The Centers for Medicare & Medicaid Services (CMS) issued a Quality, Safety & Oversight (QSO) memo to states instructing them to return to the normal survey process as soon as resources in the state allow and in accordance with states’ COVID-19 reopening plans.

The memo also provides guidance on how to resolve pending enforcement actions suspended as a result of prior QSO memos on March 23 and June 1 that suspended some survey enforcement actions during the COVID-19 pandemic, according to a summary of the CMS instructions by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

On March 23, CMS issued the QSO 20-20-All memorandum, which limited survey activity to focused infection control surveys. On June 1, CMS issued the QSO 20-31-All memorandum that provided survey reprioritization guidance to transition to more routine oversight and survey activities. This latest memo instructs states to restart all normal surveys as soon as is possible, AHCA/NCAL said.

CMS resolved suspended enforcement cases and provided guidance for closing them out going forward starting mid-August. This process involved four components that are described in the QSO memo:
1. Expanding the Desk Review policy for Plans of Corrections;
2. Processing enforcement cases that were started before March 23, 2020;
3. Processing enforcement cases that were started on March 23, 2020, through May 31, 2020; and
4. Processing enforcement cases that were started on or after June 1, 2020.

CMS is also issuing updated guidance for the reprioritization of routine state survey agency (SA) Clinical Laboratory Improvement Amendments (CLIA) survey activities, subject to the SA’s discretion, in addition to lifting the restriction on processing CLIA enforcement actions and issuing the Statement of Deficiencies and Plan of Correction (Form CMS-2567) for CLIA citations.

AHCA/NCAL said providers with questions about past enforcement actions suspended during the COVID-19 pandemic should contact their state survey agency for guidance as there are many scenarios that may not be fully addressed by the new memo.

CMS said questions about a specific enforcement cycle may be addressed with the specific CMS location:
■ Long-Term Care questions should be addressed to:
■ CLIA questions should be addressed to:​