State Cross-Agency Guidance on Flexibility in Hiring and Training Staff for Healthcare Providers

To: Emergency Medical Service Providers, Skilled Nursing Facilities, Hospitals, Home Care Agencies, and In-Patient Care Facilities To facilitate the safe delivery of health care services to members throughout the state of emergency declared in response to the COVID-19 illness, the Departments of Health Care Policy and Financing (HCPF), Public Health and Environment (CDPHE) and the Department of Regulatory Agencies (DORA), are empowered to authorize several temporary changes in order to expand efforts to combat COVID-19. This table is meant to serve as a guide to help providers navigate cross-agency flexibility in hiring and training healthcare staff. Providers are encouraged to visit the affiliate links detailed below for further information. Emergency Medical Service (EMS) Providers: TEMPORARY SCOPE OF PRACTICE EXPANSIONS On Feb. 28, 2020 the Colorado Department of Public Health and Environment expanded EMS provider scope of practice to include nasal and oral swab sample collection for all EMS provider levels. For more information, please visit the Department of Public Health and Environment’s waiver here. EXTENSION OF EMS PROVIDER CERTIFICATION EMS provider certification expiration dates may be subject to the Governor’s Executive Order 2020-015. Emergency rule changes were promulgated to help renewal applicants unable to complete the portions of the renewal requirements that are not available online due to COVID-19 by allowing the department to extend the certification period. For the emergency rule revisions to 6 CCR 1015-3 Chapter One, visit here.  PREVIOUSLY CERTIFIED EMS PROVIDER PROVISIONAL REINSTATEMENT CDPHE is offering provisional reinstatement for previously certified Colorado EMS providers whose certification expired after April 1, 2014 and was in good standing at time of expiration. Current NREMT, BLS, and ACLS requirements are waived, as well as the $23 provisional fee. For information on the Provisional Reinstatement, please visit here.  FINGERPRINT-BASED BACKGROUND CHECKS Applicants for EMS Provider certification who are not able to obtain a fingerprint-based background check can request a one-time provisional certification. Provisional certification is valid for 90 days and requires a name-based background check, in addition to all other certification requirements. Class B Licensed Home and Community Based Service (HCBS) Providers: For more information, please visit the Department of Health Care Policy and Financing memo here. COVID-19 COMMUNICATION FOR SUPERVISION REQUIREMENTS FOR CLASS B LICENSED HCBS PROVIDERS   Effective March 24, 2020, many supervision requirements for licensed Class B agencies providing unskilled personal care, homemaker, respite, or In-Home Support Services (IHSS) may be conducted via phone, video conference, telecommunication or in-person. Exception is that the supervisor/ supervising nurse MUST conduct an in-person supervisory visit to evaluate member complaints when such concerns cannot be successfully addressed remotely by telephone and/or video. Nursing Facilities: For more information, please visit the Department of Health Care Policy and Financing memo here. TEMPORARY TRAINING AND CERTIFICATION OF NURSE AIDES Under the CMS COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, retroactive effective date of March 1, 2020 through the end of the emergency declaration:  · “CMS is waiving the requirements at 42 CFR 483.35(d) (with the exception of 42 CFR 483.35(d)(1)(i)), which require that a SNF and NF may not employ anyone for longer than four months unless they met the training and certification requirements under §483.35(d).”  · Nursing facilities must ensure that uncertified staff working as nurse aides under this provision are adequately trained and competent to perform tasks assigned to them.  · For MED-13, nursing facilities may allocate uncertified staff who perform direct health care tasks under the parameters described above in the same manner licensed staff are allocated under 10 CCR 2505-10 section 8.443.7.A.1   Hospitals and In-Patient Care Facilities:  For more information, please visit the Department of Regulatory Agencies memo here. TEMPORARY SCOPE OF PRACTICE EXPANSIONS Governor Jared Polis issued Executive Order D 2020 038 on April 15, 2020, which authorizes the temporary expansion of scope of practice for certain healthcare professionals providing services for patients in hospitals or inpatient medical facilities - including emergency departments - during the pandemic as delegated by a physician, physician assistant, advanced practice nurse, certified nurse anesthetist, registered nurse, or respiratory therapist.  Healthcare professionals are statutorily required to work within a defined scope of practice, so inpatient facilities have previously been unable to use readily available personnel while Colorado is experiencing an unprecedented number of hospital admissions. Temporarily relaxing these restrictions via the Executive Order will allow for the cross-training of healthcare professionals and alleviate workforce shortages at hospitals and inpatient facilities, particularly in respiratory therapy and amongst critical care staff. TEMPORARY CHANGES TO NURSING AND NURSING AIDE EDUCATION REQUIREMENTS Nursing: Nursing students would have forfeited tuition, and in many cases been unable to enter the workforce in May, without a temporary suspension of Board of Nursing statutes and rules. For more information on specific changes and how the regulatory changes for nursing students will work in practice, please visit DORA’s bulletin here. Nurse Aides: Without a temporary suspension of some Board of Nursing statutes and rules, nurse aide students would have either lost their long-term care training positions, or completed their school-based program but would have been unable to enter the workforce. There have been several temporary regulatory changes granted to nurse aide students to address these challenges. For more information, please visit DORA’s bulletin here.  For more information on the temporary changes to nursing and nursing aide education requirements, please see DORA’s Executive Order Question and Answer document for more details.