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CMS NEWS: Trump Administration Unveils
Enhanced Enforcement Actions Based on Nursing Home COVID-19 Data and
Inspection Results
Today, under the
leadership of President Trump, the Centers for Medicare & Medicaid
Services (CMS) unveiled enhanced enforcement for nursing homes with
violations of longstanding infection control practices. This announcement
builds on the previous actions CMS has taken to ensure the safety and
security of America’s nursing homes as the nation battles coronavirus disease
2019 (COVID-19), and is a key step in the Trump Administration’s Guidelines
for Opening Up America Again.
“The Trump Administration
is taking consistent action to protect the vulnerable,” said CMS
Administrator Seema Verma. “While many nursing homes have performed well and
demonstrated that it’s entirely possible to keep nursing homes patients safe,
we are outlining new instructions for state survey agencies and enforcement
actions for nursing homes that are not following federal safety
requirements.”
The enhanced and targeted
accountability measures are based on early trends in the most recent data
regarding incidence of COVID-19 in nursing homes, as well as data regarding
the results of the agency’s targeted infection control inspections. CMS is
increasing enforcement (e.g., civil money penalties (CMPs)) for facilities
with persistent infection control violations, and imposing enforcement
actions on lower level infection control deficiencies to ensure they are
addressed with increased gravity.
The Coronavirus Aid, Relief,
and Economic Security Act (CARES Act) provided additional funding to CMS for
necessary survey and certification work related to COVID-19, of which $80
million in new resources will be available for states to increase surveys. To
ensure effective oversight is achieved, CMS will allocate the CARES Act
funding based on performance-based metrics. States that have not completed
100 percent of focused infection control surveys of their nursing home by
July 31, 2020 will be required to submit a corrective action plan to their
CMS location outlining the strategy for completion of these surveys within 30
days. If, after the 30-day period, states have still not performed
surveys in 100 percent of nursing homes, their CARES Act fiscal year 2021
allocation may be reduced by 10 percent. Subsequent 30-day extensions
could result in an additional 5 percent reduction. These funds would then be
redistributed to those states that completed 100 percent of their focused
infection control surveys by July 31.
Utilizing the CARES Act
funding, states will be required to perform on-site surveys of nursing homes
with previous COVID-19 outbreaks and will be required to perform on-site
surveys (within three to five days of identification) of any nursing home
with new COVID-19 suspected and confirmed cases.
To help nursing homes
implement infection control best practices, CMS will provide technical
assistance through Quality Improvement Organizations (QIOs). CMS and the
Centers for Disease Control and Prevention (CDC) will continue to monitor the
data it receives through the new nursing home COVID-19 surveillance system to
identify nursing homes with outbreaks and work with Governor’s offices and
states to keep nursing home residents safe.
Since April 19, 2020, CMS
has required nursing homes to inform, residents, their families, and
representatives of COVID-19 cases in their facilities. For the first time,
nursing homes are required to report COVID-19 cases and deaths directly to
the CDC on an ongoing basis as the result of an unprecedented CMS regulatory
requirement issued on May 1, 2020. The Trump Administration implemented the
new reporting requirement to develop a robust federal disease surveillance
system to quickly identify problem areas and inform future infection control
actions. The reporting requirement applies to long-term care facilities only
(also known as skilled nursing facilities and nursing facilities, and
generally as nursing homes). By law, CMS regulates and oversees nursing
homes, which are certified to provide Medicare and/or Medicaid skilled
nursing facility services. Therefore, the data does not include COVID-19 data
from assisted living facilities, which are not regulated at the federal
level.
As of May 24, 2020, about
12,500 nursing homes – approximately 80 percent of the 15,400 Medicare and
Medicaid nursing homes – had reported the required data to the CDC. These
facilities reported over 60,000 confirmed COVID-19 cases and almost 26,000
deaths. Of the nursing homes that reported data, approximately one in four facilities
had at least one COVID-19 case, and approximately one in five facilities had
at least one COVID-19 related death. Early analysis shows that
facilities with a one-star quality rating were more likely to have large
numbers of COVID-19 cases than facilities with a five-star quality rating.
