The Trump administration on Monday announced the results of its investigation of a Washington nursing home seen as ground zero of the United States’ COVID-19 crisis, while previewing upcoming pandemic-related policy changes.

The Centers for Medicare and Medicaid Services announced that the Kirkland, Wash.-based nursing home — Life Care Center of Kirkland — would be classified as in immediate jeopardy, meaning it could be penalized for putting the health and safety of its residents in immediate danger.

Life Care Center of Kirkland was ordered March 18 to make improvements within 23 days after almost a third of its workers tested positive for COVID-19 and at least 29 residents have died from the virus so far. When the outbreak started in February, the facility had 120 residents.

CMS also announced it would conduct an unannounced check to verify the facility’s progress. If the nursing home is unable to make the required changes, the facility will be penalized by becoming ineligible for federal health program payments.

“It’s a situation in which patients are in immediate danger; specifically, the facility failed to identify and manage sick residents,” said CMS Administrator Seema Verma in a Monday call with reporters. “They failed to notify the state health department and the state about sick residents. And they failed to have a backup plan for when their staff doctor became sick.”

Verma said that by using lessons learned from Kirkland and working alongside the Centers for Disease Control and Prevention, officials have developed a new inspection approach.

“Beginning today, we will be working with the CDC to focus and identify areas the virus is projected to strike next and target our inspections accordingly. This will allow us to focus inspections on the most urgent situations so we are getting the information we need for safety while not getting in the way of patient care,” said Verma.

Upcoming actions

Verma also hinted that CMS would take additional measures later this week and beyond related to COVID-19.

“You’re going to see more coming out from the agency this week. We’ve been having active conversations with a variety of different provider groups,” said Verma. “We’re trying to get a sense from that what are they facing and what kinds of flexibilities do they need?”

She also previewed action related to facilities and alternative care sites where care can be delivered outside of traditional health care facilities. She did not offer details about the specifics of the upcoming changes.

“That is something that we’re working on and you should see action from us. I will tell you that it will be very significant in the expansion of the waivers that we’re going to do as well as there are some things we can’t do through waivers [and] we have to go through rulemaking on.  We’re working through those issues right now and you should see something imminent on that,” she said.

Verma did not elaborate on what types of issues would fall under the rulemaking umbrella.

Last week, CMS approved its first two Medicaid waivers related to COVID-19 in Oklahoma and Washington. These waivers allow additional flexibilities during the public health emergency. For instance, Oklahoma’s waiver allows the state to provide care in alternate settings and remove some prior authorization requirements before people can get care, as well as extends some deadlines.

Other states like North Carolina have signaled either that they have already submitted applications or are in the process of doing so.

Self-assessments

CMS also announced it will provide a voluntary self-assessment tool that nursing homes can use to ensure that they are complying with safety and health standards.

“The plain fact is that with coronavirus spreading, personal protective equipment is at a premium, and some of our state inspectors can be pulled away by their governors to help with other aspects of the coronavirus response, “ said Verma, adding that the tool will supplement CMS’ survey work in cases when an inspector may not be available.

The test would emphasize federal requirements like screening staff members, using proper staff hygiene standards, and taking precautions for limiting the spread of contagious illnesses like COVID-19.

Verma said nursing home residents and their families who want to know if a nursing home is safe should ask staff directly for the results of the facility’s CMS self-assessment.