Prioritization of Survey Activities – New CMS Guidance

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Courtesy of The National Consumer Voice for Quality Long-Term Care

The most recent CMS guidance (QSO-20-20-ALL) issued March 23, 2020 further restricts the surveys that can be conducted by State Survey Agencies (SSAs). CMS is suspending certain surveys and only conducting revisits when Immediate Jeopardy (IJ) is cited.

Surveys

Beginning March 20th for a three-week period (referred to as the “prioritization period”), CMS is prioritizing and only conducting the following surveys:

  • Complaint/facility-reported incident (FRI) surveys that are triaged as IJ.
  • Targeted Infection Control Surveys of providers identified through collaboration with the Centers for Disease Control and Prevention (CDC) and the HHS Assistant Secretary for Preparedness and Response (ASPR).
  • Initial certification “in order to increase the health capacity of the country.”

These surveys will only be conducted on site if surveyors have access to Personal Protective Equipment (PPE).

Standard surveys for nursing homes and revisits not associated with IJ will not be authorized.

Conducting surveys of IJ-level complaints/facility-reported incidents

Surveyors and regional offices must adhere to the following guidelines:

  • State survey agencies should follow their normal process for triaging complaints and FRIs:
    • Non-IJ complaints should be entered into the CMS tracking system and not investigated.
    • IJ complaints should  be surveyed following normal policies and procedures.
      Note: If an active case of COVID-19 is found during an IJ complaint/FRI survey, surveyors should report the case and facility to their agency, the state health department, and the CMS Regional Office to decide on further action.
    • If IJ deficiencies are cited and not removed, a revisit will be conducted. If noncompliance is found during this revisit, but not at the IJ level:
      • A second revisit will not be conducted.
      • The provider may submit or delay submission of a plan of correction.
    • If deficiencies are cited, but not at the IJ level:
      • A revisit will not be conducted.
      • The provider may submit or delay submission of a plan of correction.

Targeted infection control surveys

Federal CMS and State Surveyors will conduct focused Infection Control surveys in specific facilities determined by CDC and ASPR, subject to availability of PPE and other state emergency responsibilities.  Surveyors will use a recently created COVID-19 Focused Survey for Nursing Homes as well as the survey protocol.  Revisits will be handled based on the guidance listed above. Enforcement actions will follow the guidance in the next section.

Enforcement

Except for unremoved IJ deficiencies, no enforcement remedies will be imposed for noncompliance before or after March 20, 2020. Any per day CMP or Denial of Payment for New Admissions already being imposed will be stopped. Surveyors will follow normal policies and procedures for removing an IJ and for imposing enforcement actions for remediating the noncompliance (such as 23 day termination).

Self-assessments

Facilities are encouraged to use the COVID-19 Focused Survey for Nursing Homes as a self-assessment tool. The tool indicates CMS’s expectations for an infection prevention and control program during the COVID-19 pandemic. If onsite, surveyors may request the facility’s assessment.

Other:

CMS survey prioritization applies only to surveys for compliance with federal regulations, not state surveys pursuant to state licensure.

Nursing homes are required to have a system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility, and when and to whom possible incidents of communicable diseases and infections should be reported.

CDC recommends nursing homes notify their health department about residents with severe respiratory infection or a cluster of respiratory illness.

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