CMS Enforcement Action Against Nursing Homes Triples compared to last year
The Centers for Medicare & Medicaid Services (CMS) has 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 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.