May 13, 2020 

CMS Requires New COVID-19 Reporting and Notification by Nursing Homes
By Elizabeth Neidig and David Kalimuthu

On May 8, 2020, CMS implemented new infectious disease reporting and notification regulations for the nation’s skilled nursing facilities when it published an interim final rule with comment (IFC) entitled “Medicare and Medicaid Programs, Basic Health Program, and Exchanges; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting.” The Rule is available at The Federal Registrar website.

Prior to COVID-19, skilled nursing facilities were required to establish and maintain an infection prevention and control program under 42 CFR 483.80, designed to provide a safe and sanitary environment in the facilities and to help prevent the development and transition of communicable diseases and infections. The regulation required that skilled nursing facilities have written standards, policies, and procedures regarding infection control and stated to whom possible incidents of communicable disease or infections should be reported.

The new Rule has been added as a subsection to 42 CFR 483.80. Under this new Rule, skilled nursing facilities are required to report certain COVID-19 related information to the Centers for Disease Control and Prevention (CDC). The Rule also requires that facilities provide the families and guardians of facility residents with timely information about COVID-19 infections and the development of respiratory illness symptoms – whether by residents or staff.

New Reporting to the CDC

The new Rule requires skilled nursing facilities to report a standardized set of COVID-19-related data to the CDC on a weekly basis. The data that must be reported can be found at 42 CFR 483.80(g)(1)-(2). The aim of the reporting is to provide a standardized, national lens on the experience of long-term care facilities to support and inform the public health response at the local, state, and federal levels. The Center for Disease Control and Prevention (CDC) will use information collected through the new Module to strengthen COVID-19 surveillance locally and nationally. Notably, this reporting is in addition to other state and local COVID reporting already in place.
The reports made to the CDC will be made publicly available by CMS through its website.

New Reporting to Resident’s Families1  
Under the new Rule, skilled nursing facilities will also be required to notify facility residents and their families of COVID-19 infections in the facility’s residents and staff, as well as the development of three or more cases of new-onset respiratory symptoms among facility residents and staff. See 42 CFR 383.80(g)(3). The requirements are as follows:
  • Notification by 5:00 p.m. the next calendar day following the occurrence of a single confirmed infection of COVID-19
  • Notification by 5:00 p.m. the next calendar day following three or more residents or staff with new-onset of respiratory symptoms occurring within 72 hours of each other
The facility will not disclose personally identifiable information, but must include information on mitigating actions the facility has implemented to prevent or reduce the risk of transmission, including whether the normal operations of the facility will be altered. Notification may take the form of email listservs, website postings, paper notification and/or recorded telephone messages. CMS does not require or expect that facilities will make individual telephone calls to each resident’s family or responsible party. However, facilities are expected to make all reasonable efforts to provide the information to the residents and their families.

CMS has also created two new F-Tags to enforce the new reporting and notification requirements: F884 and F885.

Determination that a facility failed to comply with the CDC reporting requirements of Section 483.80(g)(1) and (2) will result in an F884 enforcement action. Review of F884 compliance will be conducted offsite by CMS Federal surveyors only.

Determination that a facility failed to comply with family notification of infection as required by Section 483.80(g)(3) will result in an F885 enforcement action following the CMS guidelines relating to survey prioritization in the national health emergency. Review of F885 compliance will be conducted onsite by State and/or Federal surveyors.

Facilities are to submit their first set of data to the CDC no later than May 17, 2020. CMS will allow a short grace period for facilities to begin compliance with the new regulations. Facilities that fail to begin reporting by May 31, 2020 will receive a warning letter. CMS will begin issuing fines for facilities that have failed to report as required by Section 483.80(g)(1)-(2) by July 7, 2020. Notably, there is not a grace period for the family notification requirements. CMS intends to begin making facility reports public on its website by the end of May.

1. Notification must be provided to residents, their representatives, and their families.