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COVID-19 Guidance and Updates for Nursing Homes during COVID-19August 25, 2020The following pages include guidance released in the form of:I.II.III.IV.MemosNon-memosWaivers and flexibilitiesData ReleasesI. Memo Guidance#NameSummaryReleaseDateQSO-20-09- Information for Healthcare FacilitiesALLConcerning 2019 Novel Coronavirus Illness(2019-nCoV)Information Regarding Patients with Possible 2/6/2020Coronavirus Illness: The U.S. Centers forDisease Control and Prevention (CDC) hasissued information on the respiratory illnesscaused by the 2019 Novel Coronavirus(2019-nCoV). Links to these documents areprovided. Healthcare Facility Expectations:CMS strongly urges the review of CDC’sguidance and encourages facilities to reviewtheir own infection prevention and controlpolicies and practices to prevent the spreadof infection.QSO-20-11- Release of Additional Toolkits to EnsureNHSafety and Quality in Nursing HomesThe Centers for Medicare & Medicaid2/14/2020Services (CMS) is announcing the release oftwo toolkits that align with the CMS strategicinitiative to Ensure Safety and Quality inNursing Homes.Head-to-Toe Infection Prevention (H2T)Toolkit: CMS has created a toolkit that offerseducational materials and practicalinterventions for bedside staff designed toprevent common infections by improvingactivities of daily living (ADL) care.QSO-20-12- Suspension of Survey ActivitiesAllCMS provides information with respect to3/4/2020the temporary focus of surveys on infectioncontrol and other emergent issues.QSO-20-14- Guidance for Infection Control andNHPrevention of Coronavirus Disease 2019(Revised)(COVID-19) in nursing homes (REVISED)Guidance for Infection Control andPrevention of COVID-19: CMS is providingadditional guidance to nursing homes to3/13/2020Page 1 of 11
I. Memo Guidance#NameSummaryReleaseDatehelp them improve their infection controland prevention practices to prevent thetransmission of COVID-19.CDC and local public health departments We encourage all nursing homes to monitorthe CDC website for information andresources and contact their local healthdepartment when neededSee CDC Resources for Health Care FacilitiesQSO-20-17- Guidance for use of Certain IndustrialAllRespirators by Health Care PersonnelCMS clarifies the application of CMS policies 3/10/2020in light of recent CDC and Food and DrugAdministration (FDA) guidance expandingthe types of facemasks healthcare workersmay use in situations involving COVID-19and other respiratory infections.QSO-20-20- Prioritization of Survey ActivitiesAllCMS announced a suspension of routine3/23/2020inspections, and an exclusive focus onimmediate jeopardy situations and infectioncontrol inspections.QSO-20-25- 2019 Novel Coronavirus (COVID-19) LongNHTerm Care Facility Transfer ScenariosCMS is providing supplemental informationfor transferring or discharging residentsbetween facilities for the purpose ofcohorting residents based on COVID-19status (i.e., positive, negative,unknown/under observation).QSO-20-26- Upcoming Requirements for Notification ofNHConfirmed COVID-19 (or COVID-19 Personsunder Investigation) Among Residents andStaff in Nursing HomesCommunicable Disease Reporting4/19/2020Requirements: To ensure appropriatetracking, response, and mitigation of COVID19 in nursing homes, CMS is reinforcing anexisting requirement that nursing homesmust report communicable diseases,healthcare-associated infections, andpotential outbreaks to State and Local healthdepartments. In rulemaking that will follow,CMS is requiring facilities to report this datato the CDC in a standardized format andfrequency defined by CMS and CDC. Failureto report cases of residents or staff whohave confirmed COVID -19 and Personsunder Investigation (PUI) could result in an4/13/2020Page 2 of 11
I. Memo Guidance#NameSummaryReleaseDateenforcement action. This memorandumsummarizes new requirements which will beput in place very soon.Transparency: CMS will also be previewing anew requirement for facilities to notifyresidents’ and their representatives to keepthem up to date on the conditions inside thefacility, such as when new cases of COVID-19occur.QSO-20-28- Nursing Home Five Star Quality RatingNHSystem updates, Nursing Home Staff Counts,and Frequently Asked Questions, and Accessto Ombudsman (REVISED)Nursing Home Compare website & Nursing 4/24/2020Home Five Star Quality Rating System: Weare announcing that the inspection domain Revisedwill be held constant temporarily due to the 7/9/2020prioritization and suspension of certainsurveys, to ensure the rating system reflectsfair information for consumers.Posting of surveys: CMS will post a list of thesurveys conducted after the prioritization ofcertain surveys, and their findings, through