COVID-19 NHSN Reporting Requirements for Nursing Homes
On May 8, 2020, CMS published the interim final rule with comment. CMS’ memo QSO-20-29-NH provided additional information regarding weekly reporting of specific COVID-19 information at least every seven days through the Centers for Disease Control and Prevention’s (CDC) website. At that time, a deadline to begin reporting was set for May 17, 2020, with a two-week grace period that ended on May 24. Failure to report after May 31, 2020, resulted in a warning letter reminding the provider of its obligation. This requirement is for every CMS-certified long-term care facility, including skilled nursing facilities (SNF) and nursing facilities.
Facilities must submit data through the National Healthcare Safety Network (NHSN) at least once every seven days but can choose to do so multiple times per week. Although there’s not a specific day of the week providers are required to submit data, CMS strongly encouraged providers to be consistent with the reporting day(s). Each Monday, CMS reviews the data to assess if each facility submitted at least once in the prior seven days. The data pulled on Monday is used to update the data being publicly reported.
The COVID-19 reporting data fields include 1) suspected and confirmed COVID-19 infections among residents and staff, including residents previously treated for COVID-19; 2) total deaths and COVID-19 deaths among residents and staff; 3) personal protective equipment and hand hygiene supplies in the facility; 4) ventilator capacity and supplies in the facility; 5) resident beds and census; 6) access to COVID-19 testing while the resident is in the facility; 7) staffing shortages; and 8) other information specified by the Secretary of the U.S. Department of Health & Human Services (HHS).
This required information reporting will be used to disperse the recently announced $2 billion in provider relief funds for nursing home incentive payments. The HHS, through the Health Resources and Services Administration, announced on September 2, 2020, that the performance-based incentive payments will be distributed to facilities that have an active state certification as a nursing home or SNF and receive reimbursement from CMS. HHS plans to administer quality checks on nursing home certification status through the Provider Enrollment, Chain, and Ownership System to identify and remove facilities that have a terminated, expired, or revoked certification or enrollment. Facilities also must report to at least one of three data sources used to establish eligibility and collect necessary provider data to determine payment. Those sources include Certification and Survey Provider Enhanced Reports, Nursing Home Compare, and Provider of Services.
The performance and payment cycle is scheduled to be divided into four calendar months—September, October, November, and December 2020. Each period lasts for a calendar month and provides $500 million to nursing homes. All nursing homes or SNFs that meet the previously noted qualifications will be eligible for each of the four performance periods (calendar months). Nursing homes and SNFs will be assessed based on a full month’s worth of the aforementioned data submissions, which will result in additional HHS scrutiny and auditing before payments will be issued the following month.
The methodology will use CDC and HHS data to measure each provider against a baseline level of infection in the community where the facility is located. The CDC Community Profile Reports include county-level information on total confirmed and/or suspected COVID-19 infections per capita, as well as information on COVID-19 test positivity. Using a baseline, facilities will be measured against two outcomes: 1) ability to keep new COVID-19 infection rates low among residents and 2) ability to keep COVID-19 mortality low among residents. To measure each facility’s infection and mortality rates, the incentive program will use data from the NHSN Long-term Care Facility COVID-19 module where providers were required to report beginning in May 2020.
HHS has stated it will continue to provide updates as it works to assist providers in slowing the spread of COVID-19 through monetary support during the pandemic. This incentive was made possible from the $175 billion provider relief program funded through the bipartisan Coronavirus Aid, Relief, and Economic Security Act and the Paycheck Protection Program and Health Care Enhancement Act. The incentive payments are subject to the same terms and conditions applicable to the initial infection control payments.
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