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Plan to get tougher on infection control surveys & deficiencies published by CMS


 By Doug Beardsley |  June 4, 2020  |  SNF/NF providers

On June 1, 2020, the Centers for Medicare & Medicaid Services (CMS) released QSO-20-31-ALL, a memo containing many updates to the nursing facility survey process during times of COVID-19. The memo is effective immediately. Key items contained in the memo include the following:

  • State survey agencies (SA) were given a deadline to complete a COVID-19 focused survey at every nursing facility in each state
    • Failure of the SA to complete the surveys will result in a withholding of federal funds to the SA
    • Note–The Minnesota Department of Health completed a COVID-19 survey of every nursing facility in Minnesota by May 22, 2020, months ahead of the deadline
  • Additional required COVID-19 surveys:
    • Perform on-site surveys (by July 1) of nursing facilities 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 due to COVID-19
    • Perform on-site surveys (within three to five days of identification) of any nursing facility with three or more new COVID-19 suspected and confirmed cases in the since the last National Healthcare Safety Network (NHSN) COVID-19 report, or 1 confirmed resident case in a facility that was previously COVID-19-free
    • Starting in FY 2021, perform annual focused infection control surveys of 20% of nursing facilities based on state discretion or additional data that identifies facility and community risks
  • To transition states to more routine oversight and survey activities, once a state has entered Phase 3 of the nursing homes re-opening guidance, or earlier, at the state’s discretion, states are authorized to expand beyond the current survey prioritization (immediate jeopardy, focused infection control, and initial certification surveys) to perform the following:
    • Complaint investigations that are triaged as non-immediate jeopardy-high
    • Revisit surveys of any facility with removed immediate jeopardy (but still out of compliance)
    • Special focus facility and special focus facility candidate recertification surveys
    • Recertification surveys that are greater than 15 months (time to catch up!)
  • Enhanced enforcement for infection control deficiencies:
    • Substantial non-compliance (D or above) with any deficiency associated with infection control requirements will lead to the following enforcement remedies:
      • Non-compliance for an infection control deficiency when none have been cited in the last year (or on the last standard survey):
        • Nursing facilities cited for current non-compliance that is not widespread (levels D & E)—directed plan of correction 
        • Nursing facilities cited for current non-compliance with infection control requirements that is widespread (level F)—directed plan of correction, discretionary denial of payment for new admissions with 45-days to demonstrate compliance with infection control deficiencies
    • Non-compliance for infection control deficiencies cited once in the last year (or last standard survey):
      • Nursing facilities cited for current non-compliance with infection control requirements that is not widespread (levels D & E)—directed plan of correction, discretionary denial of payment for new admissions with 45- days to demonstrate compliance with infection control deficiencies, per instance civil monetary penalty (CMP) up to $5000 (at state/CMS discretion) 
      • Nursing facilities cited for current non-compliance with infection control requirements that is widespread (level F)—directed plan of correction, discretionary denial of payment for new admissions with 45-days to demonstrate compliance with infection control deficiencies, $10,000 per instance CMP
    • Non-compliance that has been cited for infection control deficiencies twice or more in the last two years (or twice since second to last standard survey):
      • Nursing facilities cited for current non-compliance with infection control requirements that is not widespread (levels D & E)—directed plan of correction, discretionary denial of payment for new admissions, 30-days to demonstrate compliance with infection control deficiencies, $15,000 per instance CMP (or per day CMP may be imposed, as long as the total amount exceeds $15,000)
      • Nursing facilities cited for current non-compliance with infection control requirements that is widespread (level F)—directed plan of correction, discretionary denial of payment for new admissions, 30-days to demonstrate compliance with infection control deficiencies, $20,000 per instance CMP (or per day CMP may be imposed, as long as the total amount exceeds $20,000)
    • Nursing facilities cited for current non-compliance with infection control deficiencies at the harm level (levels G, H & I), regardless of past history—directed plan of correction, discretionary denial of payment for new admissions with 30 days to demonstrate compliance with infection control deficiencies 
      • Enforcement imposed by CMS location per current policy, but CMP imposed at highest amount option within the appropriate (non-immediate jeopardy) range in the CMP analytic tool
    • Nursing facilities cited for current non-compliance with infection control deficiencies at the immediate jeopardy level (levels J, K & L) regardless of past history—in addition to the mandatory remedies of temporary manager or termination, imposition of directed plan of correction, discretionary denial of payment for new admissions, 15-days to demonstrate compliance with infection control deficiencies
      • Enforcement imposed by CMS location per current policy, but CMP imposed at highest amount option within the appropriate (IJ) range in the CMP analytic tool
  • The memo also affirmed the additional support CMS is giving to quality improvement organizations (QIOs) to help nursing facilities prevent the transmission of COVID-19, including a targeted list of “low performing” nursing facilities that have a history of “infection control challenges.




Doug Beardsley  |  Vice President of Member Services  |   dbearsl@careproviders.org  |  952-851-2489

 


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