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The Centers for Medicare & Medicaid Services (CMS) is the federal agency responsible for administering requirements governing long-term care facilities. Regulations are always evolving, especially during the COVID-19 pandemic. A waiver issued towards the end of 2021 hopefully alleviated some stress facilities were facing with hiring qualified directors of food and nutrition services.

In October 2016, CMS released a comprehensive update of regulations that included a section on Food and Nutrition Services. According to the requirements released, long-term care facilities had until November 2021 to have a Certified Dietary Manager (CDM) in charge of the food and nutrition department. If hired after the release of the regulations, individuals had no more than one year to obtain proper qualifications.

According to CMS, “In certain circumstances, the Secretary of the Department of Health and Human Services (HHS) using section 1135 of the Social Security Act (SSA) can temporarily modify or waive certain Medicare, Medicaid, CHIP, or HIPAA requirements, called 1135 waivers.  There are different kinds of 1135 waivers, including Medicare blanket waivers.  When there’s an emergency, sections 1135 or 1812(f) of the SSA allows the use of blanket waivers to help beneficiaries access care.”

On November 26, 2021, CMS issued an 1135 waiver for 42 CFR 483.60(a)(1) and 483.60(a)(2). This waived the educational requirements of the designated Director of Food and Nutrition Services. CMS states, “The specified requirements involve specialized education or training in food service management and safety resulting in an associate’s or higher degree in hospitality or food service management, a bachelor’s or higher degree granted by a regionally accredited college or university in the United States, a certified dietary manager, or a certified food service manager. These educational and training requirements range in length, at a minimum, of 18 months to four years. It has been unusually challenging for these requirements to be met due to the COVID-19 Public Health Emergency (PHE). Therefore, CMS is waiving this requirement due to the inability for individuals to enroll in, attend, or complete a certification program due to circumstances related to the COVID-19 PHE.”

As with all blanket waivers, this will be in effect for the duration of the Public Health Emergency unless CMS withdraws or terminates the waiver sooner. On January 14, 2022, the public health emergency issued the renewal for the eighth time which allows for another 90 days. The declaration will last until at least April 16, 2022, unless another renewal is issued.

This extended time provides such relief for many long-term care facilities facing multiple labor shortages.  However, facilities should continue to pursue training for individuals serving in this role to comply once the waiver ends. Current foodservice managers may already be eligible to sit for the Certified Dietary Manager Credentialing Exam. The Certifying Board for Dietary Managers (CBDM) created pathways to make it possible to meet the eligibility requirements to sit for the Certified Dietary Manager or Certified Food Protection Professional (CDM®, CFPP®) certification.  Utilize CBDMonline.org to determine the required paperwork needed to get started down the path of credentialing and discuss with your facility dietitian.

Resources:

The Certifying Board for Dietary Managers  www.CBDMonline.org

https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf

https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities

https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers