House Launches Probe into CMS, Operator Response to COVID-19 in Nursing Homes

A House subcommittee on Tuesday launched an investigation into the ongoing COVID-19 crisis in nursing homes, demanding rafts of information from both the federal government and five prominent operators in the space.

Rep. James Clyburn, the South Carolina Democrat who chairs the Select Subcommittee on the Coronavirus Crisis, announced the probe in a statement.

“The Subcommittee is concerned that lax oversight by the Centers for Medicare and Medicaid Services (CMS) and the federal government’s failure to provide testing supplies and personal protective equipment to nursing homes and long-term care facilities may have contributed to the spread of the coronavirus and the deaths of more than 40,000 Americans in these facilities,” Clyburn wrote. “Despite CMS’s broad legal authority, the agency has largely deferred to states, local governments, and for-profit nursing homes to respond to the coronavirus crisis.”

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The investigation will take two fronts, at least judging by the letters.

In the first, Clyburn asked CMS administrator Seema Verma to provide the subcommittee with a host of information regarding its efforts to curb the spread of the novel coronavirus in long-term care — including documentation regarding COVID-19 testing, projections of case counts and deaths through December 2021, and enforcement actions related to COVID-19.

Clyburn took issue with several steps CMS has taken since the start of the pandemic, such as the suspension of non-emergency inspections in order to prioritize investigations of infection-control problems, as well as giving states the final say on issues such as testing and reopening facilities to visitors.

“Despite CMS’s broad legal authority, the agency has largely deferred to states, local governments, and for-profit nursing homes to respond to the coronavirus crisis,” Clyburn wrote. “CMS has issued guidance for nursing homes, but this guidance has often been unclear, and CMS failed to take adequate steps to ensure that nursing homes comply with its recommendations. Deregulation and lax enforcement of infection control violations by CMS — both before and during the pandemic — may have contributed to the spread of the virus.”

Prior to the letters, Verma had staunchly defended her agency’s COVID-19 strategy.

“I think this idea of trying to finger-point, and blame the federal government, is absolutely ridiculous,” Verma said on a call with reporters.

In the administrator’s view, CMS has provided the broad blueprints that states and operators must follow in order to fight the novel coronavirus.

“The vast majority of nursing homes across this country didn’t have significant numbers of cases — or didn’t even have any cases, or any deaths in their nursing homes, and I think it speaks to the nursing homes that were more focused on the federal guidelines and the recommendations, and did a good job with implementing those,” she said.

The second front in the House committee’s probe focuses on five major nursing home operators: Genesis HealthCare (NYSE: GEN), The Ensign Group (Nasdaq: ENSG), Life Care Centers of America, Consulate Health Care, and SavaSeniorCare.

“We are writing to seek documents and information regarding the deaths of men and women in your company’s nursing homes during the coronavirus outbreak, the conditions that may have contributed to these deaths, and any steps taken to protect residents and workers from further tragedy,” each letter, addressed to each company’s CEO, reads in its introduction.

The subcommittee’s requests span 10 separate categories, from basic data on bed counts and resident demographics to the exact amounts of personal protective equipment (PPE) at each facility operated by the chains — along with estimates of when those supplies would be exhausted and plans for replenishment.

Clyburn also asked for Medicare and Medicaid revenue data stretching back to 2018, all documents and communications regarding COVID-related complaints, and data on any CARES Act relief they may have received.

“The Trump administration’s distribution of the funds to long-term care facilities and other companies under the CARES Act and other programs has been marked by a lack of transparency,” Clyburn asserted. “Recipients must agree to use the funds for certain purposes related to the outbreak, but there has been little public reporting on how nursing home operators have actually used the funds.”

Clyburn set a June 30 deadline for both Verma and the operators to respond to the requests.

Representatives for SavaSeniorCare and Life Care Centers of America told SNN that they had only recently received the letters and were still working through their contents.

Lori Mayer, a spokesperson for Genesis, also emphasized that the provider is still reviewing the Tuesday letter.

“We support efforts to better understand the virus, and how we as a nation and as a provider can improve care of our nation’s seniors,” Mayer said in a statement sent to SNN. “Throughout this pandemic, Genesis has been very transparent and forthcoming, providing information to patients, residents, families and the media, as well as state and federal governments.”

Leaders or press officers at the other companies did not respond to requests for comment as of press time.

The American Health Care Association, which represents for-profit nursing homes, also welcomed the opportunity for dialogue between Washington and the industry.

“AHCA/NCAL and our members appreciate any opportunity to work in collaboration with lawmakers to advance solutions that enable us to better serve the residents in our care,” CEO Mark Parkinson said in a statement. “While the federal and state governments have been helpful, much more is still needed as this pandemic is far from over. We hope this process will provide an opportunity to have a productive discussion about ways we can continue to work together to protect the vulnerable population we serve.”

The action comes after the subcommittee held a hearing on COVID-19 in nursing homes in which both frontline workers and academics described the problem as systemic.

“The only thing COVID did was rip the doors open,” Chris Brown, a CNA working in Chicago, said during the hearing, testifying that staffing and PPE shortages were a problem in nursing homes prior to the pandemic. “It blasted the doors open of a system that was already failing.”

David Grabowski, a Harvard researcher who has been outspoken about the need for systemic solutions to the problems in long-term care, used his time to call for more federal support for nursing homes.

“Much of the negative impact of COVID in nursing homes could have been avoided. However, rather than prioritizing the safety of the 1.3 million individuals who live in nursing homes and the staff that care for them, we failed to invest in testing, PPE and the workforce,” Grabowski said last week. “We allowed a problem that could have been contained to grow into a national crisis. Now that we are here, it is time for the federal government to make the necessary investment to mitigate the spread of COVID across all U.S. nursing homes.”

The subcommittee describes itself as a fact-finding group in the vein of the Truman Committee, a Senate commission established to investigate allegations of fraud and profiteering during World War II.

In the letters, Clyburn’s said the subcommittee’s mission is “‘to conduct a full and complete investigation’ of the ‘efficiency, effectiveness, equity, and transparency of the use of taxpayer funds and relief programs to address the coronavirus crisis,’ the nation’s ‘preparedness for and response to the coronavirus crisis,’ and ‘any other issues related to the coronavirus crisis.'”