Monday, June 1, 2020

CMS Announcement on NHSN Data and Guidance on COVID-19-Related Survey Activity

On June 1, CMS released a memorandum (QSO-20-31-ALL) addressing NHSN data, COVID-19 survey activities, enhanced enforcement, and engagement of Quality Improvement Organizations (QIOs).

This guidance is effective immediately and will cease to be in effect when the Secretary determines there is no longer a Public Health Emergency due to COVID-19. At that time, CMS will send public notice that this guidance has ceased to be effective via its website.

NHSN Data Initial Release 
  • CMS released a state-by-state report on COVID-19 cases for residents and staff along with numbers of infection control focused surveys completed.
Nursing Home COVID-19 Data

  • CMS will post the underlying CDC-collected data on a link on Nursing Home Compare later this week. 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. 
AHCA reminder to members: Ensure systems and processes are in place to report at least weekly to NHSN per CMS requirements. If you have difficulty reporting or accessing NHSN, keep documentation of all efforts made to be in compliance. 

Focused Infection Control Nursing Home Surveys and CARES Act Supplemental Funding 

  • CMS finds wide variation in the number of Focused Infection Control surveys of nursing homes performed by States, between 11% and 100% (with a national average of approximately 54.1%). 
  • Based on the COVID-19 nursing home data being reported to the CDC, CMS believes further direction is needed to prioritize completion of focused infection control surveys in nursing homes. 
  • States that have not completed focused infection control surveys in 100% of their state’s nursing homes 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 conducted surveys in 100% of their nursing homes, their CARES Act FY2021 allocation may be reduced by up to 10%. 
    • Subsequent 30-day extensions could result in an additional reduction up to 5%. These funds would then be redistributed to those states that completed 100% of their focused infection control surveys by July 31. 
  • Access to FY 2020 CARES Act allocations will be impacted by state performance on completing the nursing home infection control focused surveys. 

COVID-19 Survey Activities 

CMS is also requiring states to implement the following COVID-19 survey activities. States that fail to perform these survey activities timely and completely could forfeit up to 5% of their CARES Act Allocation, annually. 
  1. Perform on-site surveys (within 30 days of this memo) of nursing homes with previous COVID-19 outbreaks, defined as: 
    • Cumulative confirmed cases/bed capacity at 10% or greater; or 
    • Cumulative confirmed plus suspected cases/bed capacity at 20% or greater; or 
    • Ten or more deaths reported 
  2. Perform on-site surveys (within three to five days of identification) of any nursing home with 3 or more new COVID-19 suspected and confirmed cases in the since the last NHSN COVID-19 report, or 1 confirmed resident case in a facility that was previously COVID-free. 
    • State survey agencies are encouraged to communicate with their state healthcare associated infection coordinators prior to initiating these surveys. 
  3. Starting in 2021, perform annual focused infection control surveys of 20 percent of nursing homes based on state discretion or additional data that identifies facility and community risks. 

Enhanced Enforcement for Infection Control Deficiencies 

CMS is expanding enforcement for infection control deficiencies. Specifically, CMS announced it will impose remedies for infection control deficiencies based on the scope and severity of the current deficiency as well as findings of prior infection control deficiencies.

For all infection control deficiencies at a scope and severity of D or above, CMS will impose a directed plan of correction that will include the use of root cause analysis. 

The use of remedies will increase as the scope and severity of the survey findings increase and based on the scope and severity of prior infection control deficiencies, and will include discretionary denials of payment for new admissions (DPNA) and per instance civil money penalties (CMPs). Nursing homes cited for noncompliance with infection control regulations at the immediate jeopardy level will face mandatory statutory remedies as well as a discretionary DPNA with 15 days to demonstrate compliance and the highest CMP amount as indicated in the CMP analytic tool. 

For further details, review the memo

AHCA reminder to members: Use the self-assessment tool (.zip) provided by CMS to evaluate your infection prevention & control program in advance of focused infection control surveys. 

Expanded Survey Activities 

CMS reiterated its Nursing Homes Re-opening guidance, which indicates that once a state has entered Phase 3 of the reopening process, states may use their discretion as to whether and how they decide to expand survey activity beyond the current survey prioritization. Specifically, states may expand survey activity for all provider types to include complaint investigations triaged as non-immediate jeopardy-high, revisit surveys, special focus facility recertification surveys, and recertification surveys for nursing homes and Intermediate Care Facility for individuals with Intellectual Disability (ICF/IID) that are greater than 15 months. CMS indicates that states should prioritize these surveys based on prior survey history and allegations related to abuse/neglect, infection control, transfer/discharge, staffing, or certain quality of care issues. 

Support from Quality Improvement Organizations (QIOs) 

CMS states that nursing homes can take advantage of weekly National Infection Control Training that focuses on infection control, prevention and management to help prevent the transmission of COVID-19. 

The memo adds that QIOs are being deployed to provide technical assistance to nursing homes, which includes a targeted focus on nursing homes with a history of infection control challenges. Additionally, States may request QIO technical assistance for a specific nursing home(s) that have experienced an outbreak. 

Nursing homes can locate the QIO responsible for their state here

Additional COVID Activities 

CARES Act funds may also be used for state-specific interventions (such as strike teams, enhanced surveillance, or monitoring of nursing homes). 

Questions about this memorandum should be addressed to

Letter to Governors 

In addition to the CMS memo summarized above, CMS and CDC sent a joint letter to all the governors outlining that 
  • 80% of SNFs have reported to NHSN data with summary of major findings as described above, 
  • CMS will increase the use of enforcement “penalties” to achieve better compliance with infection control practices, 
  • QIOs are available to provide assistance to nursing homes, 
  • States need to focus their testing on nursing homes and in order to access CARES act funding to pay for testing, states must submit a testing plan to HHS, 
  • CMS funding to states for conducting surveys will be tied to the number of inspections states perform, and 
  • CDC is available to provide technical assistance to states to help with nursing home infection control practices. 

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