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 Nursing Home Industry Says COVID-19 Data Release Confirms Need for More Assistance

After the federal government released data from skilled nursing facilities (SNFs) on the number of COVID-19 infections and deaths, and also unveiled new incentives and penalties for infection control adherence, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) said the information confirms what the industry has said since March: Residents and staff of nursing centers require top priority in the coronavirus battle.

“These numbers show what we have known for months, that COVID-19 disproportionately impacts the elderly with chronic diseases and the dedicated staff who care for them,” said Mark Parkinson, president and chief executive officer of AHCA/NCAL.

“Today’s report validates the need for the assistance that nursing homes have been calling for since the beginning of this pandemic. Especially as we continue to expand testing for residents and staff in long term care centers in June, we should anticipate the number of cases to rise as asymptomatic residents and staff will be identified. While an increase in these reported numbers may be startling, it will improve our ability to confront this threat and protect our residents.”

In a Monday press conference, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said the first round of SNF-provided data on COVID-19 showed some 60,000 virus infections and 26,000 related deaths among the 12,500 facilities reporting. The information will be made public online later this week and will be updated as well before the week’s close, she said. The public reporting system that Verma has touted saw some 80 percent of the nation’s nursing facilities comply with the requirement to report coronavirus infections and deaths.

By way of background, since April 19, CMS has required SNFs to inform residents, their families, and representatives of COVID-19 cases in their facilities. For the first time, nursing facilities have also been required to report COVID-19 cases and deaths directly to the Centers for Disease Control and Prevention (CDC) on an ongoing basis since May 1.

In response, Parkinson said, “We hope this public reporting system will help identify areas that are most in need of resources to fight the battle against COVID-19. We hope state and federal public health officials can use the data to help nursing homes by sending urgently needed resources.”

Verma also announced a new CMS push to get full compliance to the reporting law as well as new incentives and penalties for states to have 100 percent of their SNFs inspected under focused surveys measuring infection control.

To this, the AHCA/NCAL head said CMS imposing additional enforcement and fines is not as helpful to improving the situation as it would be for the agency and its survey teams to work together with the nursing home industry to fight the COVID-19 battle.

“This situation will get worse if surveyors are only looking for reasons to find deficiencies and issue fines instead of identifying ways for nursing homes to make real changes and help them improve their infection control programs,” Parkinson said. “It’s time to recognize that when nursing homes receive citations, it’s a failure not just of the provider, but of CMS and the survey process as well. Citations and fines without assistance will not help us keep residents and staff safe from this virus.”

He also stressed that the reality is that long term care providers “are facing an unprecedented situation that has left them begging for testing, personal protective equipment [PPE], and staffing resources. Just like hospitals, we have called for help. In our case, it has been difficult to get anyone to listen.

“Whether it’s federal, state, or local health agencies, long term care needs to be a priority for supplies and help. It’s time that America rally around our long term care residents just as they did with hospitals,” he said.

In prepared remarks before her press availability, CMS’ Verma in commenting on the coronavirus pandemic and nursing facilities said, “While many nursing homes have performed well and demonstrated that it’s entirely possible to keep nursing homes patients safe, we are outlining new instructions for state survey agencies and enforcement actions for nursing homes that are not following federal safety requirements.”

The enhanced and targeted accountability measures are based on early trends in the most recent data regarding incidence of COVID-19 in SNFs, as well as data regarding the results of the agency’s targeted infection control inspections, she said.  

CMS is increasing enforcement (that is, civil money penalties) for facilities with persistent infection control violations, and imposing enforcement actions on lower-level infection control deficiencies to ensure they are addressed with increased gravity.

Verma said the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) provided additional funding to CMS for necessary survey and certification work related to COVID-19, of which $80 million in new resources will be available for states to increase surveys.

To ensure effective oversight is achieved, CMS will allocate the CARES Act funding based on performance-based metrics. States that have not completed 100 percent of focused infection control surveys of their nursing facilities by July 31 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 facilities, 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, she said.

Utilizing the CARES Act funding, states will be required to perform on-site surveys of nursing facilities with previous COVID-19 outbreaks and will be required to perform on-site surveys (within three to five days of identification) of any nursing home with new COVID-19 suspected and confirmed cases.

Verma said to assist SNFs in implementing infection control best practices, CMS will provide technical assistance through Quality Improvement Organizations. CMS and CDC will continue to monitor the data CDC receives through the new nursing facility COVID-19 surveillance system to identify facilities with outbreaks and work with governors’ offices and states to keep residents safe, she said.

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