CMS Orders Nursing Homes to Report All COVID-19 Cases to CDC, Plans Public Data Release

Following weeks of pressure from industry leaders, resident advocates, and the media, the federal government on Sunday night ordered the nation’s nursing homes to begin reporting all positive COVID-19 cases directly to the Centers for Disease Control & Prevention (CDC).

Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma described the move as a vital step for nursing home operators and public officials as they seek to stop the spread of the virus.

“Nursing homes have been ground zero for COVID-19. Today’s action supports CMS’s long-standing commitment to providing transparent and timely information to residents and their families,” Verma said in a statement. “Nursing home reporting to the CDC is a critical component of the go-forward national COVID-19 surveillance system and to efforts to reopen America.”

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The CDC will provide a new reporting tool to nursing home operators; CMS will then make the data available to the public. Facilities must still comply with “existing privacy regulations and statute,” according to CMS. Operators must also cooperate with all CDC efforts to surveil the spread of COVID-19, CMS noted.

While the actual rulemaking remains forthcoming, a brief summary of the new guidance indicated that operators could face enforcement actions if they fail to report cases of residents or staff with confirmed COVID-19 cases, as well as persons under investigation (PUI) for the illness.

CMS is also “previewing” a new requirement that will compel nursing homes to inform residents and their families or legal representatives of all new COVID-19 cases at individual buildings.

“Scientific data derived from solid surveillance is a key element of recommendations to protect Americans, particularly our most vulnerable, from the devastating impact of COVID-19,” said CDC director Robert Redfield said in a statement. “This coordinated effort with CMS will allow CDC to provide even more detailed information to state and local health departments about how COVID-19 is affecting nursing home residents in order to develop additional recommendations to keep them safe.”

The Wall Street Journal on Sunday reported that such guidance was forthcoming this week, while Verma herself hinted at the release of a formal plan in Wednesday comments with reporters.

“One of those areas is going to be the nursing homes, that’s going to be the foundation of our surveillance efforts,” Verma said Wednesday. “That’s one of the reasons why we’re enhancing the reporting of nursing homes directly into CDC around the cases of COVID virus.”

Multiple states had implemented their own reporting requirements, but Sunday’s announcement marks the first coordinated federal effort to develop an official public database.

Calls for more transparency from the federal government around COVID-19 and nursing homes reached a crescendo this week, as outlets such as NBC News and the New York Times began compiling their own figures — with the former organization pegging the death toll at 5,500 on Wednesday. The Times on Friday placed that number at “at least 7,000.”

A pair of U.S. senators at the start of April called on Verma and CDC director Redfield to provide a public list of all nursing homes with reported COVID-19 cases. Rep. Jan Schakowsky of Illinois on Wednesday issued a similar demand to Verma and Department of Health and Human Services (HHS) secretary Alex Azar, NBC News first reported.

“We fear that there may be hundreds, if not thousands, of more COVID-19 cases that have gone unreported,” Schakowsky wrote in the letter, co-signed by 77 of her fellow House Democrats.

The American Health Care Association, which represents more than 14,000 senior living and care facilities, last weekend advised all of its members to report confirmed cases and deaths to CMS’s network of state survey agencies, which oversee nursing home inspections and citations.

The organization framed the effort as a way to direct testing and personal protective equipment (PPE) — both in short supply, and both vital to keeping seniors in all kinds of congregate living facilities safe — to the regions that need it most.

“We encourage CMS to use this data, in collaboration with other federal agencies, to help target PPE and testing resources that long term care providers desperately need,” AHCA CEO Mark Parkinson said in a statement. “Without testing it will be hard to keep state and federal agencies apprised of how this virus is spreading and get the help facilities desperately need.”

COVID-19 has taken a devastating toll on nursing facilities, with this past week bringing a wave of stories illustrating the severity of the situation on the ground — including the widely reported case of 17 bodies found in a morgue designed for only four at a nursing home in New Jersey.

Under the strain of an unprecedented global pandemic, long-developing cracks in the complex web of support and oversight of nursing homes have burst open, with some states implementing strict reporting requirements — but many not amending their policies at all. State and local authorities have also grappled with their conflicting mandates to keep the public safe and protect the medical privacy rights of nursing home residents.