U.S. Department of Health and Human Services  
Office of Inspector General 
Data S  napshot  
 
June  2021, OEI-02-20-00490  
 
COVID-19  Had  a  Devastating  Impact  on Medicare Beneficiaries 
in Nursing  Homes  During  2020  
Key Takeaways  
Why These Data  Are Important  
   2  in 5 Medicare beneficiaries in  nursing  
The COVID-19 pandemic has presented extraordinary  
homes were diagnosed with either 
challenges  for the Nations health  care system.  Nursing home 
COVID-19 or likely  COVID-19 in  2020.  
residents have been  particularly affected  by the disease, as     Almost  1,000 more  beneficiaries  died  
they are predominately elderly, tend to have underlying  per day  in April 2020  than in  April  2019.    
conditions, and live in close quarters.       Overall mortality in  nursing  homes  
increased  to 22 percent in  2020 from  17  
The media  have  chronicled the fear, loneliness, and isolation  percent  in 2019.   
residents have endured,  as well as the grief they have felt     About half  of Black,  Hispanic, and  Asian  
watching so  many peers die.  However, data on the number of   beneficiaries in nursing  homes  had  or  
nursing home residents who  were diagnosed with COVID-19  likely  had COVID-19,  and 41 percent  of  
White beneficiaries  did.  
or  likely  COVID-19  have  not been readily available, particularly 
   Understanding  the pandemics  effects  
for early in the pandemic.  Nursing homes are not required to 
on nursing home  residents  is  necessary  
report cases and deaths that occurred before May 8, 2020.  It  
if tragedies like this are  to  be  averted.  
is important that we understand the extent of the outbreaks in 
nursing homes,  including increases in deaths, to  not only 
acknowledge the pandemics toll, but to  improve efforts to  mitigate the damage of  the 
continuing pandemic, and better prepare  for future public health emergencies.   
This data snapshot provides objective, standardized data based on Medicare claims for all  
Medicare beneficiaries in nursing homes throughout the country.a   This snapshot  is  part of  an  
Office of Inspector General (OIG)  initiative focusing on COVID-19 and nursing homes.1   Recent  
work  examined infection control and complaint  surveys conducted during the early months of  
the pandemic.  2   Upcoming  work  will focus on  strategies nursing homes have used to  combat  
the pandemic.3   The goal  of this body of work is to help protect the health and safety of  the  
vulnerable  nursing home population.  
Understanding how many beneficiaries in nursing homes were affected, who they were, and 
what characteristics may have put some at greater risk  can help prevent future tragedies.  This 
data snapshot aims to  inform public health and contribute to  the body of  knowledge needed to  
combat this pandemic and protect vulnerable seniors as well as the general population.   As this 
pandemic has shown, hardships faced in nursing homes can quickly spread across the rest of the 
Nation.   
 
a  This data snapshot provides new information and is not equivalent to other previously reported data on nursing  
home COVID-19 cases and deaths.  Our analysis is based on Medicare claims data and does not include nursing home 
residents who  are not Medicare beneficiaries.  Further, our findings include  Medicare residents diagnosed with likely  
COVID and describe trends in overall  mortality of Medicare  nursing home residents, not just those with COVID-19.   Diagnoses  and  Overall Deaths  
 
