CDC Clarifies Elements of Forthcoming Nursing Home Reporting Requirements

Regulation | April 22, 2020 | by Jodi Eyigor

A recent call with CDC has clarified some details around forthcoming requirements that nursing homes must report information about COVID-19 directly to CDC.

As previously reported, CMS previewed new COVID-19 reporting requirements for nursing homes on April 19. These new requirements are pending rulemaking that is forthcoming. While little information is available from CMS ahead of the rulemaking, a recent call with CDC shed some light on the reporting mechanism.

How and what will nursing homes report to CDC?

CDC has developed a new COVID-19 module for long-term care providers within the National Healthcare Safety Network (NHSN) system. The long-term care providers module will collect information on resident impact and facility capacity, supplies and personal protective equipment (PPE), staff and personnel impact, and ventilator capacity and supplies.

Why is CMS requiring this extra reporting?

While nursing homes presently report information about COVID-19 cases to state/local health departments per federal regulation, CDC needs information that is simply not available through present reporting mechanisms. With this information, CDC will be able to learn more about the disease and its impact on older adults, how this disease is impacting the healthcare workforce, and the PPE and equipment needs of long-term care providers related to this disease.

Is reporting required?

The collaboration of the 2 government entities (CMS and CDC) makes this a bit confusing. Recall that this information is being collected and utilized by CDC. However, the requirement to report is enforced by CMS.

The COVID-19 module that was developed by CDC for long-term care provider reporting through the NHSN system allows for “optional” reporting of all data elements. CMS will announce through final rulemaking what data elements nursing homes are required to report in this COVID-19 module. CMS also stated in CMS memo QSO-20-26-NH that enforcement actions may be imposed against nursing homes that fail to comply with this requirement.

We note that the COVID-19 reporting module developed by CDC also allows for reporting by assisted living providers. CDC encourages reporting by these providers, as COVID-19 cases in assisted living are said to be increasing. While CMS has no federal authority over assisted living, LeadingAge encourages assisted living members to keep an eye on the state for any reporting requirements that may be imposed.

How often do we have to report and is retrospective reporting available?

CMS has not commented on frequency of reporting. This information will presumably be included in the forthcoming rulemaking. The COVID-19 module for long-term care providers allows for daily reporting, but CDC requests at least weekly reporting.

CMS has not commented on retrospective reporting. Recall that CMS has announced that enforcement actions may be imposed on nursing homes that fail to comply with reporting requirements. In the interest of data collection, the CDC’s COVID-19 module allows for retrospective reporting; however, CMS will need to instruct nursing homes on whether retrospective reporting should be submitted, and under what circumstances enforcement actions may be imposed.

How do nursing homes access the COVID-19 module on NHSN?

The COVID-19 module will be available on the NHSN system page of the CDC website. LeadingAge was previously under the impression that providers could report without enrolling in the NHSN system. We have now learned that providers will be required to enroll in the NSHN system; however, CDC is currently developing an expedited enrollment process that can be completed in one day online. This expedited enrollment process will require providers to register the facility with NHSN, but will allow providers to skip the Secure Access Management Systems (SAMS) registration that requires identity verification.

The full enrollment option, which includes an identity verification and may take several days, remains an option for providers and brings the added benefit of allowing providers access to benchmarking data and additional non-COVID reporting modules that could be used for infection control and quality improvement purposes.

What support is available to nursing homes around this new reporting system?

The CDC is in the process of developing web-based training and specific form instructions that will be posted on the NHSN system page. Ahead of these resources, they have developed this presentation to share with our members. Additionally, CDC intends to hold recurrent “Office Hours” that will feature a replay of the recorded training, followed by a live Q&A period. Email updates and a User Support Desk will also be available from CDC.

It is unclear at this time what support CMS will provide or if we can expect additional guidance once the rulemaking has been published.

What is LeadingAge doing?

LeadingAge will be revising legislative requests for the next Coronavirus relief bill to include a proposal for one universal reporting system as opposed to the currently proposed multiple reporting to state/local health departments and CDC. LeadingAge also sent this letter to Department of Health and Human Services Secretary Alex Azar and CMS Administrator Seema Verma. We will continue our advocacy efforts with the CMS Division of Nursing Homes. We have additionally provided feedback to CDC in the development of the module and supporting materials.