alink on the Nursing Home Compare website.Nursing Home Staff: CMS is publishing a listof the average number of nursing and totalstaff that work onsite in each nursing home,each day. This information can be used tohelp direct adequate personal protectiveequipment (PPE) and testing to nursinghomes.Access to Ombudsman: We are remindingfacilities that providing ombudsman accessto residents is required per 42 CFR §483.10(f)(4)(i) and per the Coronavirus Aid,Relief, and Economic Security Act (CARESAct).Frequently Asked Questions (FAQ): We arereleasing a list of FAQs to clarify certainactions we have taken related to visitation,surveys, waivers, and other guidance.QSO-20-29- Interim Final Rule Updating Requirements for On May 8, 2020, CMS will publish an interim 5/6/2020NHNotification of Confirmed and Suspectedfinal rule with comment period. COVID-19Page 3 of 11
I. Memo Guidance#NameCOVID-19 Cases Among Residents and Staffin Nursing HomesSummaryReleaseDateReporting Requirements: CMS is requiringnursing homes to report COVID-19 facilitydata to the CDC and to residents, theirrepresentatives, and families of residents infacilities.Enforcement: Failure to report in accordancewith 42 CFR §483.80(g) can result in anenforcement action.Updated Survey Tools: CMS has updated theCOVID-19 Focused Survey for NursingHomes, Entrance Conference Worksheet,COVID-19 Focused Survey Protocol, andSummary of the COVID-19 Focused Surveyfor Nursing Homes to reflect COVID-19reporting requirements.COVID-19 Tags: F884 and F885.Transparency: CMS will begin posting datafrom the CDC National Healthcare SafetyNetwork (NHSN) for viewing by facilities,stakeholders, or the general public. TheCOVID-19 public use file will be available onhttps://data.cms.gov/.QSO-20-30- Nursing Home Reopening Recommendations Recommendations for State and Local5/18/2020NHfor State and Local OfficialsOfficials: CMS is providing recommendationsto help determine the level of mitigationneeded to prevent the transmission ofCOVID-19 in nursing homes. Therecommendations cover the following items: Criteria for relaxing certain restrictionsand mitigating the risk of resurgence:Factors to inform decisions for relaxingnursing home restrictions through aphased approach.Visitation and Service Considerations:Considerations allowing visitation andservices in each phase.Restoration of Survey Activities:Recommendations for restarting certainsurveys in each phase.Page 4 of 11
I. Memo Guidance#NameQSO-20-31- COVID-19 Survey Activities, CARES ActAllFunding, Enhanced Enforcement for InfectionControl deficiencies, and QualityImprovement Activities in Nursing HomesSummaryReleaseDateCMS is committed to taking critical steps to 6/1/2020protect vulnerable Americans to ensureAmerica’s health care facilities are preparedto respond to the Coronavirus Disease 2019(COVID-19) Public Health Emergency (PHE).CMS has implemented a new COVID-19reporting requirement for nursing homesand is partnering with CDC’s robust federaldisease surveillance system to quicklyidentify problem areas and inform futureinfection control actions.Following the March 6, 2020 surveyprioritization, CMS has relied on StateSurvey Agencies to perform FocusedInfection Control surveys of nursing homesacross the country. We are now initiating aperformance-based funding requirementtied to the Coronavirus Aid, Relief andEconomic Security (CARES) Act supplementalgrants for State Survey Agencies. Further, weare providing guidance for the limitedresumption of routine survey activities.CMS is also enhancing the penalties fornoncompliance with infection control toprovide greater accountability andconsequence for failures to meet these basicrequirements. This action follows theagency’s prior focus on equipping facilitieswith the tools they needed to ensurecompliance, including 12 nursing homeguidance documents, technical assistancewebinars, weekly calls with nursing homes,and many other outreach efforts. Theenhanced enforcement actions are moresignificant for nursing homes with a historyof past infection control deficiencies, or thatcause actual harm to residents or ImmediateJeopardy.Quality Improvement Organizations havebeen strategically refocused to assist nursinghomes in combating COVID-19 through suchPage 5 of 11
