New federal data show more than 60,000 confirmed Covid-19 cases and nearly 26,000 deaths were reported at nursing homes that accept Medicare and Medicaid patients, the Trump administration announced Monday.
As of May 24, about 12,500 nursing homes—roughly 80% of the 15,400 Medicare- and Medicaid-certified nursing homes—provided the required data to the Centers for Disease Control and Prevention.
About 25% of reporting facilities had at least one Covid-19 case, and about 20% had at least one Covid-19 related death, the data showed.
Facilities that had a one-star quality rating were more likely to have a large Covid-19 patient count than facilities with a five-star quality rating.
The numbers are a “grim reminder of a slow-motion tragedy that could have been averted if our federal and state governments had stepped up to provide the leadership, coordination and funds that nursing homes need to save lives,” said a statement from Katie Smith Sloan, president and CEO of LeadingAge, which represents non-profit nursing homes.
In response to the distressing numbers, the Centers for Medicare & Medicaid Services is directing states to complete more on-site inspections at problem nursing homes or risk losing the federal funding to combat Covid-19.
The CMS has also increased civil monetary penalties and other enforcement actions against nursing homes with repeated infection-control deficiencies.
“We’re increasing the penalties significantly for nursing homes,” CMS administrator Seema Verma told reporters on June 1. “We’re pushing on every lever we can to keep nursing home residents safe.”
In early March, the agency called on states to “go into every single nursing home and to do a focused inspection around infection control,” Verma said. But many states haven’t complied, even though Congress provided $80 million to states to increase their inspections, Verma said.
From now on, states’ “ability to access that funding will be based on their performance of completing these infection control” inspections, Verma said.
In addition, the HHS has provided $11 billion for states to assist with their Covid-19 relief efforts. States that fail to complete all of their inspections by July 31, 2020 must submit a corrective action plan to the CMS outlining a strategy to complete the inspections within 30 days. If they fail to do so, their allocation from the aid package Congress dubbed the CARES Act could be reduced by up to10%.
Further non-compliance could result in additional reductions of up to 5%, Verma said. The funds would then go to states that completed all their inspections by July 31.
The CMS is requiring states to do on-site inspections at any nursing home when they learn of any infections and outbreaks, Verma said. States can fund the increased testing through their CARES Act funding, she said.
“What we’re saying there is ‘yes.’ We are saying you need to be doing more inspections,” Verma said of states.
Most nursing homes appear to be following new infection control measures. “Many nursing homes have done well,” Verma said. “Our enforcement actions are around focusing on those that are not.”
Nursing homes with a history of infection control violations could face enhanced penalties under the new CMS guidance. These include denial of payment for new admissions with 45 days to demonstrate compliance, a directed plan of correction, and per-instance penalties of $5,000, $10,000 and $20,000 depending on the nature of the violation.
Smith Sloan said the new penalties offer no support to the beleaguered industry, which still struggles to obtain protective gear and testing.
“Instead it seeks to punish its way out of the pandemic,” her statement said. “Nursing homes should be held accountable when they fall short, but escalating threats of punishment will not change the outcomes for vulnerable adults if providers are still left without the tools they desperately need.”
Facilities could face penalties of up to $1,000 per week for violating the reporting requirement to the CDC. The guidance, issued in April, requires nursing homes to provide information each week about coronavirus cases among workers or residents.
They require that “nursing homes must inform residents and their representatives within 12 hours of the occurrence of a single confirmed infection of COVID-19.” The same reporting requirement applies if or three or more residents or staff develop Covid-like respiratory symptoms within 72 hours.
The move was is in response to an explosion of Covid-19 infections and deaths at the nation’s nursing homes, where hand-washing, proper use of personal protective equipment, and separation of residents by their Covid-19 status remains a challenge.