NHSN Update and FAQs

Nursing facilities were required to submit their first set of data to NHSN by 11:59 pm on May 17, 2020 to be compliant with the new requirements. Facilities may choose to report more frequently, but at minimum must report at least once every seven days. The initial two-week grace period ends at 11:59 pm on May 24, 2020. Facilities that fail to begin reporting after the third week, ending at 11:59 pm on May 31, will receive a warning letter reminding them to begin reporting the required information to CDC/NHSN. Facilities who have not started reporting in the NHSN system by 11:59 pm on June 7th, ending the fourth week of reporting, CMS will impose a per day (PD) CMP of $1,000 for one day for the failure to report that week. Each subsequent week that the facility fails to report will result in an additional one day PD CMP imposed at an amount increased by $500.

NHSN updated the instructions for the pathway forms on May 12. When completing the data collection and upload, be sure that you are using the most current instructions. You can find the new instructions on the NHSN website. During one of the NHSN data reporting webinars, the NHSN team identified that each item question must have an answer entered or it will be counted as missing data and it will be counted as not being reported. When you enter count data, even if the answer is nothing or zero, you must enter 0 in the data field. If you leave it empty, it will be flagged as “no answer”.

According to the CDC, “to maintain consistency in reporting, if a facility is using crisis level strategies” the facility is experiencing a shortage. “In other words, PPE strategies that do not commensurate with U.S. standards of care are considered as a shortage. For information in relation to CDC’s optimization strategies for PPE (standard, conventional, and crisis), we encourage facilities to refer to Optimize PPE Supply website.

A center can easily identify if they are missing data in the NSHN module by reviewing the calendar view page. Any pathway that is incomplete will be highlighted as a tan color. Pathways highlighted as green indicated all questions were answered. Missing pathway means the pathway has not been started. As of right now, NHSN does not send notices for incomplete data. Centers are encouraged to review the calendar view to ensure all four pathways are highlighted in green to ensure compliance with reporting to NHSN.

Centers are continuing to report a delay in being able to register and upload data to NHSN. There are also centers who are reporting significant delays in having their questions answered via NHSN help desk. Centers who are experiencing delays are encouraged to keep documentation of all attempts of
contacting NHSN and any communications you have with them.

Some centers are reporting that they are not receiving the Agreement to Participate and Consent email. If this is happening to your center and you do not receive the Agreement to Participate and Consent in your inbox for whatever reason, you should follow these instructions:

1. Log-in to SAMS.
2. Select Long-term Care Facility Component and your facility/group name.
3. Click “Submit” to review the “Agreement to Participate and Consent”.
4. Click ‘Accept’ next to the appropriate contact name.
5. Click “Submit”. A pop-up notification will appear confirming this action.
6. Click “ok” to acknowledge the notification.

If you log in to SAMS and see the “Annual Survey” alert on your facility homepage, you should follow these steps to remove the alert:

1. On the facility homepage, click "Survey Required 2020" alert on the facility homepage to be directed to the online survey 
2. Complete the "Facility Characteristics" section and scroll to the bottom to click "save" to submit your survey.