Health Law Daily Enforcement for nursing homes with infection control violations expanded to combat COVID-19
Tuesday, June 2, 2020

Enforcement for nursing homes with infection control violations expanded to combat COVID-19

By Elena Eyber, J.D.

CMS released guidance on focused infection control surveys and enhanced enforcement actions for nursing homes with violations of infection control practices.

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) provided additional funding to CMS to combat COVID-19, of which $80 million will be available for states to increase surveys. CMS will allocate the CARES Act funding based on performance-based metrics (CMS Letter, QSO-20-31-All, June 1, 2020).

States that have not completed 100 percent of focused infection control surveys of their nursing home 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 performed surveys in 100 percent of nursing homes, their CARES Act fiscal year 2021 allocation may be reduced by 10 percent. Subsequent 30-day extensions could result in an additional 5 percent reduction. These funds would then be redistributed to those states that completed 100 percent of their focused infection control surveys by July 31.

In addition to completing the focused infection control surveys of nursing homes, CMS is also requiring states to perform on-site surveys (within 30 days of this guidance) of nursing homes with previous COVID-19 outbreaks, defined as confirmed cases at 10 percent or greater; or confirmed plus suspected cases at 20 percent or greater; or ten or more deaths reported due to COVID-19. The states are also required to perform on-site surveys (within three to five days of identification) of any nursing home with three or more new COVID-19 suspected and confirmed cases since the last National Healthcare Safety Network (NHSN) COVID-19 report, or one confirmed resident case in a facility that was previously COVID-free. Starting in fiscal year 2021, the states are required to perform annual focused infection control surveys of 20 percent of nursing homes based on state discretion or additional data that identifies facility risks. States that fail to perform these survey activities could forfeit up to 5 percent of their CARES Act allocation annually.

Due to the heightened threat to resident safety for even low-level, isolated infection control citations (such as proper hand-washing and use of personal protective equipment (PPE)), CMS is expanding enforcement to improve accountability and sustained compliance with these crucial practices. The enhanced enforcement actions increase penalties for nursing homes that have had past infection control deficiencies. The penalty for nursing homes cited for infection control deficiencies twice or more in the last two years that is not widespread (Level D & E) is $15,000 per instance or per day, and widespread (Level F) is $20,000 per instance or per day.

CMS is also providing additional support and technical assistance to low performing nursing homes through the Quality Improvement Organizations (QIOs). QIOs are organizations composed of health quality experts and clinicians that have experience in helping healthcare providers to improve the quality of care delivered to people with Medicare. CMS has now charged the QIOs to focus their efforts on providing education and training to all nursing homes. This will include weekly National Infection Control Training, which focuses on all aspects of infection control, prevention and management to help nursing homes prevent the transmission of COVID-19.

MainStory: TopStory Covid19 CMSNews LTCHNews QualityNews SNFNews

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