Enhanced Enforcement for Infection Control Deficiencies

Infection Control requirements are nothing new, but the Centers for Medicare and Medicaid Services (CMS) is ramping up efforts to identify and assist providers who may be performing poorly in infection control practices. Providers struggling to comply with requirements could face corrective action and Civil Monetary Penalties (CMP) as outlined below. See the full memo here: QSO-20-31-All

Due to the heightened threat to resident health and safety for even low-level, isolated infection control citations (such as proper hand-washing and use of personal protective equipment (PPE), CMS is expanding enforcement to improve accountability and sustained compliance with these crucial practices.

Substantial non-compliance (D or above) with any deficiency associated with Infection Control (IC) requirements will lead to the following enforcement remedies:

• • Non-compliance for an IC deficiency when none have been cited in the last year (or on the last standard survey):
    • Cited current non-compliance (Level D & E) – Directed POC
    • Cited current non-compliance (Level F) – Directed POC, Discretionary Denial of Payment for New Admissions with 45-days to demonstrate compliance with IC deficiencies.
  • Non-compliance for IC Deficiencies cited once in the last year (or last standard survey):
    • Cited current non-compliance (Level D & E) -Directed POC, Discretionary Denial of Payment for New Admissions with 45-days to demonstrate compliance with IC deficiencies, Per Instance Civil Monetary Penalty (CMP) up to $5000 (at State/CMS discretion)
    • Cited current non-compliance (Level F) -Directed POC, Discretionary Denial of Payment for New Admissions with 45-days to demonstrate compliance with IC deficiencies, $10,000 Per Instance CMP
  • Non-compliance that has been cited for Infection Control Deficiencies twice or more in the last two years (or twice since second to last standard survey)
    • Cited current non-compliance (Level D & E) – Directed POC, Discretionary Denial of Payment for New Admissions, 30-days to demonstrate compliance with IC deficiencies, $15,000 Per Instance CMP (or per day CMP may be imposed, as long as the total amount exceeds $15,000
    • Cited current non-compliance (Level F) – Directed POC, Discretionary Denial of Payment for New Admissions, 30-days to demonstrate compliance with IF deficiencies, $20,000 Per Instance CMP (or per day CMP may be imposed, as long as the total amount exceeds $20,000)
  • Nursing Homes cited for current non-compliance with IC Deficiencies at the Harm Level (Level G, H, I), regardless of past history –
    • Directed POC, Discretionary Denial of Payment for New Admissions with 30-days to demonstrate compliance with IC deficiencies. Enforcement imposed by CMS Location per current policy, but CMP imposed at highest amount option within the appropriate (non-Immediate Jeopardy) range in the CMP analytic tool
  • Nursing Homes cited for current non-compliance with Infection Control Deficiencies at the Immediate Jeopardy Level (Level J, K, L) regardless of past history –
    • In addition to the mandatory remedies of Temporary Manager or Termination, imposition of Directed Plan of Correction, Discretionary Denial of Payment for New Admissions, 15-days to demonstrate compliance with Infection Control deficiencies. Enforcement imposed by CMS Location per current policy, but CMP imposed at highest amount option within the appropriate (IJ) range in the CMP analytic tool.

If you haven’t yet had a focused infection control survey be aware that state survey agencies must complete 100% of the focused surveys by July 31st, 2020 or be subject to corrective action. In addition, state survey agencies must:

• • Perform on-site surveys (In June, 2020) of nursing homes with previous COVID-19 outbreaks, defined as:
    • Cumulative confirmed cases/bed capacity at 10% or greater; or
    • Cumulative confirmed plus suspected cases/bed capacity at 20% or greater; or
    • Ten or more deaths reported due to COVID-19.
  • Perform on-site surveys (within three to five days of identification) of any nursing home with 3 or more new COVID-19 suspected and confirmed cases in the since the last National Healthcare Safety Network (NHSN) COVID-19 report, or 1 confirmed resident case in a facility that was previously COVID-free. State Survey Agencies are encouraged to communicate with their State Healthcare Associated Infection coordinators prior to initiating these surveys.
  • Starting in FY 2021, perform annual Focused Infection Control surveys of 20 percent of nursing homes based on State discretion or additional data that identifies facility and community risks.

Centers for Medicare & Medicaid Services. Ref: QSO-20-31-All

Contact Proactive Medical Review for assistance with your Infection Prevention and Control needs!

Blog by Eleisha Wilkes, RN, RAC-CTA, Proactive Medical Review

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