As Coronavirus Takes Forefront, CMS Issues Guidance on Suspension of Inspection Activities

The health care law attorneys at Chapman Law Group discuss compliance and regulatory matters health care practitioners should know in the wake of the Coronavirus.

In light of the Emergency Declaration issued by President Trump on March 13, 2020, the Centers of Medicare and Medicaid Services (CMS) has issued a series of memorandums. These are designed to provide guidance to various health care providers and suppliers regarding the impact that Coronavirus Disease 2019 (COVID-19) will have on their operations and on related corresponding functions of CMS.

One of the memorandums, QSO-20-12-All, discusses CMS’s decision to suspend certain survey activities of currently enrolled Medicare providers, or providers who are seeking Medicare enrollment for which a survey must be conducted, pursuant to the Medicare Conditions of Participation rules and regulations.

An Established Priority Order

This memorandum states that CMS is suspending all non-emergency inspections (known as surveys) across the U.S., in order to allow inspectors to focus on the most serious health and safety threats, including infectious disease and patient abuse.

Specifically, and effective immediately, CMS will limit inspection (survey) activity of facilities based on a Priority Order. All other non-emergency inspections across the country will be suspended until further notice from CMS.

‘Jeopardy Complaints’

The Priority Order lists, at the top, all immediate “jeopardy complaints.” These are cases that represent a situation in which entity non-compliance has placed the health and safety of patients in its care at risk for serious injury or harm, or allegations of abuse and neglect. These jeopardy complaints are not subject to the survey suspension, and they now form the highest priority on the list.

Infection Control Concerns at Facilities

The second highest category on the Priority List is for facilities against whom complaints have been made alleging infection control concerns — including any and all facilities with potential COVID-19 or other respiratory illnesses.

While “initial certifications” do appear on the Priority Order, they are listed fifth in terms of priority. This means initial certifications do not qualify as non-emergency inspections that are now directly suspended under QSO-20-12-All — but there may be some inevitable delays in the survey process for these new providers who are seeking initial certifications.

Again, it is important to note that CMS is not suspending all survey activity. CMS is only suspending certain non-emergency survey inspections, allowing inspectors to prioritize the most serious health and safety threats, like infectious diseases and abuse.

Existing Enforcement Actions Continue

Additionally, surveys for existing in-process enforcement actions, and surveys mandated by law to occur within specific time intervals, will continue uninterrupted — as will initial certification surveys for new providers to support building health care capacity (even though, as mentioned above, these initial certifications may be delayed since they rank fifth on the Priority Order list).

However, revalidation surveys and non-statutory recertification surveys are suspended to allow inspectors and facilities to focus on infection control and preparing for COVID-19.

If you are a provider who is scheduled to undergo a site survey/inspection of your facility, you will likely feel QSO-20-12-All’s impact. Contact Chapman Law Group so we may help guide you through this issue and/or other matters related to your enrollment in the Medicare program.

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