On June 1, 2020, the Centers for Medicare and Medicaid Services (CMS) unveiled enhanced enforcement for nursing homes when it comes to violations of “longstanding infection control practices.”
The enhanced accountability measures are based on early trends regarding COVID-19 in nursing homes and data regarding the results of CMS’ targeted infection control inspections. CMS is increasing enforcement (through civil money penalties (CMPs)) for facilities with persistent infection control violations and is imposing enforcement actions on lower level infection control deficiencies.
Additional Funding from the CARES Act
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) gave CMS additional funding, of which $80 million will be available for states to increase surveys of their nursing homes. CMS will allocate the CARES Act funding based on performance-based metrics and states that have not completed 100% of their focused infection control surveys of nursing homes by July 31, 2020 will be required to submit a corrective action plan to CMS, outlining the strategy for completion of these surveys within 30 days. Failure to perform surveys in 100% of nursing homes may result in a CARES Act FY 2021 reduction of 10% and additional 30-day extensions may reduce the benefit by an additional 5%. Funds that are reduced from states for failure to comply would be redistributed to states that complete 100% of their surveys by July 31, 2020.
The CARES Act funding will help states perform on-site surveys of nursing homes with previous COVID-19 outbreaks and states will then 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.
Technical Assistance from CMS
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 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. The data in the surveillance system does not include data from assisted living facilities, as they are not regulated at the federal level.
CMS is also providing additional support and technical assistance to low performing nursing homes through its QIOs, especially through education and training. This additional support and assistance will include weekly National Infection Control Training, focused on all aspects of infection control, prevention, and management to help nursing homes prevent the transmission of COVID-19.
QIOs will also provide direct assistance to small and rural nursing homes and those that serve vulnerable populations in areas where access to care is limited. The QIOs will help those nursing homes understand and comply with CMS and CDC reporting requirements. In cases where the nursing homes have been identified to have a great need with respect to infection control, the QIOs will even provide on-site support to help. CMS will also work directly with Governors’ offices to direct QIOs to nursing homes that have significant needs and have had outbreaks. QIOs will help those facilities create an action plan and implement specific steps to establish a strong infection control and surveillance program.
Increased Penalties for Noncompliance
CMS is also increasing penalties for noncompliance with infection control to prevent backsliding, improve accountability, and ensure prompt compliance. Since February 2020, CMS has published over 13 guidance documents and fact sheets about infection control and has conducted weekly calls with nursing homes to share best practices other successful nursing homes.
Conclusion
These changes are in addition to previous actions taken by CMS amid the COVID-19 pandemic. “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.”
A list of actions taken by CMS to protect nursing homes can be found here.