I. Memo Guidance#NameSummaryReleaseDateefforts as education and training, creatingaction plans based on infection controlproblem areas and recommending steps toestablish a strong infection control andsurveillance program.QSO-20-32- Release of COVID-19 Nursing Home DataNHNursing Home COVID-19 Information: CMS 6/4/2020will post COVID-19 data submitted byfacilities via the CDC National HealthcareSafety Network (NHSN). The information willbe posted on June 4th, 2020 at the followinglocations: A link to the information in the“Spotlight” section of the Nursing HomeCompare home page. The information will also be available -20-33- Posting of Nursing Home InspectionsNHNursing Home Inspections: CMS will post6/4/2020health inspection (i.e., surveys) results thatwere conducted on or after March 4th,2020, which is the first date that CMSaltered the way that inspections arescheduled and conducted. This includesinspections related to complaints andfacility-reported incidents (FRIs) that weretriaged at the Immediate Jeopardy (IJ) level,and the streamlined Infection Controlinspection process that was developedbased on the guidance for preventing thespread of COVID-19.The information will be available in the“Spotlight” section of the Nursing HomeCompare home page on June 4th, 2020.QSO-20-34- Changes to Staffing Information and QualityNHMeasures Posted on the Nursing HomeCompare Website and Five Star QualityRating System due to the COVID-19 PublicHealth EmergencyChanges to the Nursing Home Compare6/25/20Website and Five Star Quality Rating System: Staffing Measures and RatingsDomain: On July 29, 2020, Staffingmeasures and star ratings will beheld constant, and based on datasubmitted for Calendar Quarter 42019. o Also, CMS is ending thePage 6 of 11
I. Memo Guidance#NameSummaryReleaseDatewaiver of the requirement fornursing homes to submit staffingdata through the Payroll-BasedJournal System. Nursing homes mustsubmit data for Calendar Quarter 2by August 14, 2020. QSO-20-35Enforcement Cases Held during thePrioritization Period and Revised SurveyPrioritizationQuality Measures: On July 29, 2020,quality measures based on a datacollection period ending December31, 2019 will be held constant.CMS is committed to taking critical steps to 8/17/20ensure America’s health care facilitiescontinue to be prepared in response to thethreat of the 2019 Coronavirus Disease(COVID-19). CMS is revising guidance on theexpansion of survey activities toauthorize onsite revisits and othersurvey types. CMS is providing guidance to StateSurvey Agencies (SAs) on resolvingenforcement cases: CMS is providingguidance on resolving enforcementcases that were previously directedto be held, and providing guidanceon Civil Money Penalty (CMP)collection. Expanded Desk Review Authority:CMS is temporarily expanding thedesk review policy to include reviewof continuing noncompliancefollowing removal of ImmediateJeopardy (IJ), which would otherwisehave required an onsite revisit fromMarch 23, 2020, through May 31,2020. CMS is also issuing updatedguidance for the re-prioritization ofroutine SA Clinical LaboratoryImprovement Amendments (CLIA)survey activities, subject to the SA’sdiscretion, in addition to lifting therestriction on processing CLIAenforcement actions, and issuing thePage 7 of 11
I. Memo Guidance#NameSummaryReleaseDateStatement of Deficiencies and Planof Correction (Form CMS-2567).QSO-20-37- Interim Final Rule (IFC), CMS-3401-IFC,CLIA,NHUpdating Requirements for Reporting ofSARS-CoV-2 Test Results by (CLIA) of 1988Laboratories, and Additional Policy andRegulatory Revisions in Response to theCOVID-19 Public Health EmergencyCMS is committed to taking critical steps to 8/26/20ensure America’s healthcare facilities areprepared to respond to the CoronavirusDisease 2019 (COVID-19) Public HealthEmergency (PHE). On August 25, 2020, an interim finalrule with comment period (IFC) wenton display at the Federal Register. CLIA regulations have been updatedto require all laboratories to reportSARS-CoV-2 test results in astandardized format and at afrequency specified by theSecretary. Failure to report SARS-CoV-2 testresults will result in a condition levelviolation of the CLIA regulation andmay result the imposition of a CivilMoney Penalty (CMP) as requiredunder §§ 493.1804 and 493.1834. Long-Term Care (LTC) Enforcementrequirements at 42 CFR part 488have been revised to includerequirements specific to theimposition of a CMP for nursinghomes that fail to report requisiteCOVID-19 related data to theCenters for Disease Control andPrevention (CDC) NationalHealthcare Safety Network (NHSN)per §483.80(g)(1) and (2). LTC Facility Testing Requirements forStaff and Residents- Facilities arerequired to test staff and to offertesting to all nursing homeresidents.QSO-20-38- Interim Final Rule (IFC), CMS-3401-IFC,NHAdditional Policy and Regulatory Revisions inResponse to the COVID-19 Public HealthEmergency related to Long-Term Care (LTC)CMS is committed to taking critical steps to 8/26/20ensure America’s healthcare facilitiescontinue to respond effectively to theCoronavirus Disease 2019 (COVID-19) PublicHealth Emergency (PHE).Page 8 of 11
