CMS Nursing Home COVID-19 Update – Interim Final Rule

COVID-19 medicare checklist

On August 25, 2020, CMS released an interim final rule on COVID-19 testing of nursing home staff and additional information.  

Effective immediately, nursing homes that fail to comply with the requirements to report COVID-19 data to the Centers for Disease Control and Prevention (CDC) through the National Healthcare Safety Network (NHSN) will be subject to the following: 

  • Citation with a scope and severity level at “F,” which means there is no actual harm with potential for more than minimal harm that is not immediate jeopardy and that is widespread
  • Enforcement of a civil monetary penalty (CMP) of $1,000 per noncompliance 
  • Increasing increments of $500 per CMP for up to 12 instances of noncompliance

Nursing homes that fail to report on a weekly basis will receive a $1,000 CMP that increases incrementally by $500 for each subsequent missed week of reporting, and it will cap at 12 weeks ($6,500) due to pre-existing statutory caps.

CMS also announced a new infection control training available to nursing homes titled “CMS Targeted COVID-19 Training for Frontline Nursing Home Staff and Management.” The training is designed for frontline caregivers and management staff and contains separate training modules. There are five modules for frontline caregivers and 10 modules for management staff. The education is available and can be accessed through the CMS Quality, Safety & Education portal. Certificates of completion are available for each course completed. In addition to the education modules, subject matter experts from CMS and CDC will be available through biweekly webinars beginning August 27, 2020, and running through January 7, 2021.

CMS’ point-of-care (POC) testing update indicates that 5,593 nursing homes have already received an antigen testing machine. CMS expects by the end of September 2020 all nursing homes with a Clinical Laboratory Improvement Amendments waiver (approximately 14,800) will have an antigen testing machine. CMS also reported that more than 2 million test kits have been shipped—enough to test each staff member at least twice—and that nursing homes would be able to order additional tests. No other details were provided.

The Food and Drug Administration (FDA) released recommendations for diagnostic tests for screening asymptomatic individuals for COVID-19. In the frequently asked questions on its website, the FDA recommended that healthcare providers screening asymptomatic individuals should consider using a highly sensitive test, especially if rapid turnaround times are available. If highly sensitive tests aren’t available or turnaround times are slow, providers should use less sensitive POC tests, even if they’re not specifically authorized for this indication (commonly referred to as “off label”). CMS stated that for congregate care settings, like nursing homes or similar settings, repeated use of rapid POC testing may be superior for overall infection control compared with less frequent, highly sensitive tests with prolonged turnaround times. Negative test results should be considered in the context of clinical observations, patient history, and infection rates in the location or surrounding community and, if indicated, should be followed with a polymerase chain reaction test. CMS also indicated that it wouldn’t be necessary to perform confirmatory high-sensitivity tests on individuals with negative antigen test results or other POC test results if they’re obtained during routine screening or surveillance.

In addition, CMS indicated there would be $2.5 billion for “testing in nursing homes.” It also indicated the $2.5 billion will be coming to nursing homes in the next week, beginning August 27. The formula used includes a base payment per facility plus additional funds based on the number of beds.

The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program performance period changes for fiscal year 2022 under the public health emergency will reduce reporting from January 1 through June 20, 2020. Under the interim final rule, CMS has changed the performance period for the SNF VBP Program to include data from April 1, 2019, to December 31, 2019, plus July 1 to September 20, 2020. This provides a full 12 months of data for the calculations. This is reported through Medicare claims, so there isn’t any information that skilled nursing providers must report.

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