CMS issued three Quality, Safety & Oversight memoranda addressed to state survey agencies and state survey agency directors identifying wide-ranging modifications to the survey and certification process in relation to the growing COVID-19 crisis in the United States. This article outlines the guidance provided by the three memoranda.

IN DEPTH

CMS issued three (3) Quality, Safety & Oversight memoranda (each a QSO Memo) addressed to state survey agencies and state survey agency directors on March 4, 2020, identifying wide-ranging modifications to the survey and certification process in relation to the growing COVID-19 crisis in the United States. The focus of the modifications is described as a “call to action” to healthcare providers to focus on infection control and prevention in light of the spread of COVID-19, and provides mechanisms for CMS and state agency inspectors to focus their efforts, personnel and related resources on addressing COVID-19 spread and containment.

CMS Administrator Seema Verma cautioned that providers “must immediately review their procedures to ensure compliance with CMS infection control requirements, as well as the guidelines from the Centers for Disease Control and Prevention (CDC).” CMS joins the CDC and NIH in shifting their focus to COVID-19 and its impact on the population as the number of cases grows.

The first QSO Memo, entitled Suspension of Survey Activities (QSO-20-12-All), announces the limitation of survey activity to (in order of priority):

• Immediate jeopardy complaints and allegations of abuse and neglect;

• Complaints alleging infection control concerns, including facilities with potential COVID-19 or other respiratory illnesses;

• Statutorily required surveys (i.e., nursing home, home health, hospice and ICF/IID facilities);

• Revisits necessary to resolve current enforcement actions;

• Initial certifications;

• Surveys of facilities/hospitals with a history of infection control deficiencies at an immediate jeopardy level during the last three (3) years; and

• Surveys of facilities/hospitals/dialysis centers with a history of infection control at a level below immediate jeopardy.

Survey protocols for facilities with complaints alleging infection control concerns and/or COVID-19 or other respiratory illness are provided in an attachment to QSO-20-12. CMS also released and will update in “real time” FAQs related to QSO-20-12.

The second QSO Memo, Guidance for Infection Control and Prevention Concerning Coronavirus Disease (COVID-19): FAQs and Considerations for Patient Triage, Placement and Hospital Discharge (QSO-20-13-Hospitals), focuses on hospitals and provides detailed guidance on screening visitors and patients and monitoring and restricting healthcare facility staff from working in case of exposure. QSO020-13 further addresses appropriate actions for hospitals to take in relation to patient placement, evaluating patients with known or suspected COVID-19, precautions in caring for patients requiring diagnostic or therapeutic interventions, and discharge and visitation matters.

The third QSO Memo, Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes (QSO-20-14-NH), similarly provides guidance designed to help nursing homes limit the transmission of COVID-19, including guidance for monitoring or restricting staff and managing transfers and admissions of patients with suspected or confirmed COVID-19 infection.

Updates to these memoranda are expected as the situation evolves.