On June 1, CMS issued guidance to states on new requirements for nursing homes in light of the COVID-19 pandemic. Since March 6, 2020, CMS has relied on State Survey Agencies to perform Focused Infection Control surveys of nursing homes across the country. Based on the results of these surveys, CMS initiated a “performance-based funding requirement” for nursing homes. The requirement is tied to the Coronavirus Aid, Relief, and Economic Security (CARES) Act supplemental grants for State Survey Agencies.

CMS also announced enhanced penalties for noncompliance with infection control requirements to provide greater accountability and consequences for such noncompliance. These penalties are most significant for nursing homes that have a history of infection control deficiencies or of causing actual harm to residents.

On March 4, 2020, CMS called for states to focus surveys on infection control. Based on COVID-19 nursing home data being reported to the CDC, CMS determined that nursing homes need further direction to prioritize focused infection control surveys. Thus, states that have not completed 100% of their focused infection control nursing home surveys by July 31, 2020 will be required to submit a corrective action plan to their CMS location. The plan must outline the state’s strategy for completing these surveys within 30 days. If a state still has not completed surveys in 100% of its nursing homes after 30 days, its CARES Act Fiscal Year (FY) 2021 allocation may be reduced by up to 10%. Subsequent 30-day extensions could result in additional reductions. These funds would then be redistributed to states that have completed their surveys by July 31.

CMS is also requiring states to take the following COVID-19 survey measures:

• Perform on-site surveys of nursing homes with previous COVID-19 outbreaks;
• Perform on-site surveys of any nursing home with 3 or more new COVID-19 suspected and confirmed cases since the last National Healthcare Safety Network COVID-19 report, or 1 confirmed resident case in a facility that was previously COVID-free; and
• Starting in FY 2021, perform annual Focused Infection Control surveys of 20 % of nursing homes based on state discretion.

The CMS memo to State Survey Agency Directors is available here.