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CMS Leaning on Nursing Homes – and Surveyors – to Improve Infection Control Compliance (Pt. 1)

On June 1, 2020, The Centers for Medicare & Medicaid Services (CMS) released a media announcement, “Trump Administration Unveils Enhanced Enforcement Actions Based on Nursing Home COVID-19 Data and Inspection Results,” with an accompanying QSO Memo and overview of what early results of the new infection surveillance reporting requirement has shown.

What the Initial Data Shows

Alarmingly – but not surprisingly – early trends based on the recent nursing home reporting requirement to the Center for Disease Control’s National Health Safety Network (CDC NHSN) show that a significant number of nursing home residents have been impacted by the COVID-19 pandemic.

  • As of May 24, 2020, approximately 80% of nursing homes across the United States (~12,500 out of 15,400) had reported data as required to the CDC NHSN. The updated requirements for infection surveillance and reporting were announced in an April 19, 2020 QSO Memo. The Agency provided additional information in its May 1, 2020 Interim Final Rule.
  • Nursing homes reported more than 60,000 confirmed cases of COVID-19 in their facilities, and approximately 26,000 residents died. These numbers are what has been reported by the approximately 80% of providers who submitted their data to the CDC, so when the remaining 20% provide their data, these numbers could increase.
  • Of the facilities that reported data, approximately:
    • 1 in 4 facilities had at least one COVID+ case.
    • 1 in 5 facilities had at least one COVID-19-related death.
    • 1-star facilities were more likely to have more COVID-19 cases than facilities with 5-star ratings

Facilities that have not reported data yet will have enforcement actions taken against them by CMS as outlined in the May 6, 2020 QSO Memo regarding the mandatory reporting requirements. In that memo, CMS announced the addition of two Federal regulatory tags, F884 COVID-19 Reporting to CDC and F885 COVID-19 Reporting to Residents, their Representatives and Families.

CMS Turning the Screws on State Agencies to Conduct More Surveys

In an April 30, 2020 announcement, CMS shared that approximately $81 million in CARES Act funding would be available to State Agencies for use through September 20, 2023. In the new QSO memo, CMS has added some caveats to how State Agencies can access that funding, including – you guessed it – getting more Focused Infection Control surveys completed. This is due to the “wide variation” that has been identified across the states in how these surveys are being completed, with some states having surveyed as low as 11% of nursing homes and others having surveyed 100% of their facilities. Further, CMS stated:

  • States must complete 100% of their Focused Infection Control Surveys by July 31, 2020. Any State that does not meet this goal will have to submit a corrective action plan to CMS detailing how they will complete all necessary surveys within the next 30 days. This means that by mid-summer, most nursing homes in the United States should have had a Focused Infection Control Survey, and any facilities that have not had one should have one by the end of August.
  • To further incentivize State Agencies to get their surveys completed, States that have not completed 100% of their surveys after the 30-day period, then their CARES Act FY2021 allocation may be reduced by up to 10%.
  • If State Agencies requires subsequent 30-day extensions – meaning they stretch surveys out into the fall – then they could receive an additional funding reduction of up to 5%. What happens to that funding? Other States who have met their goal of 100% completed surveys by July 31, 2020, will have those funds redistributed to them.

What About Other Surveys?

Not only do State Agencies need to complete Focused Infection Control Surveys of every nursing home in their states, the QSO memo directs States to conduct the following additional surveys:

  • Within 30 days of the QSO Memo, conduct on-site surveys of all nursing homes with previous COVID-19 outbreaks. One of these criteria would trigger this survey:
    • Cumulative confirmed case/bed capacity at 10% or greater OR
    • Cumulative confirmed plus suspected cases/bed capacity at 20% or greater OR
    • 10+ deaths reported due to COVID-19
  • Within 3-5 days of identification, conduct on-site surveys of any nursing home that has 3 or more new COVID-19 suspected and confirmed cases since the last NHSN COVID-19 report has come out, OR 1 confirmed resident case in a facility that was previously COVID-19-free.
  • Beginning in FY2021, perform annual Focused Infection Control Surveys of 20% of nursing homes that have been identified through data related to facility and community risks or chosen based on State discretion.

View the CMS QSO Memo, “COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control Deficiencies, and Quality Improvement Activities in Nursing Homes” (Ref-QSO-20-31-ALL) for more details.

In our next CMSCG Blog posts, we will look at what providers need to be thinking about and what to expect on survey going forward – including an increase in enforcement actions and lots of potential for Directed Plans of Correction.

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