On
June 1st, 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.
CMS Public Health Action for Nursing Homes on COVID-19 as of
June 1, 2020
|
February 6, 2020
|
CMS took action to prepare the nation’s
healthcare facilities for the COVID-19 threat.
|
March 4, 2020
|
CMS issued new guidance related to the screening
of entrants into nursing homes.
|
March 10, 2020
|
CMS issued guidance related to the use
of personal protective equipment (PPE).
|
March 13, 2020
|
CMS issued guidance on the restriction
of nonessential medical staff and all visitors except in certain limited
situations.
|
March 23, 2020
|
CMS announced a suspension of routine
inspections, and an exclusive focus on immediate jeopardy situations and
infection control inspections.
|
March 30, 2020
|
CMS announced that hospitals,
laboratories, and other entities can perform tests for COVID-19 on people
at home and in other community-based settings outside of the hospital –
including nursing homes.
|
April 2, 2020
|
CMS issued a call to action for nursing homes
and state and local governments reinforcing infection control
responsibilities and urging leaders to work closely with nursing homes on
access to testing and PPE.
|
April 15, 2020
|
CMS announced the agency will nearly
double payment for certain lab tests that use high-throughput
technologies to rapidly diagnose large numbers of COVID-19 cases.
|
April 19, 2020
|
CMS announced it will require nursing
homes to report cases of COVID-19 to all residents and their families, as
well as directly to the CDC. On May 1, CMS implemented the proposed
policy in an Interim Final Rule. The rule became effective on May 8.
|
April 30, 2020
|
CMS announced the formation of an
independent Commission that will conduct a comprehensive assessment of
the nursing home response to COVID-19.
|
May 6, 2020
|
CMS released a memorandum to State Survey Agency
directors providing more details on the new reporting requirements of the
Interim Final Rule.
|
May 13, 2020
|
CMS published a new informational toolkit comprised of
recommendations and best practices from a variety of front line health
care providers, governors’ COVID-19 task forces, associations and other
organizations and experts that is intended to serve as a catalogue of
resources dedicated to addressing the specific challenges facing nursing
homes as they combat COVID-19. Toolkit is found here: Toolkit
|
May 18, 2020
|
CMS issued guidance for state and local
officials on the reopening of nursing homes.
|
June 1, 2020
|
CMS issued guidance to states on COVID-19 survey
activities, CARES Act funding, enhanced enforcement for infection control
deficiencies, and quality improvement activities in nursing homes. CMS
also issued a letter to Governors.
|
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
###
Get
CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS
Administrator @SeemaCMS and @CMSgov
|
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