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LTC Special Waivers

TermDefinition
What is the licensed RN nursing requirement for skilled nursing facilities? (7014.1.1) They provide 24-hr licensed nursing services, an RN for 8 consecutive hours a day, 7 days a week, AND an RN designated as DON on a full time basis.
Who may waive requirements on behalf of the Secretary of HHS? The Regional Office (RO), acting on behalf of the Secretary, may waive a requirement.
Where would one find guidance pertaining to Special Waivers? SOM Chapter 7 7014 - 7014.4
There are 4 circumstances where the licensed RN requirement may be waived. The first is? Facility is located in a rural area & supply of skilled nursing facility services is not sufficient to meet area needs.
The second? Facility has 1 full-time RN on duty 40 hrs/wk; may be 1 person or multiple part-time. RN may or may not be DON & may perform some DON & clinical duties if facility so desires.
The third? Facility has residents whose physicians have indicated, through admission notes or orders that residents do not need RN or Dr. care for a 48 hr period.
The fourth? A Dr. or RN will spend necessary time at facility to provide care residents need on days RN is not on duty. Refers to clinical care for residents needing skilled nursing services.
Whom must the Regional Office notify if waiver is granted? RO must provide notice of waiver to the State long-term ombudsman & to the State protection & advocacy system for the mentally ill & intellectually disabled.
Whom must the Facility notify when waiver is granted? Must notify facility residents or responsible guardians & members of their immediate families.
How often must a facility renew their waiver of the RN requirement? Annually
What is the licensed nurse staff requirements for nursing facilities? (7014.1.2) For long-term care facilities to provide 24-hours licensed nursing care.
Which regulatory body has the authority to waive the Nurse Staffing Requirements in Nursing Facilities (7014.1.2)? The State
There are 2 circumstances where the licensed nursing requirement may be waived. The first is? Facility satisfactorily demonstrates to State that diligent efforts to recruit appropriate personnel have been made and been unsuccessful.
The second? State determines a waiver will not endanger the health or safety of residents AND they find that an RN or Dr. is obligated to respond immediately to phone calls for periods when licensed nursing services aren't available.
If waiver for 24-hour licensed nursing is granted whom must the State provide notice to? To the State long-term care ombudsman & to the State protection & advocacy system for the mentally ill & intellectually disabled.
Whom must the Facility notify when waiver is granted? Must notify facility residents or responsible guardians & members of their immediate families.
What does it mean for a facility to be dually participating? It means the facility participates in both the Medicare & Medicaid programs.
Waiver of Nurse Staffing Requirements for Dually Participating Facilities falls under whose jurisdiction? (7014.1.3) The Regional Office (Federal). If a facility dually participates in both Medicare & Medicaid it is subject to criteria for a skilled nursing facilities.
True or False- The first time a nursing facility applies for a waiver, the State will conduct an onsite survey? True- Purpose of survey is to establish that the waiver will not endanger the health & safety of residents & requirements for conditions are met. A full survey is not required. (7014.1.4))
What are the two legal requirements for a multi resident room? 1. May have no more than four beds per room 2. Must have a minimum of 80 square feet per bed.
True or False- A variance and a waiver are the same things? TRUE
What is the legal requirement for a single resident room? The room must measure at least 100 square feet.
True or False- In cases of variations of patient room size and/or beds per room the State and Regional Office have equal jurisdiction to approve them? FALSE- The State has jurisdiction to approve them in Medicaid-only cases.
What is the condition for approval for variations to room size and/or beds per room? (7014.3) Variations may be permitted in individual cases where facility demonstrates in writing that variations are in accordance with the special needs of residents & will not adversely affect health & safety.
Where does one document the support of waivers or variations? (7014.4) An asterisk should be placed to the left of the data tag on the SoD & PoC, CMS form 2567, and include required documentation to support recommendation with the certification packet. Enter a "W" in the PoC field in certification tab in ASPEN.
Created by: Debra Bernier 1
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