CMS to Target Nursing Homes with Infection Control Problems in New COVID-19 Hotspots

The Centers for Medicare & Medicaid Services (CMS) on Friday announced a plan to support nursing homes in new “COVID-19 hotspot areas,” with a combined focus on technical support and targeted inspections for facilities with a history of infection control issues.

The White House Coronavirus Task Force, led by Vice President Mike Pence and coordinator Dr. Deborah Birx, will be responsible for identifying the specific hotspots, according to CMS; case counts have been on the rise across the South and Sun Belt states in the wake of eased lockdown restrictions.

“The agency is implementing an enhanced survey process tailored to meet the specific concerns of hotspot areas and will coordinate federal, state, and local efforts to leverage all available resources to these facilities,” CMS advised. “The purpose of these efforts is to target facilities with known infection control issues by providing resources and support that will help them improve quality and safety and protect vulnerable Americans.”


CMS will also deploy Quality Improvement Organizations (QIOs), or contractors dedicated to raising care standards at Medicare-certified facilities, to “provide immediate assistance.”

The implementation of QIOs and stricter infection control inspections is not new to CMS’s overarching coronavirus strategy; the federal government had previously pointed to the contractors as vital resources for technical support, while also completely reorienting its survey strategy to focus on infection control violations and other emergency situations.

Individual State Survey Agencies (SSAs) have until July 31 to complete mandatory targeted infection control surveys or risk the loss of CARES Act stimulus funding. CMS also increased fines for infection-related violations, which can rise up to $20,000 per instance for facilities with a history of issues in that domain.


Resident advocates have been skeptical of the inspection progress so far: Just this past week, the Center for Medicare Advocacy (CMA) released an analysis showing that just 2% of post-COVID inspections resulted in infection control citations, with fewer than 1% leading to fines. Those that did receive civil monetary penalties (CMPs) saw an average fine of $76,000, according to the CMA.

More than 35,000 nursing home residents died from the novel coronavirus through June 28, according to the most recent set of official statistics from CMS and the Centers for Disease Control & Prevention (CDC), with more than 126,000 confirmed positives and 78,692 suspected cases.

Studies have shown a direct correlation between the extent of an overall community’s infection rate and the likelihood of cases in nursing homes, prompting industry leaders to sound alarms about the potential for more facility-wide outbreaks as the United States fails to flatten the COVID-19 curve.

“Nursing homes are especially vulnerable to the prevalence and spread of COVID-19,” CMS noted. “Additional resources are needed to ensure nursing homes take proactive steps to enhance infection control policies and practices to limit potential transmission and prevent widespread outbreaks within these facilities.”

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