On May 8, 2020, CMS published an Interim Rule, one portion of which is focused on new reporting requirements for skilled nursing facilities. The new reporting requirements, effective May 8, 2020, fall into two categories: (a) reporting COVID-19 Information to the Centers for Disease Control (CDC); and (b) reporting COVID-19 information to residents and family members. Details regarding the new reporting regulations follow:

CDC REPORTING

Facilities will be required to electronically report information in a standardized format no less than weekly through the CDC/National Healthcare Safety Network (NHSN).

• The first report is to be submitted in the NHSN system by 11:59 pm on May 17, 2020.
  • CMS is providing an initial grace period and has stated that they will not begin imposing penalties for a failure to submit a report unless a report has not been submitted by 11:59 p.m. on June 7^th. After June 7, civil monetary penalties begin issued starting at $1,000 per day and increasing by increments of $500 for each week a report is not submitted.
• Data must be submitted at least weekly.
  • Facilities can submit more often if they choose to.
  • If submitting weekly, should do so on the same day each week so collection period remains consistent.

The Report shall include:

• Suspected and confirmed COVID-19 infections among residents and staff, including residents previously treated for COVID-19;
• Residents who had suspected or laboratory positive COVID-19 who died in the facility or another location;
• Any resident deaths;
  • Facility needs to report total death counts (COVID-19 related deaths + non-COVID-19 deaths)
• PPE and hand hygiene supplies in the facility;
  • This is a “Yes” or “No” question and is requesting information regarding whether a facility has sufficient PPE for the day on which report is completed and the following week
• Ventilator capacity and supplies;
• Resident beds and census;
• Whether the facility has access to COVID-19 testing while the resident is in the facility; and
• Whether the facility is experiencing a shortage of staffing and/or personnel.

The procedure contemplated by NHSN is that a facility will pick one day a week to report information and will then log-in and update information on that same day each week. For example, if you complete an initial submission Friday, May 8, second report will be completed Friday, May 15. For the weekly update you will only have to answer questions that may have changed, ex. PPE and resident census. While the report provides the opportunity to submit information going back to January 2020, CMS has stated that retroactive information is not required and failure to input older data will not result in an enforcement action.

CMS anticipates publicly posting the information provided (including facility names, number of COVID-19 suspected and confirmed cases, deaths, and other data as determined appropriate) weekly on https://data.cms.gov/ starting at the end of May.

FAMILY REPORTING

The facility shall notify all residents, representatives, and families of residents by 5 pm the next calendar day following the occurrence of either:

• a single confirmed infection OR
• 3 or more residents or staff with new-onset of respiratory symptoms within 72 hours of each other
  • Respiratory symptoms that should be tracked are those identified as potential symptoms for COVID-19 by the CDC.

Facilities are not required to personally call all residents and family members but can utilize forms of communication such as email listservs, website postings, paper notification, and/or recorded telephone messages. The key is to make it easy for residents, their representatives, and families to obtain information from facilities.

When making reports facilities should:

• NOT include personally identifiable information;
• Include information on mitigating actions implemented to prevent or reduce the risk of transmission;
• Provide cumulative weekly updates for residents, their representatives and families, at least weekly or by 5pm the next calendar day following the subsequent occurrence of either a confirmed positive, or 3 or more residents or staff with respiratory symptoms within 72 hours.

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