CMS Encourages State Agencies to Resume Surveys

By A.J. Plunkett

CMS is gearing up to resume surveys, starting with closing out cases suspended by the March declaration of a national public health emergency (PHE) because of the 2019 coronavirus pandemic.

A nine-page Quality & Safety Oversight (QSO) group letter to state and regional CMS survey offices issued late Monday outlines the priorities for state surveyors to begin culling through the backlog of cases at long-term care or nursing facilities as well as all other providers.

Throughout the memo, CMS notes that surveys should resume primarily in areas that have entered the White House’s Phase 3 of reopening—which can vary from region to region—and that individual facilities can ask for delays if they are experiencing a surge in COVID-19 cases. Many surveys may still focus primarily on infection control and conditions that pose an immediate jeopardy to patients or staff, as they have throughout the PHE.

The bulk of the guidance in QSO-20-35-ALL, “Enforcement Cases Held during the Prioritization Period and Revised Survey Prioritization,” focuses on nursing homes and how and when the clock starts on charging those facilities any civil monetary penalties allowed by law. It also discussed the resumption of cases that could not meet the conditions of a “desk review,” meaning that an in-person site visit was not necessary to determine compliance.

The last three pages of the QSO guidance focus on non-long-term care facilities as well as laboratories that must meet CLIA regulations.

Once a state has entered Phase 3 or reopening “or earlier at the state’s discretion,” the memo says state survey offices are instructed to resume normal survey activities, prioritizing the survey backlog in this order:

“1. Revisit surveys for past non-compliance that do not otherwise qualify for a desk review;

2. Complaint surveys triaged as non-IJ level or higher that have not been completed;

3. Special Purpose Renal Dialysis Facilities (SPRDF);

4. Initial surveys of new providers;

5. Past-due recertification surveys with a statutorily required survey interval; and

6. Past-due recertification surveys without a statutorily required survey interval.”

The memo also advises surveyors to continue to focus their efforts on “the COVID-19 Focused Infection Control Survey: Acute and Continuing Care specified in QSO-20-20-All as part of any survey that is conducted.”

Validation surveys in which CMS officials check behind accrediting organizations are still in limbo.

“While CMS recognizes that resumption of surveys will depend on State reopening plans, staffing, and resources, CMS is requesting that states work with their respective CMS locations to discuss plans and proposed timeframes for completion of required surveys postponed due to the COVID-19 PHE,” notes the August 17 memo.

“Accrediting organizations with Medicare-approved programs may resume normal activity based on State reopening criteria. Any variations from the approved reaccreditation survey process must receive CMS approval prior to implementation.”

That last bit of guidance may explain why late last week The Joint Commission (TJC) removed from its Coronavirus Resources page a position statement on “Preventing Nosocomial COVID-19 Infections as Organizations Resume Regular Care Delivery.”

In a two-paragraph replacement document, TJC said it was removing the position statement. “This guidance document was originally written in May 2020 when COVID-19 cases in the U.S. were declining, healthcare organizations were rapidly working to resume elective procedures and ambulatory care, and The Joint Commission was receiving many questions regarding reopening. Unfortunately, COVID-19 cases surged across many parts of the country that had been relatively unaffected, and we are now in a very different situation; healthcare organizations are trying to balance providing safe, routine care while combatting the continuing epidemic amidst persistent shortages of personal protective equipment (PPE).”

“The situation in the U.S. continues to evolve, and we have heard from a number of professional societies and healthcare organizations that sections of the position statement were problematic because of the changes in the COVID-19 epidemic and our understanding of the science around COVID-19 transmission. The CDC has updated their guidance to address some of the issues discussed in the position statement, including definitions of contingency strategies and crisis standards of care for conservation of PPE and when these should be applied. For these reasons, we believe the position statement is no longer useful, so we are removing it from the website,” according to TJC.

A.J. Plunkett is editor of Inside Accreditation & Quality, a Simplify Compliance publication.