CMS Issues NF Guidance for the End of the COVID-19 Public Health Emergency

The Centers for Medicare and Medicaid Services (CMS) issued QSO-23-13-ALL (PDF).

The memo outlines the expiration of emergency waivers issued during the COVID-19 Public Health Emergency (PHE) related to the minimum health and safety requirements for nursing facility (NF) providers. It also describes the timelines for certain regulatory requirements issued during the PHE. The PHE declaration ended on May 11, 2023.

The following is a high-level overview of key information in the memo. Nursing facilities must read the memo details to stay in compliance.


  • COVID-19 staff vaccination mandate — requirement will end soon. CMS will provide more information.
  • Reporting COVID-19 info to NHSN — ends Dec. 31, 2024, except COVID-19 vaccination status, which is a permanent requirement.
  • COVID-19 vaccination education and offering — ends May 21, 2024, unless CMS decides to make it a permanent requirement.
  • COVID-19 testing — ended May 11, 2023.
  • COVID-19 Focused Infection Control (FIC) surveys — HHSC is required to conduct FIC surveys at 20% of all annual surveys through Fiscal Year 2023 (Sept. 30, 2023). This is not required in Fiscal Year 2024, but states will have the option to conduct discretionary FIC surveys.

    Waivers ended on May 11, 2023:

    • Emergency Preparedness Training and Testing Program Exemption — blanket waiver allowed an exemption to one of the annual exercises. NFs can still be exempted from one full-scale exercise if the provider activates their Emergency Plan. Read Appendix Z (PDF) for more information.
    • Alcohol-Based Hand Rub (ABHR) — waiver allowed more ABHR be stored and provided than normally permitted.
    • Three-day prior hospitalization — waiver allowed Medicare recipient to be admitted to a skilled nursing facility without qualifying hospital stay.
    • PASRR evaluation (PE) — waiver allowed residents to be admitted without a PASRR Level 1 screening or PE.
    • Resident roommates and grouping — waiver allowed flexibility in resident grouping and roommates for cohorting purposes due to infection prevention and control measures.
    • Resident transfer and discharge — waiver allowed an NF to not have to provide advance notice.
    • CNA working more than four months without certification — Texas-specific waiver ended May 11, 2023. Current nurse aides must be certified by Sept. 10, 2023. Anyone hired after May 11, 2023, must be certified within four months of hire date. Note: surveyors will begin surveying for compliance on Sept. 11, 2023.

    Read PL 2023-05 (PDF) for more information about the end of the CNA waiver.

    Read PL 2021-19 (PDF) for more information about the alternative certification process for nurse aides working under the waiver.

    Read QSO-23-13-ALL (PDF) for more details.