Nursing homes will face fines of “at least” $1,000 per week for not reporting COVID-19 infections within 12 hours of learning about them, federal regulators said Monday.

Some final legal kinks are being worked out, but the system could be up and running as early as next week. Centers for Medicare & Medicaid Services Administrator Seema Verma said during a Monday morning press briefing that providers should start notifying residents and family members of any COVID-19 infections right away. 

She said rulemaking and coordination with the Centers for Disease Control and Prevention would be finalized soon but declined to speculate on a completion date. A CDC spokeswoman told McKnight’s Monday evening that a reporting tool the agency will supply to providers is not ready yet. “We hope to have this reporting up sometime next week,” she said.

Verma said the new, “unprecedented” reporting requirement — which is in addition to the normally expected local health department reporting — is being implemented because providers weren’t doing enough on their own.

“The nursing home association even a week ago put out recommendations that nursing homes inform patients and their families, but we understood that that wasn’t happening so we went a step further to make that a requirement,” she said.

She was referring to recommendations by the American Health Care Association and LeadingAge, which each put out a recommendation April 11, calling for nationwide reporting of COVID rates and incidence at facilities. The moves were even mentioned in the CMS press release announcing the new measures.

But even though providers had been expecting new reporting guidelines for about a week, federal officials announced the new policies in an unusual Sunday night unveiling that caught many off guard.

“Long-term care providers stand ready to share reports with CDC once we have final information on the details of the announcement,” said AHCA President and CEO Mark Parkinson on Monday.

LeadingAge President and CEO Katie Smith Sloan said elements of the Sunday surprise did not sit well with her group. It had supported disclosure of infections to local health authorities, residents and families, “with the expectation of prioritization for personal protective equipment and tests as our members battle this pandemic.”

“We are concerned with the specifics of the new reporting requirements, announced on Apr. 19 by the Centers for Medicare & Medicaid Services, that were not previously disclosed to us,” she said in a statement early Monday. 

Concerns centered on burdens of duplicative reporting, potential fines while facilities are already strapped due to coronavirus measures, and a lack of testing supplies and protective equipment.

“Without sufficient PPE and testing supplies, our members are not fairly armed to fight the novel coronavirus, and are not able to protect staff and residents,” Smith Sloan said.

PPE assistance near

Verma said Monday that relief over PPE concerns could be at hand.
“The other thing we announced last night is that [the Federal Emergency Management Agency] is particularly focused on nursing homes, and you’ll hear more about their efforts to directly supply nursing homes to ensure that they have PPE,” Verma told reporters.

She said the CDC reporting tool will ask for information on admissions, confirmed COVID-19 cases, suspected cases and deaths — regarding both residents and workers.

“This nationwide reporting system will create a crucial element of the surveillance and monitoring system in communities so we can quickly identify outbreaks, conduct contact tracing and stem outbreaks at the community level,” she explained.

Providers will be required to report COVID-19 numbers on a weekly basis, based on the information they have in hand. Initially, there will be a grace period “for the first couple of weeks,” Verma said, to clear the reporting system of any glitches.

The CDC will gather data from providers and pass along the information to CMS, which will then post results to the public-facing Nursing Home Compare website, or a similarly effective vehicle, Verma noted. Legal counsel is still reviewing options.

Nursing homes at ‘ground zero’

“At a very high level, I think it’s fair to say nursing homes have been at ground zero,” Verma said in response to a question asking if nursing homes were the true “front line” of the coronavirus pandemic, which Parkinson had stressed in a recent CNN interview. 

The administrator noted that the first U.S. outbreak occurred in a nursing home setting, which led to intense scrutiny and the ultimate realization that more needed to be done with regard to studying and regulating nursing homes. Accordingly, CMS has reached out to state licensing facilities and emphasized infection control-intense inspections.

“We’ve also put to local leaders to really help and support nursing homes, whether it’s around PPE, or testing, and also at the federal level we’ve increased the reimbursement and make sure that labs understood they can now go out to nursing homes and do some of that collection,” she said.

She said there is now recognition among government agencies that “nursing homes can be an early predictor for communities.”

“This virus was unknown to mankind less than six months ago and we are making decisions based on the latest information we’re getting out of the CDC and the situation on the ground,” she noted.

“If we are very focused on nursing homes and we can see early outbreaks in nursing homes, that can be an early predictor for the entire community and gives us the ability to do that contact tracing, not only for whoever was impacted in the nursing homes but also have an impact on mitigating the spread of the virus inside communities.”

Better pay ahead?

Providers still need to do better on factors they can control, she emphasized.

“From the early results of our surveys, as well as investigations, hand washing continues to be an issue. Use of PPE continues to be an issue, and probably the more significant one is isolating or cohorting patients according to their COVID status,” she said. “That continues to be a challenge for nursing homes. That’s why it’s so important for state and local officials to really support nursing homes.”

She noted several times that local authorities must take control of conditions in their area and respond accordingly since some may have more COVID cases then others. Some providers take machines to facilities and drive around to do testing, while others might collect samples and send them off to labs. 

“We’re also considering doing more reimbursement around the collection of samples, not just labs, so other types of healthcare providers can do more around this,” she revealed on the media call. “You’ll be seeing more from us shortly on that. That’s something we’re considering and thinking about in future rulemaking.”

States following suit

Several states have already begun to release lists of long-term care facilities that have confirmed coronavirus cases. Among those are Florida and California. 

Data from Florida showed that less than 100 of the state’s more than 3,700 long-term care facilities have confirmed cases of coronavirus, which providers said is a “testament to hard, exhaustive planning and dedicated caregivers.” 

“Our members have been vigilant in their infection prevention strategies since long before the rapid progression of this virus in our state; however, facilities must be reinforced with vitally needed resources during this state of emergency,” the Florida Health Care Association said in a statement

“Some long term care facilities are still experiencing critical shortages of personal protective equipment, and the need to expand and routinely test both symptomatic and asymptomatic residents and front-line staff is critical to helping us make important clinician decisions that will reduce the spread of COVID-19,” the organization added. 

Meanwhile, the California Department of Public Health announced that 261 of the skilled nursing facilities in the state — or 21% of SNFs — reported having at least one confirmed case of COVID-19. More than 1,200 facilities, 86% of SNFs in the state have reported data to the state department. In total, more than 3,000 confirmed cases — including 1,740 residents and 1,290 staff members — have been reported.