Courtesy of Centers for Medicare & Medicaid Services
The Centers for Medicare & Medicaid Services (CMS) is responsible for the Medicare and Medicaid Programs. As part of that responsibility, CMS develops and enforces the essential health and safety standards that health care providers must meet in order to participate in the programs. In other words, providers must comply with federal standards as a requirement to receive federal reimbursement through those Programs. To ensure compliance with federal standards, CMS conducts inspections – called “surveys” – of providers across the health care system, including hospitals, nursing homes, home health agencies, end-stage renal disease facilities, hospices, and other facilities serving Medicare and Medicaid beneficiaries. While CMS itself conducts surveys to ensure compliance with federal standards, surveys may also be performed on CMS’s behalf by state-based State Survey Agencies. This function is outlined in Section 1864 of the Social Security Act. Additionally, CMS accepts the certification of some private organizations called Accrediting Organizations (AOs).
All long-term care facilities that seek to participate in Medicare and Medicaid must comply with basic health and safety requirements set forth in statute and regulation. Compliance with these requirements is determined through unannounced, annual on-site surveys conducted by state survey agencies in each of the 50 states, the District of Columbia, and the U.S. territories. State survey agencies act as agents of CMS in performing these surveys. Nursing homes must remain in substantial compliance with these requirements, as well as applicable Federal, state, and local laws, and accepted professional standards, to continue as a Medicare or Medicaid participating provider. Failure to meet Federal health and safety requirements can lead to penalties including fines, payment denials for new admissions, and ultimately, loss of the ability to participate in, and receive reimbursement from, the Medicare and Medicaid programs.
Increasing numbers of COVID-19 cases have begun to strain the country’s health care system. This strain has resulted in an increasing workload for front-line clinicians as they care for patients. Based on lessons learned from Kirkland and in response to frontline clinicians, CMS has developed a targeted, streamlined survey process. This new process is three-pronged. First, CMS will continue its responsiveness to Immediate Jeopardy; second, CMS will work with the Centers for Disease Control and Prevention (CDC) to identify areas at risk of COVID-19 spread to ensure providers are compliant with longstanding federal infection control requirements; third, CMS is rolling out a voluntary self-assessment tool so providers can review their own compliance with federal infection control requirements.
Under CMS’ focused survey process, during the next few weeks, only the following types of federal inspections will be prioritized and conducted:
- Complaint inspections: State survey agencies will continue to conduct inspections related to complaints and facility-reported incidents that are triaged at the Immediate Jeopardy level. These include allegations such as physical or sexual abuse, neglect, or other conditions that may create an imminent threat to the health and safety or patients and residents. Inspectors will use a streamlined Infection Control review tool, regardless of the Immediate Jeopardy allegation.
- Targeted Infection Control inspections: Federal and state inspectors will conduct targeted infection control inspections of providers identified through CMS collaboration with the Centers for Disease Control and Prevention (CDC). These inspectors will use a streamlined targeted review checklist to minimize the impact on provider activities, while ensuring providers are implementing actions to protect health and safety. The goal of these inspections will be to provide a quick, focused assessment of a provider’s infection control practices in those areas where such increased oversight will be most effective. Providers will then receive immediate feedback to allow them to address any potential gaps or shortcomings.
- Self-Assessments: The Infection Control checklist referenced above will also be shared with providers and suppliers, to allow for self-assessment of their Infection Control plans. This may be the best solution in some cases when there is a lack of personal protective equipment or state surveyors available.
During this time frame, the following inspections will not be conducted:
- Standard inspections for nursing homes, hospitals, home health agencies, intermediate care facilities for individuals with intellectual disabilities, and hospices; and
- Revisit inspections not associated with Immediate Jeopardy.
During this time, CMS will prioritize Immediate Jeopardy investigations over recertification surveys for Clinical Laboratory Improvement Amendment (CLIA) laboratories. CMS will use enforcement discretion, unless Immediate Jeopardy situations arise. Finally, initial inspections will be conducted in accordance with current guidance and prioritization.
Because revisits to verify compliance will not be authorized during this time to focus on Immediate Jeopardy and infection control concerns, CMS is suspending current enforcement actions, including denials of payment for new admissions, to allow for increased capacity and hold providers harmless for penalties that may otherwise accrue without an opportunity to demonstrate compliance. Enforcement remedies associated with identified and unresolved Immediate Jeopardy, however, will continue.
For more information, please visit: https://www.cms.gov/newsroom/press-releases/cms-announces-findings-kirkland-nursing-home-and-new-targeted-plan-healthcare-facility-inspections
This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.