether or not the Building America’s Healthcare Workforce Act passes, Empeon is here to help. We’ve created a five-star, customizable system to empower you to handle recruitment, onboarding, benefits, reporting, and time-tracking.
Manage employee records with software that lets you identify training or testing problems before they arise. Contact us today to see how we can make your life a little easier. Because we all know that you deserve it.
