On Wednesday, August 19, Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS) and a member of the White House Coronavirus Task Force, convened a roundtable discussion with Dallas-area health care leaders to discuss the effects the coronavirus disease 2019 (COVID-19) has had on vulnerable populations in Texas, with a focus on long term care residents and facilities.
The roundtable opened with a discussion about the devastation caused by coronavirus in nursing homes in Texas, and around the country, and attendees expressed concern for the many ways in which residents in nursing homes are being affected by COVID-19 – including the effects the virus is having on nursing home residents’ quality of life. Administrator Verma conveyed that, as America reopens, CMS will continue to urge states and governors to fight fiercely for nursing home residents, to vigilantly oversee facilities, and to fulfill the needs of nursing homes as it relates to testing and other needed supplies.
Participants in the roundtable included representatives from Baylor Scott and White, C.V. Roman Medical Society, Dallas County Health and Human Services, Dallas County Medical Society, DFW Hospital Council, Focused Post Acute Care Partners, HMG Healthcare, Kindred Healthcare, Medical City Healthcare (HCA), Parkland Health & Hospital System, Southwest Long Term Care, Texas Health Care Association, Texas Long-Term Care Ombudsman, and The Senior Source.
Administrator Verma discussed the recently released initial results of an unprecedented transparency effort by CMS that requires nursing homes to report new cases directly to the Centers for Disease Control and Prevention (CDC). She noted that while families and residents have had this information for months, this reporting allows for a standardized nationwide picture that is forming the backbone of a nationwide virus surveillance system capable of protecting Texans, and people across the country.
In Texas, the data shows 29 COVID-19 deaths per1000 nursing home residents, compared with 38.2 COVID deaths per1000 nursing home residents nationally. In conjunction with state partners, over 10,000 surveys have been completed focused exclusively on infection control to ensure that nursing homes are complying with CMS’ detailed infection control guidance. The expectation is the states complete focused surveys in every nursing home. The nationwide average of successfully completed inspections is around 99.2%--Texas has completed 100% of their nursing home inspections. Administrator Verma noted that these inspections are the eyes and ears of both federal and state regulators, providing essential data.
In conjunction with data collection, the Trump Administration has deployed strike teams to nursing homes across the country that experienced severe outbreaks. These visits revealed one major connection among the majority of these facilities: deficient infection control practices.
In addition to an incredible amount of guidance and regulatory flexibilities, CMS has provided tangible tools to help nursing homes keep their residents safe. Our Quality Improvement Organizations (QIOs) have developed training that is web-based and accessible anywhere with an internet connection. In addition, a point-of-care testing machine is being delivered to every one of the 14,000 CLIA-certified nursing homes around the country.
Below is a list of CMS public health actions for nursing homes on COVID-19 to date:
February 6 - CMS took action to prepare the nation’s healthcare facilities for the COVID-19 threat.
March 4 - CMS issued new guidance related to the screening of entrants into nursing homes.
March 10 - CMS issued guidance related to the use of personal protective equipment (PPE).
March 13 - CMS issued guidance for a nationwide restriction on nonessential medical staff and all visitors.
March 20 - CMS announced a suspension of routine inspections, and an exclusive focus on immediate jeopardy situations and infection control inspections.
March 30- CMS announced that hospitals, laboratories, and other entities can perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital – including nursing homes.
April 2- CMS issued a call to action for nursing homes and state and local governments reinforcing infection control responsibilities and urging leaders to work closely with nursing homes on access to testing and PPE.
April 15 - CMS announced the agency will nearly double payment for certain lab tests that use high-throughput technologies to rapidly diagnose large numbers of COVID-19 cases.
April 19- CMS announced it will require nursing homes to report cases of COVID-19 to all residents and their families, as well as directly to the CDC. On April 30, 2020, CMS codified this guidance.
April 30 - CMS awarded a contract which includes a new Commission to advise the contractor for reporting to CMS on addressing patient safety in safety and quality in nursing homes.
May 6 - CMS issued guidance in an Interim Final rule that updates reporting requirements for nursing homes to notify confirmed and suspected COVID-19 cases among residents and staff.
May 18 - CMS issued guidance for state and local officials on the reopening of nursing homes.
June 1 - CMS issued guidance to states on COVID-19 survey activities, CARES Act funding, enhanced enforcement for infection control deficiencies, and quality improvement activities in nursing homes. CMS also issued a letter to governors.
June 4 - CMS posted first set of underlying COVID-19 nursing home data and results from targeted inspections conducted by the agency since March 4, 2020 linked on Nursing Home Compare.
June 19 - CMS announced membership of Independent Coronavirus Commission on Safety and Quality in nursing homes
June 23, 2020 - CMS released FAQs on nursing home visitation.
June 25, 2020 - CMS released a memo announcing the end of the emergency blanket waiver for the nursing home staffing data submission requirement.
July 10, 2020 - CMS announced it will deploy Quality Improvement Organizations (QIOs) across the country to provide immediate assistance to nursing homes in hotspot areas.
July 14, 2020 - HHS and CMS announced initiative for rapid point-of-care diagnostic devices and tests in nursing homes.
July 22, 2020 - CMS announced several new initiatives designed to protect nursing home residents from COVID-19, including new funding, enhanced testing and additional technical assistance and support.
Aug. 7, 2020 - HHS announced the distribution of $5 billion in Provider Relief Funds, consistent with the Administration’s announcement in late July, which will be used to protect residents of nursing homes and long-term care facilities from the impact of COVID-19.
Aug. 12, 2020 - CMS released nursing home enforcement actions during pandemic.
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