News & Insights
Mar 25, 2020
On March 23, 2020, the Centers for Medicare & Medicaid Services (CMS) announced updates to its survey process in response to COVID-19 (press release, press release, and memo). Specifically, as authorized pursuant to section 1135(b)(5) of the Social Security Act, CMS is prioritizing certain surveys and exercising enforcement discretion for all certified provider and supplier types for the next three weeks.
Ordinarily, CMS requires physical inspections of healthcare facilities that serve Medicare and Medicaid beneficiaries. Such facilities include hospitals, nursing homes, home health agencies, end-stage renal disease facilities, and hospices. During these surveys, facilities are evaluated for compliance with the applicable conditions of participation that must be met in order for the provider to participate in those programs. Failure to meet statutorily prescribed health and safety requirements can lead to penalties, payment denials, and potentially, the loss of the ability to participate in, and receive reimbursement from, Medicare and Medicaid programs.
Under CMS’s updated survey process, only the following types of federal inspections will be prioritized and conducted during the three-week period:
During the prioritization period, standard inspections and revisit inspections not associated with immediate jeopardy situations will not take place. Additionally, in regards to Clinical Laboratory Improvement Amendment (CLIA) laboratories, CMS will prioritize immediate jeopardy investigations over recertification surveys. Further, any initial certification surveys remain authorized in order to increase healthcare capacity. This updated survey process will enable CMS to focus inspections on the most urgent situations, which will protect patients from harm and assure that providers are implementing actions to prevent the spread of COVID-19.
Because revisit inspections that are not associated with immediate jeopardy situations will not be authorized, CMS stated that it is suspending current enforcement actions related to these revisit inspections. However, enforcement remedies associated with immediate jeopardy findings will continue.
Additionally, CMS notes that while its directive specifically applies to CMS’s federal and state agency surveyors, it is also urging other surveyors (including accrediting organizations) to proceed similarly.
This updated survey process comes on the heels of the recent immediate jeopardy investigation conducted at a nursing home in Kirkland, Washington, which was one of the initial sites of the COVID-19 outbreak in the United States. CMS determined that there were three immediate jeopardy situations at the site:
CMS notified the nursing home of its intent to terminate its participation in federal health programs, and is requiring that the facility provide CMS with a plan regarding removal of the issues for which it was cited. The new self-assessment tool will enable providers to independently determine if they are prepared to meet CMS’s expectations for preventing the spread of COVID-19.
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