CMS will take enforcement action against the nursing homes that have not
reported data into the CDC as required under CMS participation requirements.
CMS will post the
underlying CDC-collected data on a link on Nursing Home Compare later this
week, so the public can view general information of how COVID-19 has impacted
nursing homes in a user-friendly format. The data will be broken down by
state, number of residents and number of staff. The data will be searchable
by facility name and will be downloadable so researchers and other
stakeholders can perform their own in-depth analysis. CMS will update
the data weekly. CMS will also post a link to the data on the home page of
the Nursing Home Compare website so patients, residents, and families can
easily find it. Nursing Home Compare is a valuable tool for patients,
residents, and families to understand the quality of nursing homes and to
support their healthcare decisions. Adding this information only increases its
value and reinforces CMS’s commitment to transparency.
CMS is ratcheting up
penalties for noncompliance with infection control to help prevent
backsliding, improve accountability, and ensure prompt compliance. Since
February 2020 CMS has provided over 13 guidance documents and facts sheets
pertaining to infection control and conducted weekly calls with nursing homes
to share best practices from the field. The enhanced enforcement actions will
increase penalties for nursing homes have had past infection control
deficiencies.
As part of CMS’s response
to the COVID-19 pandemic, the agency prioritized the types of nursing home
inspections that take place. On March 4, 2020 CMS prioritized inspections to
allow inspectors to focus on the most serious health and safety threats like
infectious diseases and abuse. On March 23, CMS suspended certain inspections
to increase our focus on preventing the spread of COVID-19. Since March 4,
CMS and its network of state-based inspectors have conducted over 8,300
surveys with the results of a total of 5,700 available today. There is
currently wide variation in the number of focused infection control surveys
of nursing homes performed by states, between 11.4 percent and 100 percent,
with a national average of approximately 54.1 percent. CMS plans to post the
results of the inspections later this week, on a monthly basis as they are
completed.
All of this information
are being used to strengthen CMS enforcement action going forward, such that
nursing homes are held accountable for resident care. Older Americans are
particularly vulnerable to complications arising from the virus and nursing
home residents have been uniquely affected. The Trump Administration is
intensely focused on protecting this population, but it ultimately falls to
the nursing homes themselves to ensure they provide care compliant with
essential health and safety requirements.
CMS is also providing
additional support and technical assistance to low performing nursing homes
through its QIOs. QIOs are organizations composed of health quality experts
and clinicians that have experience in helping healthcare provider to improve
the quality of care delivered to people with Medicare. CMS has now charged
the QIOs to focus their efforts on providing education and training to all
nursing homes in the country. This will include weekly National
Infection Control Training, which focuses on all aspects of infection
control, prevention and management to help nursing homes prevent the
transmission of COVID-19.
QIOs are also providing
direct assistance to small and rural nursing homes and those serving
vulnerable populations in areas where access to care is limited. The QIOs
will help them understand and comply with CMS and CDC reporting requirements
and, in some cases, they will provide on-site support to help nursing homes
that have been identified as having the greatest needs in infection control.
CMS will be working with Governors’ offices to direct QIOs to those nursing
homes that have significant needs and have had outbreaks. QIOs will help
these facilities create an action plan and implement specific steps to
establish a strong infection control and surveillance program.
Since the beginning of the
pandemic, CMS has taken unprecedented and aggressive steps to address the
impact of COVID-19. The importance of ongoing transparency and
information sharing has proven to be one of the keys to the battling this
pandemic.
The full list of CMS
Public Health Action for Nursing Homes on COVID-19 to date is in the chart
below.
To view the state survey
memo, visit: https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/covid-19-survey-activities-cares-act-funding-enhanced-enforcement-infection-control-deficiencies-and
To view the letter to the
Governors, visit: https://www.cms.gov/files/document/6120-letter-governors.pdf
To view a state breakdown
of the Nursing Home COVID-19 data, visit: https://www.cms.gov/files/document/6120-nursing-home-covid-19-data.pdf
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Tuesday, June 2, 2020
CMS NEWS: Trump Administration Unveils Enhanced Enforcement Actions Based on Nursing Home COVID-19 Data and Inspection Results
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