I. Memo Guidance#NameFacility Testing Requirements and RevisedCOVID-19 Focused Survey ToolSummary II. Non-Memo GuidanceNameToolkit for States to Mitigate COVID19 in Nursing Homes (PDF)Frequently Asked Questions (FAQs)on Nursing Home VisitationReleaseDateOn August 25, 2020, CMS publishedan interim final rule with commentperiod (IFC). This rule establishesLong-Term Care (LTC) Facility TestingRequirements for Staff andResidents. Specifically, facilities arerequired to test residents and staff,including individuals providingservices under arrangement andvolunteers, for COVID-19 based onparameters set forth by the HHSSecretary. This memorandumprovides guidance for facilities tomeet the new requirements.Revised COVID-19 Focused SurveyTool -To assess compliance with thenew testing requirements, CMS hasrevised the survey tool forsurveyors. We are also adding to thesurvey process the assessment ofcompliance with the requirementsfor facilities to designate one ormore individual(s) as the infectionpreventionist(s) (IPs) who areresponsible for the facility's infectionprevention and control program(IPCP) at 42 CFR § 483.80(b). Inaddition, we are making a number ofrevisions to the survey tool to reflectother COVID-19 guidance updatesSummaryDateCMS published a new toolkit comprised of recommendations UPDATEDand best practices from a variety of front line health care(6/29/20)providers, governors’ COVID-19 task forces, associations andother organizations and experts that is intended to serve asa catalogue of resources dedicated to addressing the specificchallenges facing nursing homes as they combat COVID-19.CMS provides clarifications related to relaxing nursing homevisitation restrictions.6/24/20Page 9 of 11
II. Non-Memo GuidanceNameSummaryDateNursing Home ReopeningThis FAQ answers a range of questions on the topics of:Recommendations Frequently Asked ReopeningQuestions Visitation Testing RequirementsCMS letter to Nursing Home Facility CMS provided information to nursing homes to protectManagement & Staff (PDF)residents during the pandemic.5/18/20COVID-19 Long-Term Care FacilityGuidanceCMS and the CDC are issuing new recommendations to Stateand local governments and long-term care facilities (alsoknown as nursing homes) to help mitigate the spread of theCOVID-19.4/2/20Coronavirus Commission for Safetyand Quality in Nursing HomesCMS will have an independent Commission conduct acomprehensive assessment of the nursing home response tothe COVID-19 pandemic. The Commission will be convenedand lead by a CMS contractor and will provide independentrecommendations to the contractor to review and report toCMS to help inform immediate and future responses toCOVID-19 in nursing homes.4/30/20Frequently Asked Questions forState Survey Agency and AccreditingOrganizationCoronavirus Disease 2019 (COVID19) Survey SuspensionOn March 4, 2020, CMS suspended survey activity for certain 3/10/20non-emergency state survey inspections, allowing inspectorsto prioritize the most serious health and safety threats likeinfectious diseases and abuse. This document containsfrequently asked questions for State Surveyors, healthcarefacilities, patients and caregivers and accreditingorganizations.Long-Term Care Nursing HomesTelehealth and Telemedicine Toolkit(PDF)CMS has broadened access to Medicare telehealth servicesso that beneficiaries can receive a wider range of servicesfrom their doctors without having to travel to a healthcarefacility.5/11/203/27/20Page 10 of 11
III. Waivers and FlexibilitiesNameLong Term Care Facilities (SkilledNursing Facilities and/or NursingFacilities): CMS Flexibilities to FightCOVID-19SummaryThe document contains temporary regulatory waivers andnew rules to equip the American healthcare system withmaximum flexibility to respond to the COVID-19 pandemic.Date7/9/20(updated)IV. Data ReleasesNameCOVID Nursing Home Compare DataNursing Home Data Release FAQs (PDF)General Information: CDC.gov/coronavirus has the latest public health and safety information from CDC and for the overarchingmedical and health provider community on COVID-19. Preparing for COVID-19 in Nursing Homes Coronavirus.gov or USA.gov is the source for the latest information about COVID-19 prevention, symptoms, andanswers to common questions. FDA.gov/Coronavirus recommendations, regulatory information, guidance, and technical assistance necessary tosupport rapid coronavirus disease 2019 (COVID-19) response efforts.Follow Us: Twitter: @CMSGov @MedicareGov @Medicaid.govFacebook: Facebook.com/MedicarePage 11 of 11
QSO-20-33- Posting of Nursing Home Inspections Nursing Home Inspections: CMS will post 6/4/2020 NH health inspection (i.e., surveys) results that were conducted on or after March 4th, 2020, which is the first date that CMS altered the way that inspections are scheduled and conducted. This includes inspections related to complaints and
