On August 17, 2020, the Centers for Medicare & Medicaid Services (CMS) made an announcement regarding the Agency’s plan to resume routine inspections for all providers, including nursing homes, and issued updated enforcement guidance. Highlights of the press announcement include:
- Resumption of onsite revisit surveys
- Resumption of non-Immediate Jeopardy Complaint Surveys
- Resumption of annual recertification surveys
Resumption of these activities is contingent upon State Agencies having the necessary staff and personal protective equipment (PPE) to conduct these activities. As a reminder, CMS had directed all survey & certification activities to focus on targeted infection control surveys and a limited number of other survey activities. The State Agencies were expected to complete focused surveys of all facilities in their states by the end of July, so this return to usual survey activities was anticipated.
The press release also touts the $15 million in Civil Monetary Penalties (CMPs) imposed against nearly 3500 nursing homes across the country related to non-compliance with Infection Control requirements and failure to report COVID-19 data as required.
View the August 17, 2020 CMS Press Release, “CMS Announces Resumption of Routine Inspections of All Provider and Suppliers, Issues Updated Enforcement Guidance to States, and Posts Toolkit to Assist Nursing Homes,” for more details.
New QSO Memo Issued
CMS also issued a QSO Memo on August 17, 2020, “Enforcement Cases Held during the Prioritization Period and Revised Survey Prioritization” (Ref: QSO-20-35-ALL). This QSO Memo includes a significant amount of enforcement guidance for State Agencies for surveys conducted during certain time frames of the pandemic. As per the CMS Guidance issued on June 1, 2020, surveys had already been reprioritized for States that entered Phase 3 of the Nursing Homes Reopening Guidance. Now, the guidance has been updated to authorize additional on-site survey types:
- On-site revisits specified in the SOM revisit policy
- Complaint investigations triaged as non-IJ Medium
- Annual recertification surveys required to be conducted within 15 months from a provider’s last recertification survey
Many providers are now significantly overdue for survey due to the focused prioritization of infection control surveys over the past few months. It is important to look beyond COVID-19 when you are prepping for survey since while Infection Control is likely to be a major focus, the LTCSP provides a much broader look at a facility’s practices, including those that are non-clinical in nature.
The QSO Memo also includes sections related to:
- Expansion of desk review policy – Guidance has been provided to States to resolve open enforcement cases. These will be handled differently depending on the dates they were conducted, with a focus on enforcement cases started from March 23, 2020 through May 31, 2020. For surveys that ended after June 1, 2020, there are different requirements. Regardless, CMS notes that desk reviews cannot be completed without supporting evidence from the facility, including documentation such as training dates and evidence that staff competency evaluations were conducted.
- Enforcement cycle information – This is dependent on date. There is information for enforcement cycles started prior to March 23, 2020, cycles started on March 23, 2020 through May 31, 2020, and enforcement cycles started on or after June 1, 2020.
- CMP Collections – CMS will be re-issuing notices for CMP Due and Payable with a due date that is 15 dates from the date of the notice. If the due CMPs are not paid, CMS will send the CMP to the Medicare Administrative Contractor (MAC) to offset, and interest will be assessed beginning on the new due date.