White House Task Force and CMS Focuses on COVID-19 in Nursing Homes & Governor Eric Holcomb issues Executive Order for Indiana

Friday, March 6, Governor Eric Holcomb signed this executive order declaring a public health
emergency for Coronavirus Disease 2019 outbreak. It declares a public health emergency for
the COVID – 19 exists in Indiana and sets the stage for how the state of Indiana will respond
through the Indiana State Department of Health as the lead state agency to coordinate the
response activities for the state agencies and local governments.

LeadingAge Indiana is working closely with the leadership at the Indiana State Department of
Health specifically on COVID-19 and what these changes at CMS will mean to Indiana
operations and continues to monitor the situation. Any new updates can be found on our

On March 4, the White House announced changes to nursing home survey practices in
response to the mounting threat of COVID-19, known as the coronavirus. The Trump
Administration has expressed its desire for Centers for Medicaid and Medicare Services (CMS)
surveyors to prioritize infection control in the wake of increasing numbers of Americans suffering
from the disease.

The White House Coronavirus Task Force announced the change in focus at a press
conference that afternoon. Vice President Pence, acting on behalf of the task force, announced
that:
“At the President’s direction, we’re going to focus exclusively on ensuring that those who are in
nursing homes — people operating the nursing homes, like many of the CEOs that we met with
today — are complying with the new standards to keep our elderly safe.

“CMS is committed to taking critical steps to ensure America’s health care facilities and clinical
laboratories are prepared to respond to the threat of the COVID-19 and other respiratory illness.
Specifically, CMS is suspending 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. This shift in approach will also allow inspectors to focus on addressing the
spread of the coronavirus disease 2019 (COVID-19). CMS is issuing this memorandum to State
Survey Agencies to provide important guidelines for the inspection process in situations in which
a COVID-19 is suspected.”

The announcement references guidance being provided to state survey agencies to change
their approach to surveying nursing homes, including: limiting standard and complaint surveys;
focusing efforts on nursing facilities that have had previous citations related to infection control;
and continuing to focus on immediate jeopardy complaints and allegations of abuse and
neglect.

“We will be focusing all of our state agency resources that are involved in inspecting nursing
homes and other healthcare facilities to focus on infection control practices,” stated Seema
Verma, Administrator for CMS. “Healthcare providers are going to play a very critical role in
preventing the spread of the coronavirus, and CMS has a unique role in holding healthcare
providers accountable for maintaining these essential health and safety standards.”

She went on to note other plans, including:
  • Issuing a call to action to hospitals, nursing homes, dialysis providers, and all healthcare facilities to review their infection control and emergency preparedness procedures;
  • Reissuing some guidance around infection control, transfers between nursing homes and hospitals, and encouraging and requiring providers to consult with local healthcare officials;
  • Issuing guidance around screening visitors and healthcare workers; and
  • Issuing guidance to state surveyors that provides information on the latest Centers for Disease Control and Prevention (CDC) protocols that they must follow when inspecting these facilities with suspected cases of respiratory illness, including coordinating with the CDC, CMS, and local healthcare officials.

The response from LeadingAge (national) appeared to be optimistic, while
additionally urging policymakers to address the needs of older adults living in other congregate
and community-based settings.

“They (the CMS directives) appear to represent an opportunity for much-needed collaboration
with surveyors to achieve our joint goals of infection containment and high-quality care,” stated
Katie Smith Sloan, President & CEO of LeadingAge.

Rebecca Bartle, Regulatory Consultant to LeadingAge Indiana advised “Facilities should
continue to be diligent in their infection control and prevention efforts, including judicious hand
hygiene, cough etiquette, use of personal protective equipment, and the need to continually
educate staff, residents, and visitors of these preventative measures. Each facility should be
reviewing policies and procedures, including but not limited to, a pandemic plan in the event its
implementation is necessary.”

Members with concerns about the impact of COVID-19 to their operations are encouraged to
contact Becky Bartle at bbartle@leadingageindiana.org