The Centers for Medicare and Medicaid Services is now requiring nursing homes to test staff for COVID-19.
The regulatory change, announced Tuesday, is a move from the former policy of recommending staff get tested.
Nursing homes that fail to meet staff testing requirements risk suspended participation in the Medicare and Medicaid programs. They will be cited for noncompliance and may face enforcement sanctions based on the severity of the noncompliance, such as civil money penalties in excess of $400 per day, or more than $8,000 for an instance of noncompliance.
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Surveyors will be inspecting nursing homes for adherence.
The Administration is helping facilities offset the cost of testing through $2.5 billion in funding, on top of $5 billion already authorized from the Provider Relief Fund of the Coronavirus Aid, Relief, and Economic Security Act.
Nursing homes using point-of-care testing devices will be required to report diagnostic test results.
The new rule also require hospitals to provide COVID-19 cases and related data to the U.S. Department of Health and Human Services.
CMS recommendations for the frequency of staff testing will be based on the degree of community spread, to be announced shortly through guidance, that indicates the facility may be at increased risk for COVID-19 transmission.
Nursing homes should also offer testing to residents for COVID-19, CMS said. CMS now requires that nursing homes offer tests to residents when there is an outbreak or residents show symptoms.
CMS will be putting out new guidance on visitation soon.
In addition, HHS announced today the release of 1.5 million N95 respirators from the Strategic National Stockpile for distribution to approximately 3,336 nursing home facilities.
Beginning August 28, the Defense Logistics Agency will direct shipments of N95 respirators to select nursing homes that recently reported having enough supplies for only zero to three days of operations. These respirators are meant to supplement existing supplies of personal protective equipment and will provide a seven-day supply for each nursing home to support an entire shift before discarding used products.
WHY THIS MATTERS
CMS said it is acting to safeguard nursing home residents from the ongoing threat of COVID-19 by revising its infection-control regulations for long-term care facilities by the requirement to test their staff.
The requirements will support federal and state efforts to identify early spread of the virus and allocate personal protective equipment and other resources.
Hospitals, and not nursing homes, were the first priority for getting needed PPE early in the pandemic, according to David Coppins, CEO and cofounder of IntelyCare. Nursing home executives were maxing out credit cards to buy face masks and staff were wearing garbage bags for gowns, he said.
Earlier this month, CMS issued more than $15 million in fines to nursing homes for noncompliance with infection-control requirements and failure to report infection data. The monetary civil penalties went to more than 3,400 nursing homes.
THE LARGER TREND
The new rule follows a series of actions designed to increase testing in nursing homes, CMS said.
In April, CMS called on governors to create a testing plan for their nursing homes, provided new payment for collection of lab samples and increased payment for certain tests.
In May, CMS provided reopening recommendations to nursing homes and states that called for baseline testing of all residents and staff, and routine testing of staff.
Rapid point-of-care diagnostic devices were distributed to all nursing homes that were certified to perform these types of tests.
On July 22, President Trump announced the release of an additional $5 billion from the Provider Relief Fund to help nursing homes address critical needs, including hiring additional staff, increasing testing, and providing additional services such as technology so residents could connect with their families.
The $5 billion was on top of a previous $4.9 billion allocation of Provider Relief Funds to nursing homes made in May.
WHAT ELSE YOU NEED TO KNOW
In March, Vice President Mike Pence sent a letter to all hospitals requesting they provide the results of COVID-19 tests performed in their in-house laboratories to help better understand and track disease patterns. CMS' new rules require such reporting of test results.
CMS' new rule implements a CARES Act requirement that laboratories report COVID-19 test results daily to the HHS Secretary or face a penalty in the amount of $1,000 a day for the first day, and $500 for each subsequent day. Labs will have a one-time, three-week grace period to begin reporting required test data.
CMS is also revising its previous policy that covered repeated COVID-19 testing for Medicare beneficiaries without practitioner orders during the PHE. The revised policy specifies that each beneficiary may receive one COVID-19 test without the order of a physician or other health practitioner, but Medicare will require such an order for all further COVID-19 tests.
To help ensure that beneficiaries have broad access to testing, CMS is also paying for tests when ordered by a pharmacist or other healthcare professional authorized under applicable state law to order diagnostic laboratory tests.
In addition to today's announcement regarding testing and reporting, earlier this week, CMS released guidance for state Medicaid agencies on new flexibilities CMS has made available under emergency authorities to increase reimbursement for nursing facilities that implement specific infection control practices, such as designating a quarantine or isolation wing for COVID-19 patients.
ON THE RECORD
"These new rules represent a dramatic acceleration of our efforts to track and control the spread of COVID-19," said CMS Administrator Seema Verma. "Reporting of test results and other data are vitally important tools for controlling the spread of the virus and give providers on the front lines what they need to fight it."
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