Waiver of 6 CCR 1011-1, Chapter 5, 9.3(B) regarding 24/7 RN Coverage

 

To: Nursing Home Administrators The Department recognizes that the prolonged nature of the COVID-19 pandemic, as well as the emergence of highly-transmissible variants, has exacerbated the existing staffing crises in our healthcare facilities. The Department understands this situation has made it increasingly difficult for nursing care facilities to hire and retain qualified registered nurses (RNs) to provide care in facilities. Acknowledging this current situation, the following regulation is temporarily waived for all Nursing Care Facilities, with no waiver application necessary: 6 CCR 1011-1, Chapter 5, 9.3(B) Except as provided in section 9.5, a nursing care facility shall be staffed at all times with at least one registered nurse who is on duty on the premises. Each resident care unit shall be staffed with at least one licensed nurse. For context: Section 9.5 provides that rural nursing care facilities that are skilled nursing facilities need only to satisfy the federal certification requirements, as opposed to those set forth in Section 9 (Nursing Services). Section 9.5 sets forth the requirements to be considered a rural facility and sets conditions for these facilities. The overall regulatory expectation at 6 CCR 1011-1, Chapter 5, 9.3, as follows, remains in place: The facility shall be staffed with qualified nursing personnel, awake and on duty, who are familiar with the residents and their needs in a number sufficient to meet resident functional dependency, medical and nursing needs. Facilities intending to utilize this waiver may do so, and agree to accept the following conditions: A charge nurse (RN or LPN) shall be appointed for each shift. A facility that is certified by CMS shall develop and implement policies and procedures that meet the CMS requirement for RN coverage (8 consecutive hours of RN coverage, 7 days per week). The facility shall ensure an LPN is present in the building and available when an RN is not available. The LPN shall be trained to provide special treatments or complex care for residents, as needed. The facility shall ensure an RN or other licensed independent practitioner is available and on call to respond within 10 minutes of contact at all times an RN is not in the building. The facility shall not permit medical technicians to pass medications when an RN is not in the building. Medical technicians shall not be supervised by LPNs. The facility shall ensure LPNs are instructed, and are able to show with return demonstration, what they need to do in the event of an emergency (e.g. implement the appropriate emergency preparedness plan, call 911, etc.) The facility shall ensure medication administration or treatments that must be completed by an RN are completed when an RN is on duty. These shall not be delegated to another individual. The facility shall conduct a daily IDT meeting, to include direct care, housekeeping, and dietary staff, to review adverse events, emergencies, incidents, and effectiveness of the staffing plan to determine if the plan is working or needs to be modified to ensure resident care and safety. The facility shall continue and document all efforts to obtain RN employees. Please note: This waiver is only for Colorado state regulations for Nursing Care Facilities, and does not waive the Centers for Medicare and Medicaid Services (CMS) regulations. CMS-certified agencies must implement the waiver only to the extent allowed under current CMS waivers and regulations. The waiver will terminate upon notice from the Department. Once the waiver is terminated, all facilities must immediately come into compliance with the existing regulation. CDPHE continues to explore additional options to ease the burden for providers during this public health emergency. We will provide updates as they become available.   For questions regarding this waiver, contact Jo Tansey (jo.tansey@state.co.us).   Jo Tansey Branch Chief Acute and Nursing Facilities Branch Chief