As a new report shows 43% or nursing home residents who contracted COVID-19 have died of the disease, the Centers for Medicare and Medicaid Services is stepping up infection-control enforcement using CARES Act funding as an incentive.
The Coronavirus Aid, Relief, and Economic Security Act gave CMS funds for survey and certification work related to COVID-19, of which $80 million is available to states to increase surveys of nursing homes.
CMS said it would allocate the CARES Act funding based on performance-based metrics. States that have not completed 100% of focused infection-control surveys of their nursing home by July 31 will be required to submit a corrective action plan to their CMS location outlining the strategy for completion of these surveys within 30 days.
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If, after the 30-day period, states have still not performed surveys in 100% of nursing homes, their CARES Act 2021 allocation may be reduced by 10%. Subsequent 30-day extensions could result in an additional 5% reduction.
These funds would then be redistributed to those states that completed 100% of their infection control surveys by July 31.
CMS said it is increasing enforcement and civil money penalties for facilities with persistent infection-control violations, and imposing enforcement actions on lower level infection-control deficiencies to ensure they are addressed.
Using 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.
WHY THIS MATTERS
Nationwide, nursing homes have reported 60,439 cases and 25,923 deaths, according to CMS. Of staff working in nursing homes, 34,442 contracted COVID-19 and 449 have died.
These statistics pertain to nursing homes only, and not to assisted-living facilities, which are not regulated at the federal level, according to CMS Administrator Seema Verma.
As of May 24, about 12,500 nursing homes – approximately 80% of the 15,400 Medicare and Medicaid nursing homes – had reported the required COVID-19 case data to the Centers for Disease Control and Prevention. CMS will take enforcement action against the nursing homes that have not reported data into the CDC as required under CMS participation requirements.
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 post the underlying CDC-collected data on a link on Nursing Home Compare on Thursday, June 4, so the public can view general information of how COVID-19 has impacted nursing homes.
It's clear to CMS that the spread of the coronavirus in nursing homes is through staff coming into the facilities who have either not been tested or who are asymptomatic, Verma said.
CMS is recommending that all residents and staff be tested and is releasing guidance on the type of testing later this week.
THE LARGER TREND
This announcement builds on the previous actions CMS has taken to ensure the safety and security of nursing homes and is a step in the Trump Administration's Guidelines for Opening Up America Again.
To help nursing homes implement infection-control best practices, CMS will provide technical assistance through Quality Improvement Organizations.
CMS and the CDC will continue to monitor the data they receive through the new nursing home COVID-19 surveillance system. 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 CMS regulatory requirements issued on May 1.
The reporting requirement applies to long-term care facilities only (also known as skilled nursing facilities and nursing facilities, and generally as nursing homes).
Since April 19, CMS has required nursing homes to inform residents, their families, and representatives of COVID-19 cases in their facilities.
CMS has continued to prioritize the types of nursing home inspections that take place. On March 4, 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 its focus on preventing the spread of COVID-19.
There is currently wide variation in the number of focused infection-control surveys of nursing homes performed by states, CMS said.
ON THE RECORD
"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."
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