Federal regulators on Thursday finally released details of an interim rule that mandates nursing homes report COVID-19-related infections directly to the Centers for Disease Control and Prevention. 

The newly disclosed details loosen a previously mentioned 12-hour window to report. They also expand the number of people to be notified and characteristics to report. The interim rule did not mention enforcement details.

As McKnight’s reported Thursday, nursing homes will be required to report facility conditions via the National Healthcare Safety Network’s long-term care COVID-19 module. A training session on the reporting mechanism will take place for all providers at 1:30 p.m. ET today. Call-in information can be found here.

The interim rule says providers will have to report new cases “no less than weekly.” CMS will then publicly display the information, although Thursday’s notification did not say in what manner.

Hope for unified reporting

The rule does not relieve providers of their obligations to state or local health authorities, though there could be some light at the end of the tunnel.

“CMS said they do hope that states will utilize the information that you will be reporting to CDC, but they cannot direct states to do this,” noted Jodi Eyigor, Leading Age’s director of nursing home policy, on the group’s daily COVID-19 call on Thursday. “ We will continue our advocacy for one universal reporting system.”

The following facility characteristics must be reported to the CDC:

  • Suspected and confirmed COVID-19 infections
  • Total deaths
  • COVID-19-related deaths
  • PPE and hand hygiene supplies
  • Ventilator capacity and supplies
  • Resident beds and census
  • Access to testing
  • Staffing shortages information 

Reporting updates

An early version of the rule said that operators would have to report COVID-19 infections to residents and resident representatives. The newly released rule expands that to families, as well, Eyigor said.

The earlier version also stated that providers should give notifications only for confirmed COVID-19 infections of residents or staff; the interim rule states that information has to be supplied for both confirmed and suspected COVID-19 infections.

In addition, operators  must relay information on “mitigation strategies to prevent or control the spread of the virus.” They also must disclose any alterations to normal operations. 

“The examples provided are visitation and activities, so presumably this reporting will take place long after the visitations and activity restrictions have been lifted from nursing homes,” Eyigor explained. “We will seek clarification on that but that’s how the rule reads.” 

The timeline has also changed since CMS first disclosed the requirements. Last week, Verma said in offhand comments that providers would have to report COVID-19 infections to residents and their camp within about 12 hours of first learning about them. But the timeline proposed Thursday is more relaxed.

“The rule says must inform family and representatives by 5 p.m. of the next calendar day following the occurrence of a single confirmed COVID-19 infection, or the occurrence of three or four — that’s your cluster — within 72 horus of residents and staff, and that is new onset of respiratory symptoms,” Eyigor observed.

CMS says that notifications to residents, family members and their representatives can be made by paper notification, listserv, website posting or by telephone recording.

Eyigor pointed out that clusters are usually considered three or more actual respiratory infections in 72 hours. But the proposed rule specifies only respiratory symptoms are needed to report, “which could include quite a bit more reporting than if you were reporting simply on respiratory infections.” Cumulative stats will need to be reported to the CDC on a weekly basis.

While there was nothing that addressed enforcement actions, they would presumably “follow the similar path of other reporting requirements,” Eyigor said. Last week, CMS Administrator Seema Verma estimated that penalties would be “$1,000 or more” per week for non-reporting or false submissions.

The 279-page interim rule will become official once it is published in the Federal Register, which should be either today or tomorrow. That will be followed by a 60-day comment period, in which LeadingAge said it will take part.

• Too early for states to reopen

Providers are extremely concerned that the decision to reopen several states amid the coronavirus pandemic may be happening too soon and could come at a severe cost to nursing homes and its residents. 

American Health Care Association President and CEO Mark Parkinson on Wednesday explained that there’s a correlation between the presence of COVID-19 in a community and its presence in a long-term care facility. States that are deciding to reopen could open up their local nursing homes to severe risk. 

Oklahoma and Georgia are among a handful of states that have reopening plans. Nursing home associations in those states both warned the moves could put workers at an increased risk of unknowingly catching and spreading the disease.

“If state’s open up too early and we have a resurgence in COVID-positive cases in the general community, this virus is so infectious and so insidious it will make its way into long-term care facilities,” Parkinson said during a press teleconference. 

“From a public policy and public health perspective, as these governors think about what they do next, I completely understand the need to get the economy going again, but a really important consideration needs to be what ends up happening in the long-term care facilities,” he added. “If we open up too soon, the results will not be good.”