CMS Orders Nursing Homes to Resume Reporting Staffing Data as COVID-19 Waiver Expires

Nursing homes must resume the submission of staffing data to the federal government later this summer after the Centers for Medicare & Medicaid Services (CMS) allowed an emergency COVID-19 waiver to expire.

CMS on Thursday announced that facilities must report their payroll-based journal (PBJ) staffing data for the second quarter of 2020 by August 14, ending a temporary suspension of the requirement that the agency implemented as part of broader COVID-19 paperwork waivers.

“We continue to emphasize the importance of staffing based on its relationship to quality,” CMS wrote in a memo to operators. “Therefore, this memorandum serves as notice that, effective immediately, CMS is ending the blanket emergency waiver of 42 CFR 483.70(q), and all nursing homes are required to resume submission of staffing data through the PBJ system as required by the regulation.”

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Despite the waiver, about 60% of facilities reported their data for the first quarter, and CMS encouraged nursing homes to still submit that information retroactively — though it will not be used when calculating a facility’s overall star rating.

Due to the lack of a mandatory reporting requirement for the first quarter, CMS will also not update the PBJ measure data and staffing domain for individual buildings’ five-star ratings.

The agency will provide a special dispensation for buildings that received automatic one-star staffing ratings due to a failure to report the last round of PBJ data.

“Specifically, facilities whose staffing rating was automatically downgraded to one-star due to missing the deadline for the previous submission, or for reporting four or more days in the quarter with no registered nurse, now will not have the opportunity to correct and improve their staffing rating since the ratings will be held constant,” CMS announced. “Therefore, CMS will remove the one-star staffing rating downgrade, and instead, these facilities will have their measures and ratings temporarily suppressed.”

CMS will also freeze quality measures for the period ended December 31, 2019, as resident assessment requirements were also waived due to the coronavirus public health emergency.

“We note that CMS is not holding quality measure ratings constant, as a facility’s quality measure rating can still be updated by a quality measure with underlying data that is earlier than December 31, 2019,” CMS cautioned.

Finally, the agency asserted its desire to restart health inspection ratings “as soon as possible,” though those remain on hold due to the emergency.

The move comes as emerging research shows a connection between staffing levels and the intensity of COVID-19 outbreaks in nursing facilities: An additional 20 minutes of RN coverage was associated with a 22% decline in confirmed cases among facilities with at least one COVID-19 infection, a team from the University of Rochester Medical Center found; among nursing homes that reported at least one death, 20 more minutes of RN staffing was linked to 26% fewer deaths due to COVID-19.

“Nursing homes with higher RN staffing and quality ratings have the potential to better control the spread of the novel coronavirus and reduce deaths,” the researchers concluded.

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