CMS and MedPAC Guidelines and Trends

With 26,000 COVID-19 deaths in nursing homes, CMS ties money to outcomes

June 3, 2020 2:17 pm
  • Nursing homes were found to have only 4% of COVID-19 cases but 17% of deaths.
  • States that don’t complete infection control surveys of all nursing homes will lose federal funds.
  • CMS’s Quality Improvement Organizations will take on an increased role in supporting nursing homes.

Federal coronavirus funding to states will be cut if they don’t take more steps to reduce the virus’s spread in nursing homes, CMS announced.

After the Centers for the Disease Control and Prevention (CDC) required first-time national reporting of COVID-19 infections and deaths from the nation’s 15,400 nursing homes, 80% of them reported back. The data showed that as of May 24, nursing homes had:

  • 60,000 confirmed COVID-19 cases
  • Almost 26,000 COVID-19 deaths

The data also showed that there was:

  • At least one COVID-19 case at one in four facilities
  • At least one COVID-19-related death at one in five facilities
  • A higher likelihood of large numbers of COVID-19 cases at facilities that received a one-star quality rating compared with five-star facilities

Nursing home COVID-19 cases accounted for only 4% of the 1,635,760 cumulative U.S. cases but 17% of the 91,941 deaths reported by May 24.

“Older Americans are particularly vulnerable to complications arising from the virus, and nursing home residents have been uniquely affected,” CMS stated. “The Trump Administration is intensely focused on protecting this population, but it ultimately falls to the nursing homes themselves to ensure they provide care compliant with essential health and safety requirements.”

The total nursing home numbers are likely higher, Seema Verma, administrator of CMS, said during a media briefing. That’s because not all facilities reported to the CDC, and facilities were not required to report cases from before May 8 — although many may have done so. Federal agencies cannot issue “retroactive rulemaking,” and the reporting requirement was finalized May 8.

“We tried,” Verma said about issuing retroactive reporting requirements covering the entire pandemic.

She noted recent media reports have identified about 40,000 deaths at nursing homes and assisted living facilities. The latter group, where many additional COVID-19 cases are suspected, were not required to report since they are not regulated by the federal government.

CMS plans “enforcement actions” against nursing homes that did not report COVID-19 data to the CDC as required, Verma said.

CMS will post the COVID-19 data for individual nursing homes at the Nursing Home Compare tab of

Funding cuts in store for states

Among new safety initiatives, CMS has requested that states complete targeted infection control surveys of nursing homes.

“There is no substitute for boots on the ground, for going into a facility to assess whether a facility is abiding by longstanding infection control practices,” Verma said.

CMS previously announced distribution of $81 million from the CARES Act for state governments to inspect nursing homes. But new requirements placed on the money include:

  • A July 1 deadline for states to submit plans to achieve a 100% inspection rate
  • 10% reductions in FY21 CARES Act allocations for states that haven’t achieved a 100% survey rate for infection control by July 31
  • 5% additional reductions for each additional 30 days not reaching 100%

Withheld payments will be redirected to states that have reached 100% by July 31.

The rate of focused infection control surveys of nursing homes varies widely by state, from 11.4% to 100%, with a national average of about 54.1%.

Penalties for nursing homes will be increased for infection control violations, including larger fines for those with previous such violations.

New assistance

Since March 4, CMS and its network of state-based inspectors have conducted over 8,300 surveys, with 5,700 results made public so far.

Recent nursing homes issues identified by CMS include:

  • Insufficient handwashing
  • Insufficient preparation to isolate and group COVID-19 patients or suspected cases

CMS is also providing additional support and technical assistance to low-performing nursing homes through its Quality Improvement Organizations (QIOs). CMS relies on 12 QIOs to provide a range of training and technical assistance on infection control, share best practices, create action plans and implement specific steps to create strong infection control and surveillance programs in nursing homes.

CMS has asked governors to direct QIOs to nursing homes that have “significant needs and have had outbreaks,” CMS stated.



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