CMS News: Trump Administration Has Issued More Than $15 Million in Fines to Nursing Homes During COVID-19 Pandemic

Jackie Pappalardi and Lisa Volk in Clinical & Quality

CMS Enforcement Action Against Nursing Homes Triples compared to last year

Under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) today announced that the agency has imposed more than $15 million in civil money penalties (CMPs) to more than 3,400 nursing homes during the public health emergency for noncompliance with infection control requirements and the failure to report coronavirus disease 2019 (COVID-19) data. This is part of the Trump Administration’s commitment to safeguarding nursing home residents from the ongoing threat of COVID-19 and holding nursing homes accountable for the health and safety of the residents they serve.

“The Trump Administration is taking aggressive enforcement action against Medicare and Medicaid certified nursing homes that fail to implement proper infection control practices,” said CMS Administrator Seema Verma.  “Now more than ever, nursing homes must be vigilant in adhering to federal guidelines related to infection control to prevent the spread of infectious disease, including COVID-19.  We will continue to hold nursing homes accountable and work with state and local leaders to protect the vulnerable population residing in America’s nursing homes.”

On March 4, 2020, CMS prioritized its inspection protocols to allow inspectors to focus on the most serious health and safety threats like infectious diseases and abuse.  These inspections – also called surveys – are just one of the many tools being used to determine if facilities are safely caring for this vulnerable population. Since March 4, 2020, CMS and the state survey agencies have completed infection control surveys in over 15,276 (99.2 percent) of nursing homes.  These surveys have resulted in more than 180 immediate jeopardy level findings for infection control, which is triple the rate of such deficiencies found in 2019.  Immediate Jeopardy represents a situation in which a nursing home’s noncompliance with CMS requirements of participation has caused or is likely to cause serious injury, serious harm, serious impairment, or death to a resident.  CMS has imposed CMPs for these violations totaling nearly $10 million to nursing homes in 22 states. The average CMP imposed was $55,000.

Early on in the pandemic, CMS and the Centers for Disease Control and Prevention (CDC) developed an unprecedented nationwide reporting system that requires Medicare and Medicaid certified nursing homes to report COVID-19 cases and deaths, among other information, directly to the CDC.  The Administration implemented the new reporting requirement to develop a robust federal disease surveillance system to quickly identify problem areas and inform future actions regarding infection control. The majority of nursing homes are reporting data as required.  As of August 3, 2020, over 99 percent of facilities are reporting data.  However, for those nursing homes that have not reported data or have lapsed, CMS is taking enforcement action.  As of August 3, 2020, CMS has also cited more than 3,300 deficiencies and imposed more than $5.5 million in CMPs to nursing homes for failing to report required COVID-19-related data to the CDC.

CMS oversight is intended to ensure nursing homes fulfill their responsibility to provide safe and effective care to their residents.  The oversight responsibility of nursing homes is a shared responsibility between CMS and the state. CMS sets standards to participate in Medicare and Medicaid programs and states are responsible for surveys required for licensing nursing homes to operate and for conducting surveys to determine compliance with CMS requirements.  CMS has directed states to survey 100 percent of the Medicare and Medicaid certified nursing homes in their state with a focus on infection control protocols to make sure facilities are effectively preventing the spread of COVID-19.  The responsibility for ensuring infection control processes and protocols are consistently implemented and maintained ultimately rests with the nursing homes.

Throughout this public health emergency, CMS has taken several actions to protect residents from the ongoing threat of COVID-19.  The agency issued more than 18 sets of guidance in the last six months to provide states and nursing homes with ongoing information on proper infection control practices and protocols.  By comparison, in all of 2019, CMS issued 9 guidance documents related to nursing homes.  On June 1, CMS announced increased enforcement for facilities with persistent infection control violations, including enforcement actions on lower level infection control deficiencies to ensure they are addressed with increased gravity.   Nursing homes now face fines up to $5,000 when cited for lower level infection control deficiencies that were identified on a previous survey and up to $20,000 if cited for infection control findings twice or more in the last two years.  CMS will continue to take appropriate enforcement actions against facilities that fail to comply with infection control requirements, and use every tool at its disposal to ensure residents are protected during this pandemic.

The full list of CMS Public Health Actions for Nursing Homes on COVID-19 to date is in the chart below.

CMS Public Health Action for Nursing Homes on COVID-19 as of August 14, 2020

February 6, 2020

CMS took action to prepare the nation’s healthcare facilities for the COVID-19 threat.

March 4, 2020

CMS issued new guidance related to the screening of entrants into nursing homes.

March 10, 2020

CMS issued guidance related to the use of PPE.

March 13, 2020

CMS issued guidance on the restriction of nonessential medical staff and all visitors except in certain limited situations.

March 23, 2020

CMS announced a suspension of routine inspections, and an exclusive focus on immediate jeopardy situations and infection control inspections.

March 30, 2020

CMS announced that hospitals, laboratories, and other entities can perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital – including nursing homes.

April 2, 2020

CMS issued a call to action for nursing homes and state and local governments reinforcing infection control responsibilities and urging leaders to work closely with nursing homes on access to testing and PPE. 

April 15, 2020

CMS announced the agency will nearly double payment for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of COVID-19 cases.

April 19, 2020

CMS announced it will require nursing homes to report cases of COVID-19 to all residents and their families, as well as directly to the CDC. On May 1, CMS published the proposed policy in an Interim Final Rule. The rule became effective on May 8.

April 30, 2020

CMS announced the formation of an independent commission by a contractor that will conduct a comprehensive assessment of the nursing home response to COVID-19.

May 6, 2020

CMS released a memorandum to State Survey Agency directors providing more details on the new reporting requirements of the May 8, 2020, Interim Final Rule.

May 13, 2020

CMS published a new informational toolkit comprising recommendations and best practices from a variety of front line health care providers, governors’ COVID-19 task forces, associations and other organizations and experts that is intended to serve as a catalogue of resources dedicated to addressing the specific challenges facing nursing homes as they combat COVID-19. Toolkit is found here: Toolkit

May 18, 2020

CMS issued guidance for state and local officials on the reopening of nursing homes.

June 1, 2020

CMS issued guidance to states on COVID-19 survey activities, CARES Act funding, enhanced enforcement for infection control deficiencies, and quality improvement activities in nursing homes. CMS also issued a letter to Governors.

June 4, 2020

CMS posted the first set of underlying COVID-19 nursing home data and results from targeted inspections conducted by the agency since March 4, 2020, linked on Nursing Home Compare

June 19, 2020

CMS announced membership of Independent Coronavirus Commission on Safety and Quality in nursing homes

June 23, 2020

CMS released FAQs on nursing home visitation.  

June 25, 2020

CMS released a memo announcing the end of the emergency blanket waiver for the nursing home staffing data submission requirement.

July 10, 2020

CMS announced it will deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in hotspot areas. 

July 14, 2020

HHS and CMS announced an initiative for rapid point-of-care diagnostic devices and tests in nursing homes. 

July 22, 2020

CMS announced several new initiatives designed to protect nursing home residents from COVID-19, including new funding, enhanced testing and additional technical assistance and support.

August 7, 2020

HHS announced the distribution of $5 billion in Provider Relief Funds, consistent with the Administration’s announcement in late July, which will be used to protect residents of nursing homes and long-term care facilities from the impact of COVID-19.


NYSHFA/NYSCAL CONTACTS:

Jackie Pappalardi, RN, BSN
Executive Director
518-462-4800 x16

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15