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CMS Issues Guidance to Resume Healthcare Facility Surveys and Enforcement Action


In the early stages of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) issued guidance to state survey agencies to suspend standard surveys for long-term care facilities, hospitals, home health agencies, intermediate care facilities, and hospices, directing that only targeted infection control and certain complaint and incident-related surveys be prioritized and conducted. At that time, CMS also suspended certain enforcement actions for nursing home and home health agencies until revisit surveys were again authorized, directing that only enforcement actions for unremoved immediate jeopardy deficiencies should continue. In June 2020, CMS revised its earlier guidance to allow expanded surveys of all provider and supplier types for complaint investigations, revisit surveys, and certain recertification surveys. Earlier this month, CMS took further steps toward the resumption of customary survey and enforcement activities in issuing Memorandum QSO-20-35-ALL.

With respect to long-term care facilities, CMS continues to encourage state survey agency activity. While prior survey guidance already allowed resumption of certain onsite surveys, such as those involving immediate jeopardy and infection control, CMS has now expanded onsite survey authorization to include revisits in connection with plans of correction and onsite surveys for complaint investigations for incidents of non-immediate jeopardy and annual recertification surveys. The surveys authorized for long-term care facilities are in addition to those authorized by CMS under previous guidance.  

As a new component of long-term facility surveys, CMS has issued an Interim Final Rule requiring long-term care facilities to meet certain COVID-19 testing requirements, including issuance of a COVID-19 Focused Survey Tool to assess compliance with these testing requirements. Facilities must test residents and staff at routine testing intervals that are dictated by the prevalence of COVID-19 in the community. Compliance with these requirements will be evaluated by surveyors’ review of facility documentation of COVID-19 testing, as well as observation of facility testing in action. 

With respect to non-long-term care facilities, CMS encouraged states to resume their normal survey activities, while prioritizing revisit surveys for non-compliance, complaint surveys, initial surveys, and past due recertification surveys. The guidance noted that infection control should be an integral part of any surveys conducted. Additionally, Medicare-approved accrediting organizations are permitted to resume normal activity based on the state reopening criteria.

With the issuance of the survey guidance from CMS, providers and suppliers of all types should refocus attention and resources to preparing for possible surveys. Undoubtedly the focus of many providers and suppliers has been the ongoing battle against COVID-19, but the recent guidance by CMS serves as a reminder to providers and suppliers that even during these unprecedented times, regulators will continue to ensure compliance. Based on the recently issued guidance, facilities can fully expect a detailed focus by surveyors on infection control related standards and should be prepared to produce documentation of compliance with the same.

In addition to reinvigorating survey efforts, CMS announced enforcement activities should also resume, including enforcement of cases in process at the time of suspension and those started after the suspension. As part of the resumption of enforcement activities, surveys with cited deficiencies must prepare plans of correction for submission to the surveyors. The CMS guidance directs surveyors to request plans of correction from providers and suppliers who have not previously submitted them and require providers and suppliers with surveys that ended prior to June 1, 2020, to submit plans of correction within 10 calendar days. Plans of correction for surveys that ended on or after June 1, 2020, will be subject to the normal submission procedure.

This latest survey and enforcement guidance signals CMS’s intent that compliance activities return in earnest. Thus, providers and suppliers of all types should ensure that they are prepared and refocus any compliance efforts that may have been paused during the pandemic.  

Please contact MMM’s healthcare group with any questions or for assistance regarding CMS surveys.