CMS releases changes to the COVID-19 survey activities and increased NH oversight

CMS recently released changes to the COVID-19 survey activities and increased oversight in nursing homes. CMS announced steps to assist State Survey Agencies (SAs) in addressing the backlogs of complaint and recertification surveys including: 
  • Revising criteria for conducting Focused Infection Control (FIC) surveys;
  • Guidance for resuming recertification surveys; and
  • Temporary guidance and monitor flexibilities related to complaint investigations.
Focused Infection Control Surveys
  • CMS is no longer requiring a FIC survey to be conducted within three to five days of a nursing home having three or more new COVID-19 confirmed cases or one confirmed resident case in a facility that was previously COVID-19-free. 
  • Each survey agency must continue to perform annual FIC surveys of at least 20 percent of nursing homes. 
  • Prioritization of these surveys should be made to those facilities reporting new cases and low vaccination rates. 
Recertification Surveys
  • SAs should be able to resume recertification surveys on regular basis by establishing new intervals based on each facility's next survey, not based on the last survey that was conducted prior to COVID-19 public health emergency. 
  • SAs should prioritize recertification surveys according to the potential risk to residents such as facilities with history of noncompliance, or allegations of noncompliance (abuse/neglect, infection control, violations of transfer or discharge requirements, insufficient staffing or competency, special focused facilities and/or SFF candidates, and other quality-of-care issues such as falls and/or pressures, etc.)
  • CMS is temporarily allowing certain mandatory survey protocol tasks to be discretionary or triggered based on concerns identified during offsite preparation activities such as complaints to be investigated during the survey, or those that raise to ombudsman, and pervious patters of citations.
  • Mandatory survey tasks eligible for temporary discretion include Resident Council Meeting, Dining Observation Task, and Medication storage.
Investigating Complaints with the Recertification Survey
  • SAs must utilize the efficiencies built into the long term care survey process software application to investigate complaints with the recertification survey. 
Complaints/Facility Reported Incidents (FRIs)
  • SAs to investigate the backlog of complaints/FRIs according to level of triage and would remain in effect only until States are able to clear any backlogs and resume routine operations. 
  • LTC Complaints and FRIs triaged as IJ or non-IJ High are required to be investigated as soon as possible.
  • LTC Complaints and FRIs triaged as non-IJ Medium may be investigated at next scheduled standard survey if received within one year of the scheduled standard survey date or if the allegation involves staff to resident abuse, neglect, or misappropriation of resident property, regardless of the date received.
  • LTC Complaints and FRIs triaged as non-IJ Low – SAs are not required to investigate backlogged complaints/FRIs at this level and may be closed in ACTS at the next standard survey.  
Increasing Oversight in Nursing Homes
  • Surveying for nurse competency: Ensure temporary nurse aides are competent to perform skills and techniques necessary to care for residents' needs.  
  • CMS is alerting SAs to pay attention to compliance with the requirements for nursing services regarding sufficient nursing staff with appropriate competencies and skills sets to provide nursing and related services.
  • SAs continue to focus on efforts of identifying inappropriate use of antipsychotic medications and emphasis on non-pharmacological approaches and person-centered care practices.
  • SAs are assessing other care areas.
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