CMS announces new reporting and testing requirements for nursing homes, other providers

Aug. 27, 2020

The Centers for Medicare & Medicaid Services (CMS) stated it is making sweeping regulatory changes that require nursing homes to test staff and offer testing to residents for COVID-19.

Laboratories and nursing homes using point-of-care (POC) testing devices will be required to report diagnostic test results as required by the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The new rules also require hospitals to provide COVID-19 cases and related data to the U.S. Department of Health and Human Services (HHS).

The requirements will support federal and state efforts to identify early spread of the virus and allocate personal protective equipment (PPE) and other resources.

CMS is again acting to safeguard nursing home residents from the ongoing threat of COVID-19 by revising its infection-control regulations for long-term care facilities to require nursing homes to test their staff for COVID-19.

The new rules follow a series of actions designed to increase testing in nursing homes. In April, CMS called on governors to create a testing plan for their nursing homes, provided new payment for collection of lab samples in nursing homes as well as increasing payment for certain tests. In May, CMS provided re-opening recommendations to nursing homes and states which called for baseline testing of all residents and staff, and routine testing of staff.

CMS’s testing requirement goes along with the announcement that rapid, POC diagnostic devices would be distributed to all nursing homes across the country that are certified to perform these types of tests.

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

CMS now requires that nursing homes will offer tests to residents when there is an outbreak or residents show symptoms. This is part of CMS’ continued efforts to help nursing homes to control the spread of the virus.

The administration is holding nursing homes accountable for the testing requirement by directing surveyors to inspect nursing homes for adherence to the new testing requirements. 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 Administration is helping facilities offset the cost of testing through new funding from the Provider Relief Fund, authorized under the CARES Act. On July 22, 2020, an additional $5 billion was announced from the Provider Relief Fund to help nursing homes address critical needs, including hiring additional staff, increasing testing, and providing additional services, such as technology so residents can connect with their families if they are not able to visit.  The $5 billion comes on top of a previous $4.9 billion allocation of Provider Relief Funds to nursing homes made in May.

Hospitals must report data

The emergency regulations will also require hospitals and critical access hospitals to report daily important data critical to support the fight against COVID-19, 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 PPE.  These elements are essential for planning, monitoring, and resource allocation during the COVID-19 Public Health Emergency (PHE).  While many hospitals are voluntarily reporting this information now, not all are. The new rules make reporting a requirement of participation in the Medicare and Medicaid programs. This reporting is needed to support broader surveillance of COVID-19.

New reporting requirements for labs

CMS’ new rule implements a CARES Act requirement that laboratories report COVID-19 test results daily to the HHS Secretary. All laboratories conducting COVID-19 testing and reporting patient-specific results – including hospital labs, nursing homes, and other facilities conducting testing for COVID-19 – will be required to comply. If a laboratory does not report the required information, CMS will impose a civil monetary penalty in the amount of $1,000 a day for the first day, and $500 for each subsequent day. Labs will have a one-time, three-week grace period to begin reporting required test data. This requirement complements existing HHS guidance requiring laboratories to report test results and additional information, such as demographic data.

This change allows CMS to take enforcement action against laboratories that fail to provide the required data, which is needed by federal, state, and local officials to conduct effective surveillance of the COVID-19 pandemic.

Physician and pharmacist orders for tests

CMS 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. This change helps ensure that beneficiaries receive appropriate medical attention if they need multiple tests. It is also designed to stop fraudsters from performing or billing for unnecessary 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. 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.

In addition to this announcement regarding testing and reporting, earlier this week, CMS released guidance for state Medicaid agencies on new flexibilities CMS has made available under emergency authorities to increase reimbursement for nursing facilities that implement specific infection control practices, such as designating a quarantine or isolation wing for COVID-19 patients. These can be temporary rate enhancements tailored to the specific needs of the state and community, and the guidance highlights case studies in states who have taken advantage of this flexibility.

Providers and stakeholders seeking assistance or more information on the interim final rule and the comment period should visit CMS’ Coronavirus Waivers & Flexibilities page for additional information, including fact sheets for changes for each provider type. More information is on the COVID-19 Emergency page at https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers. More information on the new rule is at https://www.cms.gov/files/document/covid-ifc-3-8-25-20.pdf.

CMS has the release.

More COVID-19 coverage HERE.

Photo 100961553 © Mohamed Ahmed Soliman | Dreamstime.com
Photo 63686453 © Convisum | Dreamstime.com
Photo 112500600 © Ken Wolter | Dreamstime.com
Photo 171785729 © Mark Gomez | Dreamstime.com