The Guidance addresses these priorities and activities for three groups of providers: long-term care facilities, laboratories, and other providers.
On June 1, 2020, CMS revised its previously issued guidance regarding long term care surveys. At that time, CMS indicated that in addition to the survey priorities that were always in effect (Immediate Jeopardy, Focused Infection Control, and Initial Certification surveys), state survey agencies were authorized to begin conducting additional types of surveys in states that have entered Phase 3 of the reopening, or earlier at the state’s discretion. As of August 17, 2020, CMS added the following additional surveys to be conducted, subject to sufficient state resources:
The Guidance addressed enforcement activities that are dependent on when the enforcement cycle was initiated.
For CMPs that became due and payable during the March 23, 2020 through May 31, 2020 time period but were not paid, CMS will issue a new due and payable notice and the provider will have 15 days from the date of the notice to make the payment. If the payment is not paid within that time, interest will begin to accrue from the due date, and CMS will notify the Administrative Contractor to offset future payments. For providers who were unable to notify CMS within the 60-day time frame to appeal during the March 23, 2020 through May 31, 2020 period that they were waiving their right to a hearing, CMS will reduce the CMP by 35%.
CMS is re-prioritizing CLIA on-site survey activities, subject to the SA’s discretion and within the state’s COVID-19 restrictions and safety precautions. SAs will begin conducting complaint surveys that require immediate corrective action, revisit surveys to resolve current enforcement activities, recertification surveys for laboratories whose certificates have been extended to August 31, 2020 and other providers with certificates expiring soon, initial certification surveys, and other complaints. However, SAs will not conduct validation surveys for accredited laboratories or Provider Performed Microscopy Project surveys.
For non-long-term care providers, CMS is encouraging states to resume survey activities and to address the backlog of surveys. These surveys would be in addition to the ongoing focused infection control surveys utilizing the COVID-19 Focused Infection Control Survey: Acute and Continuing Care for as long as there is a Public Health Emergency. States that have entered Phase 3 of the reopening, or earlier at the state’s discretion, should resume normal survey activities, and should also prioritize the backlog of surveys in the following descending order of priority:
How these surveys affect acute care hospitals is discussed further in our blog post, Hospitals Be Ready: CMS Announces Return to Routine Surveys.
For all surveys that ended prior to June 1, 2020, CMS is requiring providers to submit a POC within 10 calendar days of the effective date of the Guidance. For surveys ending after June 1, 2020, providers will follow the usual survey submission process. The state surveyors can conduct a desk review for all citations except for an unremoved IJ, which requires a revisit survey. Providers must submit supporting evidence of compliance for the SA to conduct a desk review.
Providers should be aware that surveys are resuming and all open surveys will need to be resolved and closed in the near term, and the break that CMS had given for the imposition and payment of CMPs is now over.