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New Criteria Should Reduce Number of Infection Control Surveys for Nursing Homes

CMS issued a revised memo QSO-20-31-ALL-REVISED on Jan. 4 detailing new triggers for focused infection control (FIC) surveys. In addition to the two triggers previously identified, CMS has added 5 additional scenarios that will be used to help state survey agencies more narrowly target FIC surveys. The new criteria are effective immediately and will have the effect of reducing the volume of FIC surveys for many providers.

Focused Infection Control Survey Criteria

As outlined in the original memo issued June 1, 2020, FIC surveys must be initiated within 3-5 days of identification for nursing homes that report 3 or more new COVID-19 cases in the past week or 1 new resident case in a nursing home that was previously COVID-free. National Healthcare Safety Network (NHSN) data is utilized for these criteria. With the January 4, 2021 update, CMS has now outlined the following additional criteria for triggering a focused infection control survey:

  • Multiple weeks with new COVID-19 cases,
  • Low staffing,
  • Selection as a Special Focus Facility,
  • Concerns related to conducting outbreak testing per CMS requirements, or
  • Allegations or complaints that pose a risk of harm or immediate jeopardy to the health or safety of that are related to certain areas such as abuse or quality of care (e.g. pressure ulcers, weight loss, depression, decline in functioning).

In order to trigger a FIC survey, nursing homes must meet one of the original case criterion (3 or more new cases or one new resident case) plus at least one of the new conditions. CMS will assist state survey agencies in identifying nursing homes that meet the above criteria, and surveyors must initiate an inspection within 3-5 days of identification.

In addition to narrowing the criteria for what triggers a FIC, CMS states that facilities that meet the criteria above to trigger an FIC survey do not need to be resurveyed if a FIC survey was conducted (as a stand-alone FIC survey or as part of a recertification survey) within the previous three weeks. For example: “If a facility is surveyed with a FIC survey within 3-5 days after meeting the criteria, and the same facility meets the criteria for being surveyed within 3-5 days in any of the next three weeks, the survey team does not need to conduct another survey within those three weeks. However, if the facility meets the criteria for a survey in the fourth week after a FIC survey was conducted, an additional FIC survey must be conducted within 3-5 days.” 

CMS also directs surveyors to be alert to and investigate any concerns related to residents who have had a significant decline in their condition (e.g., weight loss, mobility) during the public health emergency, when conducting a FIC survey.

Information in the June memo relating to enhanced enforcement related to infection control citations remains unchanged and continues to apply.

Survey and Surveyor Protocols: FAQ

Noting that it has received questions from stakeholders as well as federal and state surveyors related to the resumption and expansion of survey activities, CMS has addressed a number questions on LTC facility Health surveys, Emergency Preparedness surveys and Life Safety Code surveys (for all provider types), along with a Guide to Waived F-Tags and K-Tags for clarification. Scroll through to page 8 of the memorandum to find that FAQ, which will be a useful reference tool for care centers.

Among other issues, the FAQ addresses infection control safety protocols for surveyors, including that all surveyors should wear appropriate PPE and adhere to the practices for COVID-19 infection prevention (e.g., social distancing, hand hygiene, etc.) while onsite, and adhere to any health-related screening protocols before entering a facility, including temperature checks and noting any potential signs or symptoms of infection.

In the event of active confirmed cases within the nursing home, CMS recommends that one surveyor be assigned to COVID-19 positive residents only, and that that a different surveyor be assigned to any COVID-19 suspected residents or residents under observation. The surveyor that is assigned to the COVID-19 unit should stay on that unit for the entire survey while completing the investigation and tasks specific to that unit. If a surveyor is restricted to a specific area of the building (e.g., because of cohorting), the surveyor should not physically meet with any other survey team member. The surveyor should meet virtually (on his/her own) with the team throughout the survey.  Surveyors should not move between COVID-19 positive, suspected positive, and nonCOVID-19 areas within the facility.

What This Means for Members

This new survey prioritization will provide some relief for nursing homes from the frequency and repetition of FIC survey activity you have experienced this year, diverting less time, energy, and attention away from resident. Likewise, state survey agencies will be able to better focus and allocate resources to nursing homes where more assistance is needed to provide the safe and high-quality care that our members are accustomed to providing. We will monitor the situation in the weeks ahead, and share any data we can with members about the impact of this welcome CMS policy change.

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