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COVID-19 Updates and Developments (Week of June 1)

  • June 05, 2020

The Centers for Medicare & Medicaid Services (CMS) released June 4 updated data on COVID-19 in nursing homes indicating more than 95,000 confirmed cases and almost 32,000 deaths.

The data reflect information reported by 13,600 nursing homes, or roughly 88% of the 15,400 nursing homes that participate in Medicare and Medicaid, as of May 31. CMS said the next set of data will be updated in two weeks. The agency plans to issue weekly updates thereafter. 

In April, CMS required nursing homes to inform residents and their families of COVID-19 cases in their facilities. CMS also mandated that nursing homes report confirmed or suspected cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC) in a standardized format. 

Based on an early analysis, facilities with a one-star quality rating were more likely to have large numbers of COVID-19 patients than those with a five-star quality rating, the agency reported. CMS said it is increasing civil money penalties on facilities with persistent infection control violations and imposing enforcement for less serious deficiencies to help ensure those issues are addressed before they become more serious.

In March, CMS asked states to focus nursing home surveys on infection control practices. Since then, about half of the nation’s nursing homes have been surveyed for infection control, the agency said.

Based on the COVID-19 nursing home data reported to CDC, CMS is now calling on states to ensure all Medicare and Medicaid certified nursing homes receive an infection control survey or risk losing funding under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The CARES Act set aside $80 billion for state survey and certification work.

In a June 1 memorandum to state survey directors, CMS gave states until July 31 to complete their infection control nursing home surveys. States that don’t meet that deadline must submit a corrective action plan to CMS outlining their strategy for completing the surveys within 30 days.

States that fail to meet the new deadline, could see their funding under the CARES Act reduced by up to 10%, CMS said. Further reductions of up to 5% are possible for continued non-compliance. The agency said the withheld funds would be redistributed to other states that meet the July 31 deadline.

In addition to the infection control surveys, CMS is requiring states to perform within 30 days onsite surveys of nursing homes with previous COVID-19 outbreaks. States also must perform onsite surveys within three to five days of any nursing home with three or more new COVID-19 suspected or confirmed cases or one confirmed case in a facility that previously was COVID-free.

“While many nursing homes have performed well and demonstrated that it’s entirely possible to keep nursing homes patients safe, we are outlining new instructions for state survey agencies and enforcement actions for nursing homes that are not following federal safety requirements,” CMS Administrator Seema Verma said.

Agency Action

June 4—The Department of Health and Human Services (HHS) released new guidance to standardize what laboratories report to public health officials along with COVID-19 test results, including relevant demographic data. The agency said the new data reporting requirements will help improve the monitoring of disease trends, contact tracing, and identifying supply chain needs. “The requirement to include demographic data like race, ethnicity, age, and sex will enable us to ensure that all groups have equitable access to testing, and allow us to accurately determine the burden of infection on vulnerable groups,” said Brett P. Giroir, MD, Assistant Secretary for Health. The CARES Act requires labs that perform COVID-19 or SARSCoV-2 tests to report the results to HHS. The guidance indicates in general that data should be sent to state or local public health departments using existing reporting channels to ensure rapid initiation of case investigations.

June 2—HHS awarded an additional $250 million to hospitals and other health care providers to train workforces, expand telemedicine and virtual health care, procure supplies and equipment, and increase regional and local coordination to combat COVID-19. The CARES Act funding is in addition to $100 million released by the agency in April to help health care providers respond to the COVID-19 pandemic.

June 1—HHS is devoting an additional $628 million to a contract with Emergent BioSolutions to advance manufacturing capabilities and capacity for a potential COVID-19 vaccine and therapeutics. The existing contract is part of the administration’s Operation Warp Speed initiative to speed the development, manufacturing, and distribution of COVID-19 medical countermeasures—vaccines, therapeutics, and diagnostics.

Other Developments

June 3--The Senate approved by unanimous consent the Paycheck Flexibility Act (H.R. 7010), which modifies the Paycheck Protection Program to provide more flexibility to small businesses. The measure, among other things, extends the loan forgiveness period from eight to 24 weeks and eases restrictions limiting non-payroll expenses to 25% of loan proceeds. The measure also extends the two-year limit on loan repayment, ensures full access to payroll tax deferment, and expands the rehiring deadline. The House passed the measure last week and President Trump is expected to sign the bill.

June 3—A bipartisan group of House and Senate lawmakers is questioning HHS about delays in distributing emergency funding aid to Medicaid providers. Congress set aside $175 billion in the Public Health and Social Services Emergency Fund (PHSSEF) to help ease the financial strain on health care providers in the wake of the COVID-19 pandemic. While providers participating in Medicare have received distributions from the emergency fund, the same has not been true for safety net providers that rely on Medicaid for the bulk of their payments. “We are concerned that the delay in disbursing funds from the [PHSSEF] for Medicaid-dependent providers could result in long term financial hardship for providers who serve some of our most vulnerable populations,” the lawmakers said in a letter to HHS Secretary Alex Azar. “We write regarding the need for a dedicated distribution from the PHSSEF for providers who rely on Medicaid and to share our serious concerns with the ongoing delay of funding,” the letter said, which was signed by Senate Finance Committee Chairman Charles Grassley (R-IA) and Ranking Member Ron Wyden (D-OR) and House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ) and Ranking Member Greg Walden (R-OR). The lawmakers acknowledged “federal data limitations in Medicaid that do not exist in Medicare,” but urged HHS to work with the states “to develop a methodology to fairly and robustly allocate funds for Medicaid providers that reflects their costs, the nature of their care, and the financial pressures they face.” The Committee leaders asked HHS, by June 10, to provide a timeline for distributing funds to Medicaid providers and to explain why the agency waited until May 1 to request information from the states about Medicaid providers.

June 2—The American Hospital Association (AHA) urged HHS to quickly distribute additional aid to all hospitals and health systems, with a direct application process for specific relief to follow. In a letter to HHS Secretary Alex Azar, AHA said hospitals and health systems are continuing to experience “historic financial pressures” as many elective procedures remain cancelled and Americans postpone care because of the coronavirus. AHA previously estimated that hospitals and health systems will see $202.6 billion in losses over a four-month period. AHA urged the agency to use a “phased approach” for the distributions that includes providing $10 billion in additional funds for “hot spot” hospitals experiencing a larger number of COVID-19 cases; $2 billion for hospitals serving a substantial number of low-income and uninsured patients; and $30 billion to all other hospitals. An application process then could be put in place to distribute funds based on hospitals’ COVID-19 related costs and lost revenue, AHA said.

May 27—The Joint Commission (TJC) will restart regular surveys and reviews in June, prioritizing low-risk areas first, the group announced. In mid-March, TJC suspended all regular surveys due to the COVID-19 pandemic. TJC is revising the survey process to maximize safety, including limiting the numbers of individuals in group sessions and relying more on audio or video conference calls. Using masks will be routine practice, and TJC expects organizations to provide personal protective equipment to surveyors. Surveys will not retroactively review compliance, TJC said. “Rather, we will work to understand how you have adapted to the pandemic and review your current practices to assure you are providing safe care and working in a safe environment.”