News Alert: CMS Unveils Regulatory Changes for Nursing Homes in Wake of Soaring COVID Death Toll  

The CARES Act included provisions mandating reporting of test results.

Federal officials announced a set of sweeping regulatory changes for nursing homes nationwide this week, an expected move considering the disproportionate impact the continuing COVID-19 pandemic has had on such facilities since its onset earlier this year.

The Centers for Medicare & Medicaid Services (CMS) announced via a press release that it is now requiring nursing homes to test staff and offer testing to residents, with facilities using point-of-care testing devices being further required to report diagnostic test results, as required by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The new rules also will require hospitals to provide COVID-19 cases and related data to the U.S. Department of Health and Human Services (HHS).

“These new rules represent a dramatic acceleration of our efforts to track and control the spread of COVID-19,” CMS Administrator Seema Verma said in a statement. “Reporting of test results and other data are vitally important tools for controlling the spread of the virus, and give providers on the front lines what they need to fight it.”

Media outlets earlier this summer estimated that residents of nursing homes accounted for 40-45 percent of COVID-related deaths nationwide, with states in the Northeast being hit particularly hard. Nursing homes number about 15,600 in the U.S., caring for 1.3 million residents in all, according to 2016 figures compiled and published by the National Center for Health Statistics.

Among the regulatory changes CMS announced was also the revision of its infection-control regulations for long-term care facilities. In April, the agency noted, governors across the country were called upon to create a testing plan for their nursing homes, provide new payment for collection of lab samples in nursing homes, and increase payment for certain tests. In May, CMS provided reopening recommendations to nursing homes and states that called for baseline testing of all residents and staff, and routine testing of staff.

“From the beginning of this pandemic, President Trump has worked tirelessly to protect our vulnerable elderly in nursing homes. The provisions in today’s rule on nursing homes represent his expectation that CMS pull every available regulatory lever to maximize nursing home residents’ safety and quality of life,” Verma added. “These Americans and their families, who have already gone through so much, deserve nothing less.”

That recommendation for testing nursing home staffers routinely is now a requirement for participation in the Medicare and Medicaid programs under CMS’s authority through the Social Security Act. CMS said that recommendations for the frequency of staff testing will be based on the degree of community spread, to be announced shortly through guidance, that indicate a facility may be at increased risk for COVID-19 transmission.

“The Administration is holding nursing homes accountable for the testing requirement by directing surveyors to inspect nursing homes for adherence,” the CMS press release read. “Facilities that do not comply with the new requirements will be cited for non-compliance and may face enforcement sanctions based on the severity of the noncompliance, such as civil money penalties in excess of $400 per day, or over $8,000 for an instance of noncompliance.”

The new regulations will also require hospitals and critical access hospitals (CAHs) to report certain data on a daily basis, including but not limited to elements such as the number of confirmed or suspected COVID-19 positive patients, ICU beds occupied, and availability of essential supplies and equipment such as ventilators and personal protective equipment (PPE). 

Penalties for laboratories that do not report required information on a daily basis include a civil monetary penalty in the amount of $1,000 a day for the first day, and $500 for each subsequent day. Labs will also have a one-time, three-week grace period to begin reporting required test data.

Notably, CMS said it is also revising its previous policy that covered repeated COVID-19 testing for Medicare beneficiaries without practitioner orders during the PHE. The revised policy specifies that each beneficiary may receive one COVID-19 test without the order of a physician or other health practitioner, but Medicare will require such an order for all further COVID-19 tests.

“To help ensure that beneficiaries have broad access to testing, CMS is also paying for tests when ordered by a pharmacist or other healthcare professional authorized under applicable state law to order diagnostic laboratory tests,” the press release noted. “Medicare makes payment for services of pharmacists and certain other healthcare professionals only when they have an arrangement with a physician or other billing practitioner. The changes being made allow Medicare to continue to pay for these tests during the PHE when they are ordered by pharmacists and other healthcare professionals without such an arrangement.”

To view the new rule, go online to https://www.cms.gov/files/document/covid-ifc-3-8-25-20.pdf

The global COVID-19 pandemic has now reportedly sickened more than 24 million and killed more than 825,000 people worldwide, with the U.S. accounting for approximately a quarter of those figures.