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Nursing facility surveys stop; IJ investigations & focused infection control surveys continue

 By Doug Beardsley |  March 27, 2020  |  SNF/NF providers

On March 23, 2020, the Centers for Medicare & Medicaid Services (CMS) released QSO-20-20-ALL containing guidance for prioritizing and suspending most federal and state survey agency (SSA) surveys, and delaying revisit surveys, for the next three weeks beginning on March 20, 2020, for all nursing facilities. For non-IJ related onsite surveys that are currently in process, survey teams are instructed to end the survey and exit the facility.

State and federal surveyors should not enter the building, for any type of survey, if they are unable to meet the personal protective equipment (PPE) expectations outlined by the latest CDC guidance. They may instead obtain necessary information remotely, to the extent possible. Providers should screen surveyors for signs and symptoms of COVID-19, just like you are doing with staff at the beginning of each shift.

Federal and state surveyors will conduct targeted infection control surveys of providers identified together with the Centers for Disease Control & Prevention (CDC) and the HHS Assistant Secretary for Preparedness & Response (ASPR). They will use this survey tool to review infection prevention and control practices. While the CMS guidance states the tool may be used by facilities for a voluntary self-assessment, it also states “this document may be requested by surveyors, if an onsite investigation takes place.” Therefore, providers are strongly encouraged to utilize the tool to self-assess for infection control practices and have it available to provide to a surveyor if needed.

Surveyors will review for the following:

  • Overall effectiveness of the infection prevention and control program (IPCP) including policies and procedures
  • Standard and transmission-based precautions (with the understanding that certain essential supplies are scarce, and facilities should not be penalized for not having certain supplies if they are unable to obtain them)
  • Quality of resident care practices, including those with COVID-19 (laboratory-positive case), if applicable
  • Surveillance plan
  • Visitor entry and facility screening practices
  • Education, monitoring, and screening practices of staff
  • Facility policies and procedures to address staffing issues during emergencies, such as transmission of COVID-19

Changes in the survey process in effect for the next three weeks include the following:
  • Standard surveys and non-IJ revisits are suspended for three weeks—During this period, the following surveys will be suspended:
    • Standard surveys for nursing homes, hospitals, home health agencies (HHAs), intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and hospices
    • Life safety code and emergency preparedness elements of standard surveys
    • Revisits not associated with an IJ
    • The following enforcement actions will be suspended, until revisits are again authorized:
      • Imposition of denial of payment for new admissions (DPNA), including situations where facilities are not in substantial compliance at three months
      • Imposition of termination for facilities that are not in substantial compliance at six months
      • Per day civil money penalties (CMP) will not accumulate
      • CMS will not impose any new remedies for prior noncompliance
      • Note: Enforcement actions for unremoved or new IJs remain and will continue to be issued under normal procedures/guidance
  • Complaints and facility-reported incidents triaged at the immediate jeopardy level will continue
    • During this three-week time frame, State survey agencies (SSAs) and CMS will only conduct surveys related to complaints and facility-reported incidents (FRIs) that are triaged at the immediate jeopardy (IJ) level, and revisits to verify removal of IJ (including previously cited IJ deficiencies)
    • If the revisit survey determines there is continuing noncompliance, but at a lower level than IJ, surveyors will not conduct another onsite revisit survey
    • For non-IJ deficiencies, providers may submit a plan of correction (POC) to be held until the end of the three-week period or may delay submission of their POC until the end of this period
    • Enforcement actions for unremoved or new IJs remain and will continue to be issued under normal procedures/guidance

Doug Beardsley  |  Vice President of Member Services  |  |  952-851-2489


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