The Centers for Medicare & Medicaid Services (CMS) released an interim final rule on May 1 containing new nursing home requirements for reporting COVID-19 data. Requirements include reporting information to the Centers for Disease Control & Prevention (CDC) through the National Healthcare Safety Network (NHSN) system and notification to residents, resident representatives, and families. This rule follows CMS’s announcement on April 19 previewing these requirements. The rule is an interim final rule, scheduled to be published in the federal register on May 8 with a comment period of 60 days. Reporting requirements will be effective immediately upon publishing. LeadingAge will submit comments on this rule.

What’s in the Rule: Reporting to CDC

New sections are added to 42 CFR §483.80 Infection Control of the Requirements of Participation (RoPs) to require long-term care facilities, specifically skilled nursing facilities and nursing facilities, to report incidences and data related to COVID-19 directly to the CDC. Effective immediately upon publishing of the rule, nursing homes will report COVID-19 data to CDC through a new module on the NHSN system. The rule states that nursing homes should report data at least weekly, or more frequently if required. The module allows for daily reporting.

The rule calls for reporting of the following data to CDC:

• Suspected and confirmed COVID-19 infections among residents and staff.
• Total deaths and deaths related to COVID-19 infection, including both resident and staff deaths.
• Personal Protective Equipment (PPE) and hand hygiene supplies.
• Ventilator capacity and supplies.
• Resident beds and census.
• Resident access to testing.
• Staffing shortages.

CMS will retain and publicly report the information reported to CDC and notes that reporting to CDC does not alleviate nursing homes of additional reporting requirements, including state and local reporting requirements.

What’s in the Rule: Notification to Residents, Resident Representatives, and Families

New sections are added to 42 CFR §483.80 Infection Control of the Requirements of Participation (RoPs) to require long-term care facilities, specifically skilled nursing facilities and nursing facilities, to notify residents, resident representatives, and families of confirmed or suspected cases of COVID-19 infections among residents and staff. LeadingAge notes that this requirement differs slightly from what was previewed in CMS memo QSO-20-26-NH, when CMS limited notification requirements to residents and resident representatives.

The rule calls for notifying residents, resident representatives, and families by 5pm the next calendar day following the occurrence of either:

• A single, confirmed infection of COVID-19 or,
• A cluster of 3 or more residents or staff with new onset of respiratory symptoms that occur within 72 hours of each other.

Additionally, nursing homes must provide cumulative updates on a weekly basis. Information to be shared during notifications and weekly cumulative updates includes:

• Mitigating steps the nursing home is taking to prevent or control the spread of COVID-19.
• Any alterations to normal operations, such as restrictions or limitations to visitation or group activities.

CMS notes that nursing homes are not expected to make individual telephone calls to residents, resident representatives, and families to satisfy these notification requirements. Rather, nursing homes may utilize a number of communication methods including paper notification, listservs, website postings, or recorded telephone messages.

What This Means for Providers

Effective the date the rule is published, nursing home providers should be reporting the required information to CDC and making required notifications to residents, resident representatives, and families. While CDC promised an expedited process for enrolling in the NHSN system for those not already enrolled, we have heard already from members having difficulty with enrollment. CDC will post training and resources on the NHSN website to assist in this process; however, we anticipate the difficulty associated with any new process. We have asked CMS to allow for this transition period.

Recall that in CMS memo QSO-20-26-NH, CMS promised enforcement actions for nursing homes that did not comply with reporting requirements. No additional information is available on enforcement actions at this time and we have asked CMS to reconsider the use of enforcement actions related to this reporting.

What LeadingAge is Doing

LeadingAge continues advocacy efforts for one universal reporting requirement and eliminating requirements for nursing homes to make multiple reports to differing entities, taking valuable time away from patient care.