The Quality, Safety & Oversight Group (QSOG) within the Centers for Medicare and Medicaid Services (CMS), issued a memorandum on April 24, 2020, which outlines temporary changes to the Nursing Home Compare website and Five Star rating system, announces publication of a list of the daily average number of nursing and total staff for each nursing home, and releases frequently asked questions (FAQs) on matters related to previous CMS nursing home guidance, tools, and resources.
Nursing Home Compare and the Five Star Program
Citing a great shift in the number of nursing homes inspected and how such inspections are conducted following its March 29 announcement that nursing home surveys during the COVID-19 crisis would target potential immediate jeopardy situations and infection control, which would over-weight and affect the ratings of facilities surveyed and thus potentially mislead consumers, CMS will freeze the health inspection domain of Nursing Home Compare and the Five Star system. Instead, the agency will post a link to the results of all surveys conducted on or after March 4, 2020 on the front page of the Nursing Home Compare website. CMS stated, however, that the results of those surveys will not be used to calculate the health inspection Five Star rating for the homes surveyed.
As a means of identifying “approximate” facility needs and to help support the response of local, state, and federal agencies with respect to COVID-19, CMS also announced that it would make certain consolidated data from CY 2019 fourth quarter Payroll-Based Journal (PBJ) submission and facility census data for the same period available in a consolidated spreadsheet. Such information is aggregated by state and nationally, and covers nursing staff, total staff, certified beds and census.
The FAQs released by CMS cover four general categories—guidance on visitation and individuals entering and leaving nursing homes; waivers of federal requirements; resident cohorting, separation, and admission; and surveys and the infection control self-assessment.
- Individuals entering and leaving nursing homes – There are 10 FAQs in this grouping. Of note:
- A negative test for COVID-19 is not required before a hospitalized patient can be discharged to a nursing home. Discharge from the hospital should be based on the patient’s clinical status, the ability of the accepting facility to meet the patient’s care needs, and infection control considerations. CMS also offered guidance on the decision whether to discontinue transmission-based precautions and where individuals should be placed in the facility.
- Up to $3,000 in civil monetary penalty funds may be requested by nursing homes for the purchase of communicative devices and accessories, such as tablets and web cams, to help residents stay connected with their loved ones. CMS cautions that such funds may not be available in all states and advises facilities to check with their state agency’s CMP contact. CMS also notes that all such devices should be cleaned and disinfected between each use.
- If a resident wants to leave the nursing home against medical advice, the facility should strongly discourage the resident from leaving, though the agency stressed that it is unlawful for a facility to detain and stop a resident from leaving. If the resident insists on leaving, the facility should encourage the resident to wear a facemask, discuss the importance of handwashing, offer hand sanitizer (if available), and, most importantly, document in the medical record how the facility discouraged the resident from leaving and explained the risks of the resident leaving to the resident and/or resident representative.
- Waivers of Federal Requirements – There is one FAQ in this group that generally provides links to the various waivers that have been approved.
- Resident cohorting, separation, and admission, including admitting residents discharged from hospitals – This grouping contains three FAQs that discuss the various internal and inter-facility cohorting strategies outlined in a QSOG memorandum on April 13, 2020, the associated limited waiver of federal requirements for transferring and discharging residents, and communal dining.
- With respect to whether facilities must eliminate communal dining, CMS stated that residents without a diagnosis of COVID-19 and without signs or symptoms of a respiratory infection may be permitted to eat in a dining room as long as social distancing is observed.
- Surveys and the Infection Control Self-Assessment – There are five FAQs in this grouping. Most notable among them were two FAQs, the essence of which made the same point and reiterated statements made by CMS in a previous QSOG memorandum that surveyors may ask facilities for their voluntary infection control self-assessment based on the focused infection control survey process developed by CMS and the Centers for Disease Control and Prevention. CMS also encouraged residents and families to ask the nursing home if they’ve completed the self-assessment.
While the April 24th memorandum didn’t tackle all of the questions nursing home providers have been asking CMS on stakeholder calls, it nevertheless clarified some of the operational issues facing providers and telegraphed the issues that CMS views as paramount. Based on the survey FAQs, all facilities should complete an infection control self-assessment and be prepared not only for COVID-19 but also for the state survey agency’s inquiries about it.