Ppr Int Edea1Fb5E88D481A Intermediate Care Facility For Individuals With Intellectual Disa - Ppr Int Edea1Fb5E88D481A Intermediate Care.

Summary

CMS fact sheet, dated 2/22/2023, on COVID-19 public health emergency (PHE) waivers for Intermediate Care Facilities for Individuals with Intellectual Disabilities. It describes a three-phase CMS review of waivers and flexibilities to prepare the health care system for operation after the PHE, and lists four waivers: letting Direct Care Staff take on support duties under 42 CFR §483.430(c)(4), suspending community outings under 42 CFR §483.420(a)(11), partly waiving routine staff training under 42 CFR § 483.430(e)(1), and modifying active treatment programs under 42 CFR §483.440(a)(1). It says CMS is not waiving initial training for new hires or COVID-19 infection control training, that Individual Program Plans must be updated no later than 60 days after the PHE expires, and that each flexibility ends at the conclusion of the COVID-19 PHE.

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Intermediate Care Facility for Individuals with Intellectual Disabilities
At the beginning of the COVID-19 Public Health Emergency (PHE), CMS used emergency waiver
authorities and various regulatory authorities to enable flexibilities so providers could rapidly
respond to people impacted by COVID-19. CMS developed a cross-cutting initiative to use a
comprehensive, streamlined approach to reestablish certain health and safety standards and
other financial and program requirements at the eventual end of the COVID-19 public health
emergency.

This CMS cross-cutting initiative focused on evaluating CMS-issued PHE waivers and flexibilities
to prepare the health care system for operation after the PHE. This review happened in three
concurrent phases:

1. CMS assessed the need for continuing certain waivers based on the current phase of the
   PHE. Since the beginning of the PHE, CMS has both added and terminated flexibilities and
   waivers as needed. In doing so, CMS considered the impacts on communities — including
   underserved communities — and the potential barriers and opportunities that the
   flexibilities may address.

2. CMS assessed which flexibilities would be most useful in a future PHE, such as natural and
   man-made disasters and other emergencies, to ensure a rapid response to future
   emergencies, both locally and nationally, or to address the unique needs of communities
   that may experience barriers to accessing health care.

3. CMS is continuing to collaborate with federal partners and the health care industry to
   ensure that the health care system is holistically prepared for addressing future
   emergencies.

As CMS identified barriers and opportunities for improvement, the needs of each person and
community served were considered and assessed with a health equity lens to ensure our
analysis, stakeholder engagement, and policy decisions account for health equity impacts on
members of underserved communities and health care professionals disproportionately serving
these communities.

Please note: This fact sheet focuses on Medicare and Medicaid flexibilities only.
Staffing Flexibilities.

   •   CMS is waiving the requirements at 42 CFR §483.430(c)(4), which requires the facility to
       provide sufficient Direct Support Staff (DSS) so that Direct Care Staff (DCS) are not
       required to perform support services that interfere with direct client care. DSS perform
       activities such as cleaning the facility, cooking, and laundry services. DSC perform
       activities such as teaching clients appropriate hygiene, budgeting, or effective

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       communication and socialization skills. During the time of this waiver, DCS may be
       needed to conduct some of the activities normally performed by the DSS. This will allow
       facilities to adjust staffing patterns while maintaining the minimum staffing ratios
       required at §483.430(d)(3). CMS will end this flexibility at the conclusion of the COVID-
       19 PHE.
Suspension of Community Outings.

   •   CMS is waiving the requirements at 42 CFR §483.420(a)(11), which requires clients to
       have the opportunity to participate in social, religious, and community group activities.
       The federal and/or state emergency restrictions will dictate the level of restriction from
       the community based on whether it is for social, religious, or medical purposes. States
       may have also imposed more restrictive limitations. CMS is authorizing the facility to
       implement social distancing precautions with respect to on and off-campus movement.
       State and federal restrictive measures should be made in the context of competent,
       person-centered planning for each client. CMS will end this flexibility at the conclusion
       of the COVID-19 PHE.
Suspend Mandatory Training Requirements.

   •   CMS is waiving, in part, the requirements at 42 CFR § 483.430(e)(1) related to routine
       staff training programs unrelated to the public health emergency. CMS is not waiving 42
       CFR §483.430(e)(2)-(4), which requires focusing on the client’s developmental,
       behavioral and health needs and being able to demonstrate skills related to
       interventions for inappropriate behavior and implementing individual plans. We are not
       waiving these requirements as we believe the staff’s ability to develop and implement
       the skills necessary to effectively address clients’ developmental, behavioral, and health
       needs are essential functions for an ICF/IID. CMS is also not waiving initial training for
       new staff hires or training for staff around prevention and care for the infection control
       of COVID-19. It is critical that new staff gain the necessary skills and understanding of
       how to effectively perform their role as they work with this complex client population
       and that staff understand how to prevent and care for clients with COVID-19. CMS will
       end this flexibility at the conclusion of the COVID-19 PHE.
Modification of Adult Training Programs and Active Treatment.

   •   CMS recognizes that during the public health emergency, active treatment will need to
       be modified. The requirements at 42 CFR §483.440(a)(1) require that each client must
       receive a continuous active treatment program, which includes consistent
       implementation of a program of specialized and generic training, treatment, health
       services and related services. CMS is waiving those components of beneficiaries’ active
       treatment programs and training that would violate current state and local
       requirements for social distancing, staying at home, and traveling for essential services


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only. For example, although day habilitation programs and supported employment are
important opportunities for training and socialization of clients at intermediate care
facilities for individuals with developmental disabilities, these programs pose too high of
a risk to staff and clients for exposure to a person with suspected or confirmed COVID-
19. In accordance with §483.440(c)(1), any modification to a client’s Individual Program
Plan (IPP) in response to treatment changes associated with the COVID-19 crisis requires
the approval of the interdisciplinary team. For facilities that have interdisciplinary team
members who are unavailable due to the COVID-19, CMS would allow for a retroactive
review of the IPP under 483.440(f)(2) in order to allow IPPs to receive modifications as
necessary based on the impact of the COVID-19 crisis. Active treatment programs and
IPPs must be revised or updated no later than 60 days after the expiration of the PHE.
CMS will end this flexibility at the conclusion of the COVID-19 PHE.




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