Gov. Glenn Youngkin’s Executive Order (EO) 16 expired March 22, 2022. The expiration brings about the end of numerous health care flexibilities that have been advantageous to long term care facilities during the Omicron surge of the COVID-19 pandemic. The end of the limited state of emergency affects the following:

Out-of-State Licensees: Out-of-state health care practitioners are no longer deemed to be an active license or registration issued by the Commonwealth.

Bed Capacity: Requests for changes in bed capacity will revert to the certificate of public need process for approval.

Pre-admission Screening: Waivers related to admission screenings are affected by the expiration of the limited state of emergency. The end of the state of emergency means the end of the situation where a nursing facility did not need to obtain Medicaid Long Term Services and Support (LTSS) Screening for individuals discharging from a hospital admission to the nursing facility (as normally would be required by 12VAC30-60-308) and may admit individuals without the Medicaid LTSS screening in those situations. DMAS has used this tool that outlines the screening responsibilities during trainings with nursing facilities and other LTSS screeners.

As a reminder:

1. Hospital screening teams are responsible for conducting the LTSS Screening for:
   • individuals with any type of existing Medicaid membership or
   • for any individual requesting a LTSS Screening while in a hospital, regardless of payor type.
2.  As of January 1, 2021, nursing facility screening teams are responsible for conducting LTSS Screenings for non-Medicaid members admitted to a nursing facility who have a change in financial status and require intermediate care facility level of care.

Because the Preadmission Screening and Resident Review (PASRR) screening is coupled with the LTSS Screening for Virginia’s Medicaid program, the screening team responsible for conducting the PASRR screening prior to admission is determined by whether an individual being admitted to a nursing facility is required to have a Medicaid LTSS Screening before admission. Review this article for more information: Virginia LTSS Screening and PASRR Reminder. 

If the hospital or community screening team conducts the LTSS screening, then that screener will conduct the PASRR screening, because it is part of the LTSS Screening. Those screeners are required to provide a copy of the of the screening to the nursing facility for review prior to admission.

• A hospital screening team would conduct a screening for individuals with any type of existing Medicaid membership or for any individual requesting a LTSS Screening while in a hospital regardless of payor type.
• A community screening team would conduct a screening for individuals in the community who have an existing Medicaid membership (including those individuals who have applied and are pending approval) or for any individual requesting a LTSS Screening while living in the community, regardless of payor type. 

If an LTSS Screening is not required, the nursing facility screening teams are responsible for conducting the Level I screening and, if applicable, requesting and obtaining results from Ascend/Maximus for a Level II screening prior to admission to the nursing facility.

Important note from April Payne: Nursing facilities should be diligent in ensuring that hospital screening teams are conducting needed screenings. Medicaid payments will be jeopardized if the screening is not completed prior to admission to the nursing facility. DMAS is verifying eligibility and application dates for Medicaid beneficiaries—if those dates fall before the nursing facility admission date (regardless of payor type or length of stay at time of admission), the Medicaid LTSS Screening for nursing facility level of care must be completed prior to the admission date. A Medicaid LTSS Screening may only be conducted in the nursing facility by a certified nursing facility LTSS screener after an individual is admitted if the original payor source was private pay (or person with 100 percent alternate forms of payment excluding Medicaid) at time of admission and who experiences a change in the level of care resulting in the need for Medicaid LTSS.  

Temporary Nurse Aides: The EO included language related to temporary nurse aides (TNAs). However, this language was not necessary because VHCA-VCAL advocated for language to be included in the state’s 2021 budget to allocate ARPA Funds to reinstate eligibility for TNAs to take the National Nurse Aid Assessment Program examination for as long as the federal public health emergency and CMS 1135 waiver remains in place. Therefore, it is unknown at this time when the use of TNAs will cease. See this article for more information.

Administration of COVID-19 Vaccine by LPNs:

The end of the EO means licensed practical nurses may no longer administer the COVID-19 vaccine without the supervision of a registered nurse or licensed medical practitioner.