The Centers for Medicare & Medicaid Services has held audiences with skilled nursing providers, made presentations and entertained comments in recent months to assure operators that regulatory actions are being done with best intentions.

 

But there’s one area that remains a particularly sore spot with nursing home operators, and that point was re-emphasized at the recent NADONA annual meeting in New Orleans.

 

State surveyors do not have to be vaccinated against COVID-19 to enter any nursing home, the CMS nursing home division chief told dismayed nurse leaders during a live video address last week.

 

“I can’t go into much of the details. It basically came down to our authority of what we can and can’t do,” said Evan Shulman, director of CMS’ nursing home division, to heads shaking in disappointment. “I understand where you’re coming from, but at the end of the day, this is the direction we had to go in. For you all, you need to let the surveyors in.”

 

Providers have been incredulous that while the U.S. Supreme Court upheld a CMS requirement that healthcare workers either be vaccinated or receive a waiver, surveyors are under no such obligation. Worse, they could visit multiple facilities in a given week, acting as unknowing, asymptomatic spreaders, as occurred in the very first US outbreaks in Seattle-area long-term care facilities in 2020.

 

“If you have any concerns about [surveyors], about, for example, wearing PPE, just reach out to the state survey agency,” Shulman advised. “But it’s the direction we need to go in.”

 

In addition, providers may not require surveyors to be tested for COVID before entering a building, he added. CMS in mid-June rescinded guidance that said surveyors who aren’t fully vaccinated shouldn’t be part of the onsite survey team when inspecting certified providers.

 

“No, you need to let the surveyor in,” he explained to rising murmurs of dissatisfaction. “If you have concerns, reach out to your state survey agency. You can ask [surveyors to test] but you cannot block them.”

 

Leaders at LeadingAge received similar responses after inquiring with CMS.

 

“Providers may inquire about the vaccination status of a surveyor, may offer testing to the surveyor, and may request the surveyor to wear [PPE] such as a respirator for source control,” Jodi Eyigor, LeadingAge’s director of nursing home quality and policy, wrote in a blog post late last week. “Note, however, that the surveyor may refuse these provisions including refusing to disclose vaccination status, refusing testing, or refusing PPE such as a respirator, and other extra precautions.”

 

​​Federal data as of mid-June shows 87% of nursing home staff have completed their primary vaccination series, while 87.6% of residents have done the same.

 

In his NADONA address, Shulman addressed numerous topics that would be more fully and formally introduced in final guidance about the Phase 3 Requirements of Participation that was released the next day.

 

Another of the touchier topics was the concern some providers have about being able to get temporary nurse aides properly tested by CMS’s Oct. 6 deadline. The agency took away a pandemic-induced aide-training waiver earlier this spring.

 

“This is a very, very delicate balance, folks, I’m going to be completely candid,” Shulman acknowledged during his long-distance address. “On one hand, we do not want to create barriers for facilities to retain staff. On the other hand, we are seeing significant issues related to staff not being trained and certified. We want to be very careful about how we proceed here. We’re going to try to thread that needle the best we can.”