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 CMS Takes New Steps to Limit Surveys and Focus on COVID-19 Prevention

Among a series of new steps unveiled to battle the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) released guidance prioritizing and suspending most federal and state survey agency (SSA) surveys for three weeks from March 20. Long term and post-acute care providers backed the move as another way to further prevent spread of the virus.

CMS said in the guidance that it would also be delaying revisit surveys, for the next three weeks beginning on March 20, for all skilled nursing facilities. For non-Immediate Jeopardy related onsite surveys that are currently in process, survey teams were instructed to end the survey and exit the facility, the agency said.   

“State and federal surveyors should not enter the building, for any type of survey, if they are unable to meet the Personal Protective Equipment (PPE) expectations outlined by the latest CDC [Centers for Disease Control and Prevention] guidance. They may instead obtain necessary information remotely, to the extent possible,” CMS said.   

In response to the move, Mark Parkinson, president and chief executive officer (CEO) of the American Health Care Association/National Center for Assisted Living, said it is clear that “we are all oriented toward the same goal: doing everything we can to keep the virus out of our buildings and to stop the spread if it does get into a building.”

He added that this new step by CMS “helps balance the need for safety with preventing the spread of this virus." 

Two providers also commented on the CMS actions. Debbie Meade, CEO, Health Management, and chair of the AHCA board said the decision by CMS “helps ensure our caregivers and staff can keep their focus on resident care. Temporarily suspending certain survey and inspections gives long term care providers the ability to keep every resource dedicated to residents during this outbreak.”

Randy Bury, CEO of Sanford/Good Samaritan, said caregivers and long term care providers are taking every possible precaution to keep COVID-19 out of their buildings and at the same time continue to provide high-quality care for each resident.

“Limiting surveys and inspections to only critical issues helps us keep our focus on the health and safety of our residents and staff during this outbreak,” he said.

Offering more detail, CMS said the new protocols will see federal and state surveyors conduct targeted infection control surveys of providers identified together with CDC and the Department of Health and Human Services Assistant Secretary for Preparedness and Response.

They will use this survey tool to review infection prevention and control practices. Surveyors will review for: 

--Overall effectiveness of the Infection Prevention and Control Program, including policies and procedures.

--Standard and Transmission-Based Precautions (with the understanding that certain essential supplies are scarce, and facilities should not be penalized for not having certain supplies if they are unable to obtain them).

--Quality of resident care practices, including those with COVID-19 (laboratory-positive case), if applicable.

--Surveillance plan.

--Visitor entry and facility screening practices.

--Education, monitoring, and screening practices of staff.

--Facility policies and procedures to address staffing issues during emergencies, such as transmission of COVID-19.

CMS said changes in the survey process in effect for the next three weeks include: 

--Standard surveys and non-Immediate Jeopardy revisits are suspended for three weeks. During this period, the following surveys will be suspended: standard surveys for nursing homes, hospitals, home health agencies, intermediate care facilities for individuals with intellectual disabilities, and hospices. 

--Life safety code and emergency preparedness elements of standard surveys. 

--Revisits not associated with an Immediate Jeopardy.  

The following enforcement actions will be suspended, until revisits are again authorized:  

--Imposition of Denial of Payment for New Admissions, including situations where facilities are not in substantial compliance at three months. 

--Imposition of termination for facilities that are not in substantial compliance at six months. 

--Per day civil money penalties will not accumulate.  

--CMS will not impose any new remedies for prior noncompliance. 

--Note: Enforcement actions for unremoved or new Immediate Jeopardy cases remain and will continue to be issued under normal procedures/guidance. 

CMS said complaints and facility-reported incidents triaged at the Immediate Jeopardy level will continue. During this three-week time frame, state survey agencies and CMS will only conduct surveys related to complaints and facility-reported incidents that are triaged at the Immediate Jeopardy level and revisits to verify removal of Immediate Jeopardy. 

If the revisit survey determines there is continuing noncompliance, but at a lower level than Immediate Jeopardy, surveyors will not conduct another onsite revisit survey. For non-Immediate Jeopardy deficiencies, providers may submit a plan of correction (POC) to be held until the end of the three-week period or may delay submission of their POC until the end of this period. CMS said enforcement actions for unremoved or new Immediate Jeopardy Cases remain and will continue to be issued under normal procedures/guidance.

CMS also said providers are to perform self-assessments on infection control using a new surveyor tool. “Use the COVID-19 Infection Control Focused Survey tool contained in the CMS memo (developed with CDC) to perform self-assessment of your facility’s Infection Control plan,” CMS said. “This document may be requested by surveyors if an onsite investigation takes place.” 

CDC also recommends that skilled nursing centers notify their health department about residents with severe respiratory infection, or a cluster of respiratory illness (three or more residents or health care personnel with new-onset respiratory symptoms within 72 hours).

CMS noted that local and state reporting guidelines or requirements may vary.  

In addition, CMS also issued expanded guidance to limit visitors across other provider types. “In this memo, CMS provides guidance to restrict visitation in health care facilities such as hospitals, critical access hospitals, psychiatric hospitals, inpatient hospice units, and intermediate care facilities for individuals with developmental disabilities,” the agency said.

For further information, see the CMS fact sheet at: update-and-survey-prioritization-fact-sheet.

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