COVID-19 for Compliance Professionals: Nursing Home

by Apr 20, 2020

The Health Ethics Trust is pleased to continue its series of free briefings on compliance issues related to the COVID-19 crisis. We thought it useful to set out some of the recent guidance provided by OIG, CMS, OCR, and the CDC, among others, to assist you in navigating the laws, rules and regulations with which your organization must comply. We are grouping the guidance by the type of organization to which it applies (hospitals, home health, health plan, etc.), although some of the guidance applies across organization types. These guidance documents are not meant to cover every issue or all guidance involving a particular organization type, but may serve as a helpful starting point for the compliance issues related to COVID-19. These guidance documents are prepared with the support of Lynn Barrett, Esq., CHC, CCP an attorney and former CCO who speaks at many Trust programs and is active in Compliance Resource Group, Inc.


 

This guidance applies long-term care facilities which have been hard hit by COVID 19 and are subject to major regulatory changes. Read the long-term care guidance at https://healthethicstrust.com/category/covid-19/. Even if you are not a long-term care facility, this guidance will help with any long-term care operations you may have. Feel free to ask us questions at 703-509-3734 or info@healthethicstrust.com.

 

Nursing Homes and Other Long-Term Care Facilities

As you are likely aware, a nursing home located in Washington State, Life Care Center of Kirkland (Life Care), was at the epicenter of the state’s COVID-19 outbreak and was the subject of a complaint inspection conducted by CMS and the Washington Department of Social & Health Services State Agency (Agency). According to CMS, the findings of the inspection included three issues that caused Life Care to be placed in an “Immediate Jeopardy” disposition. Being placed in Immediate Jeopardy means that the inspection found serious deficiencies that were widespread and serious enough to constitute imminent danger to resident health. The three identified deficiencies that led to Immediate Jeopardy were Life Care’s failure to (1) rapidly identify and manage ill residents, (2) notify the Washington Department of Health about the increasing rate of respiratory infection among residents, and (3) possess a sufficient back-up plan when the facility’s primary physician fell ill. As a result, CMS advised Life Care that its Medicare provider agreement would be terminated in 23 days if the three deficiencies were not corrected before then. There were additional deficiencies that did not rise to the Immediate Jeopardy level, including those related to the governing body, medical director responsibilities, clinical records, and quality assessments and assurance programs. These deficiencies will have to be remedied by or before September 16, 2020.

In addition to CMS, the Agency also released its findings of the inspection, many of which mirror the findings of CMS, and included a finding that Life Care did not have an adequate infection control system in place. As a result of its findings, the Agency issued a “stop placement” of new residents and placed conditions on Life Care, which include that Life Care must hire, at its own expense, an independent long-term care medical director consultant experienced in internal medicine and infectious disease to assist Life Care to adhere to CMS’s requirements for infection control, quality care, emergency medical response and medical-related documentation, among other things. The “stop placement” went into effect on April 1, 2020.

On March 28, 2020, CMS conducted a revisit inspection and determined that the Immediate Jeopardy issues had been removed. As a result, the potential termination of Life Care’s Medicare provider agreement was extended to September 16, 2020, by which time all deficiencies must be fixed. In the meantime, however, CMS fined Life Care $611,325 which equates to $13,585 per day (from February 12 -March 27) and denied payment for new admissions for a 7-day period (from March 21-27, 2020).

As a result of the issues identified at Life Care, CMS announced that federal surveyors will focus on conducting targeted infection control surveys using a revised infection control protocol specifically adapted to preventing the spread of COVID-19. (CMS will also target situations of immediate jeopardy.) CMS stated that this new process will assess if certain facilities are prepared to meet CMS’s expectations for preventing the spread of COVI-19. To that end, CMS released a voluntary self-assessment tool which it urges nursing homes to utilize to determine if they are meeting federal requirements related to COVID-19 and infection control.

Recognizing that nursing homes are both healthcare providers and the full-time homes for some of the most vulnerable people, on April 2, 2020, CMS, together with the CDC, issued new, more stringent recommendations to nursing homes (and state and local governments). These recommendations are based on observations by CMS and CDC experts who have been onsite at long-term care facilities and are as follows:

  1. Nursing homes should immediately ensure they are complying with all CMS and CDC guidance relating to infection control, including adherence to appropriate hand hygiene and completing the self-assessment checklist.
  2. State and local leaders should work with long-term care facilities to address their needs for personal protective equipment (PPE) and/or COVID-19 tests.
  3. Long-term facilities should immediately implement symptom screening for everyone who enters the facility for any reason, which includes temperature checks. Facilities should also limit access points into the facility and all access points should have a screening station. In addition, every resident should be assessed for COVID-19 symptoms.
  4. Long-term care facilities should ensure all staff are using appropriate PPE when interacting with residents to the extent PPE is available.
  5. Long-term care facilities should utilize separate staffing teams for COVID-19 residents to the best of their ability, and work with state and local leaders to designate separate facilities or units to separate residents who do not have COVID-19 (negative test results) from those who either test positive for COVID-19 or whose COVID-19 status is unknown.

There are additional considerations long-term care facilities should be thinking about and we plan to publish these considerations in a later guidance document. In the meantime, please do not hesitate to contact us should you have any questions or if you need assistance to help ensure your facilities maintain compliance with the ever-changing laws, rules, regulations related to COVID-19. We can be reached at 703-683-7916 or at info@healthethicstrust.com.

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