CMS Announces Enhanced Survey Activity and Enforcement Remedies Related to Infection Control

Regulation | June 01, 2020 | by Jodi Eyigor

CMS has announced significant increases in infection control surveys and enhanced enforcement remedies for nursing homes.

CMS announced updated guidance related to survey activity and enhanced enforcement remedies for infection control citations on June 1 in QSO-20-31-NH. State survey agencies will be expected to significantly increase infection control surveys immediately or risk losing allocations from the CARES Act. CMS also laid out enhanced enforcement remedies to be implemented related to infection control citations.

State survey agencies will be required to complete infection control surveys in 100% of nursing homes by July 31, 2020. Nursing homes that are not able to survey 100% of nursing homes by that deadline will need to submit a corrective action plan to the regional CMS location to outline how they will complete all surveys within 30 days. Failure to complete surveys will result in a 10% reduction of CARES Act funds to the state survey agency.

Additionally, within the next 30 days states must perform on-site surveys of the following:

  • Nursing homes with cumulative confirmed cases at 10% of bed capacity.
  • Nursing homes with cumulative confirmed and suspected cases at 20% of bed capacity.
  • Nursing homes with 10 or more deaths reported due to COVID-19.

Within 3-5 days of identification, states must survey nursing homes with 3 or more new suspected and confirmed COVID-19 cases since the nursing home’s most recent report to Centers for Disease Control & Prevention (CDC) through the National Healthcare Safety Network (NHSN) system or 1 confirmed case in a nursing home that was previously free of COVID-19. Going forward, beginning in FY 2021, states will perform infection control surveys of at least 20% of the nursing homes in the state.

CMS has also provided guidance on enforcement remedies related to infection control. Nursing homes can expect Directed Plans of Correction, Discretionary Denials of Payment for New Admissions, and per instance Civil Money Penalties for infection control deficiencies beginning at D-level and above. Enforcement remedies are determined based on scope and severity of the citation as well as history of noncompliance and will be combined based on these factors.

What This Means for Providers

Expect an infection control survey. Be sure to complete an infection control self-assessment according to the most updated infection control survey tool CMS released in QSO-20-29-NH. The LeadingAge supplemental survey tool and checklist is available here. The Quality Improvement Organizations (QIOs) host weekly infection control trainings that can be accessed here

Recall that some of the more frequent citations on these infection control surveys have been around hand hygiene and appropriate use of personal protective equipment (PPE). Refer to CDC guidance on hand hygiene, donning and doffing PPE, and strategies to optimize PPE supplies.

Note that CMS will be utilizing data from the NHSN reporting system to identify nursing homes for survey. Refer to the resources on the NHSN site and ensure data elements are being reported accurately.

LeadingAge continues advocating for the support nursing homes need to survive this pandemic, including access to and funding for testing, adequate PPE, and resolution of NHSN enrollment and reporting issues. For more information, visit the LeadingAge COVID-19 page.