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CMS Resumes Surveys After COVID-19 Lockdown

Review worksheets and operations manuals, stay prepared

BY KARA NEWBURY | AUGUST 2020

The Centers for Medicare & Medicaid Services (CMS) announced earlier this month that it would expand survey operations for all CMS-certified providers and suppliers after the months-long suspension of “certain routine inspections as part of its response to the coronavirus disease 2019 (COVID-19) pandemic to prioritize infection control and immediate jeopardy situations and to give health care providers and suppliers time needed to respond to the spread of COVID-19.” In a memo to state agencies, CMS directed the resumption of routine survey activities “as soon as resources are available.”

Impact of COVID-19 on ASC Survey Activity

In 2019, CMS had conducted 972 standard surveys in ASCs as of July 31. This year, however, the agency has conducted only 209 standard surveys as of July 31, with 178 (85 percent) of those conducted prior to the suspension of “routine” surveys on March 23. While in January and February of this year CMS conducted 81 and 68 standard surveys, respectively, only 29 were conducted in March.

This is due to guidance released beginning in March 2020 on the suspension of most standard surveys because of the growing concerns about COVID-19. On March 4, CMS announced suspension of non-emergency inspections across the country, “allowing inspectors to turn their focus on the most serious health and safety threats like infectious diseases and abuse.” Survey activity was limited, and for ASCs that meant they might be subject to a survey during this time only for (in priority order): an immediate jeopardy complaint (case that represents a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death or harm) and allegations of abuse and neglect; complaints alleging infection control concerns, including facilities with potential COVID-19 or other respiratory illnesses; any revisits necessary to resolve current enforcement actions; or an initial certification.

On March 20, CMS announced a further suspension of routine inspections (including initial certifications), and an exclusive focus on immediate jeopardy situations and infection control inspections for a three-week period. On June 1, CMS announced an expansion of survey activities provided guidance to transition states to more routine oversight and survey activities, but the guidance was more targeted to nursing homes and did not apply broadly to most ASC survey types.

Targeted Infection Control Surveys

CMS authorized surveys specifically for infection control in March through the QSO-20-20-All memorandum. Surveyors use the streamlined review checklist at the end of the memo to minimize the impact on provider activities, while ensuring providers are implementing actions to protect the health and safety of individuals to respond to the COVID-19 pandemic (the acute and continuing care information begins on page 19 of the memorandum).

The focused infection control worksheet questions apply only when there are regulations to support them, according to CMS. So, as noted on the worksheet, not everything on there would apply to all facility types. In addition, while some facility types would be subject to fines for failure to comply, ASCs would not.

Not all states are doing these surveys due to other priorities with COVID-19 and reopening, but a few have occurred at various CMS-certified providers and suppliers. Targeted infection control surveys might result in citations for §416.51 Condition for coverage – Infection control or §416.54 Condition for coverage – Emergency preparedness. As a reminder, surveyors use the Infection Control Surveyor Worksheet to evaluate an ASC’s compliance with the infection control Conditions for Coverage (CfC); see the State Operations Manual, Appendix Z for guidance on emergency preparedness requirements.

In some cases, states could be surveying based on current state law, including executive orders. For the most current information on your state, please visit ASCA’s State Guidance on Elective Procedures page, available to ASCA members only.

Even though CMS is not conducting these targeted infection control surveys in all states, it is beneficial for ASCs to periodically review the worksheet for compliance, especially, as standard surveys begin to ramp up again.

Questions? Write Kara Newbury.