2  in 5 Medicare beneficiaries in nursing homes  were 
diagnosed with  COVID-19  or likely  COVID-19  in 2020.  
About  3.1  million Medicare beneficiaries resided in nursing  
homes  in 2020.  Forty-two percent  of them1.3 million 
beneficiarieshad or likely had  COVID-19, according to 
diagnoses on their Medicare claims.  For context, about 6 
percent of the Nations popuIation were  reported to have 
been infected by the end of  December.4   Of  the 1.3 million 
Medicare beneficiaries residing in nursing homes who had 
or likely had  COVID-19,  762,594  were confirmed to have 
COVID-19  and 532,901  were diagnosed as likely  having  it, meaning COVID-19 was suspected  
but not confirmed by a positive test result.   
This analysis includes  all  beneficiaries who  were enrolled in Medicare and resided in a  nursing  
facility or  skilled nursing facility  collectively referred to here as nursing homesduring 2020.  
It determines  the number of beneficiaries who  were diagnosed  with COVID-19 or likely COVID-
19 in  a  nursing home as well  as those diagnosed in the hospital  or other care settings after  
being transferred from the nursing home.   It  also provides the overall  number of  deaths; it does 
not attribute cause of death.  See Methodology for more detailed  information on nursing home 
residency and diagnosis codes.  
The number of infected beneficiaries in nursing homes grew exponentially in the spring of 
2020.   The countrys first confirmed case of  COVID-19 was in  January  2020.5   Over the course of  
a few  weeks in the spring, the number of beneficiaries in nursing homes who had or likely had  
COVID-19 increased dramatically.  In March,  492 Medicare beneficiaries in nursing homes per 
day were diagnosed as having or likely having COVID-19.  That increased  almost  tenfold  in April,  
which averaged  more than 4,700 new cases per day.  
In total, just  over 21,000 Medicare beneficiaries were diagnosed as having or likely having  
COVID-19 from January through March 2020.  By the end of June, there were  almost  419,000 
overall.  
The number of new  COVID-19 and  
likely COVID-19 cases grew even 
higher at the end of the year.  On  
average, more than 5,800 
Medicare beneficiaries in nursing 
homes were being diagnosed  each 
day in November.  In December, 
the number topped 6,600  per day.  
By the end of December, the total  
number of cases  (1.3 million)  was  
about 62  times more than it had  
been at the end of March.   Source: OIG  analysis of Medicare data,  2021.  
Data Snapshot:  COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes   1  
During  2020, OEI-02-20-00490  
   
Source: OIG  analysis of Medicare data,  2021.  
 
Some States were impacted  more  than others.  By the end of June, more than a quarter of the 
Medicare beneficiaries in nursing homes in each of 11 States had or likely  had  COVID-19.  These 
StatesConnecticut, Delaware, District of  Columbia, Georgia, Illinois, Louisiana, Maryland, 
Massachusetts, New Jersey, New York, and Pennsylvaniawere also some of the hardest hit in 
terms of percentage of their general population that contracted the disease  during that time.6   
By the end of December,  more than half the Medicare beneficiaries in nursing homes in each of  
four  StatesConnecticut, Illinois, Louisiana, and New Jerseyhad or likely had COVID-19.  
The overall mortality rate in nursing homes  rose  32 percent in 2020.   The pandemic had far-
reaching implications for all nursing  home beneficiaries, beyond those who had  or  likely had  
COVID-19.  Among all  Medicare beneficiaries in nursing homes, 22.5  percent died in 2020, which 
is an increase of  one-third from 2019 when 17.0  percent of Medicare beneficiaries in nursing  
homes died.  This  32-percent  increase amounts to  169,291 more deaths in 2020 than if the 
mortality rate had remained the same as in 2019.  Each  month of 2020 had a higher mortality 
rate than the corresponding month a year earlier.     
Almost 1,000 more beneficiaries died per day in April 2020 than in  the previous year.   
In April 2020 alone, a total of 81,484 Medicare beneficiaries in nursing homes died.  This is 
almost 30,000 more deathsan average of  about 1,000  per daycompared to the previous 
year.  This increase in number occurred even though the nursing home population was smaller 
in April 2020.  Overall, Medicare beneficiaries in nursing homes were almost twice as likely to die  
in April 2020 than in April 2019.  In April 2020, 6.3 percent of all Medicare beneficiaries in 
nursing homes died,  whereas  3.5 percent died in April 2019.  
Data Snapshot:  COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes   2  
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  The mortality rates also rose at the end of 2020.  In November, 5.1 percent of  all Medicare 
beneficiaries in nursing homes died,  and in December that increased to 6.2 percent.  Again, 
these rates are  markedly higher than the previous year.  In November 2019, 3.6 percent of all  
Medicare beneficiaries in nursing homes died,  and,  in December 2019,  3.8 percent did.   
 
Source:  OIG  analysis of Medicare data,  2021.  
Medicare Beneficiary Characteristics  
 
About half of Black, Hispanic, and  Asian  beneficiaries in nursing homes  had or likely had 
COVID-19 in 2020.   About half  of  Black beneficiaries, Hispanic7  beneficiaries,  and Asian  
beneficiaries in nursing homes 
had or likely had COVID-19 in 
2020.  Other research has 
similarly found that Black  
individuals and Hispanic 
individuals experience higher 
rates of  COVID-19.8    
Each of these groups was  more 
likely than White beneficiaries to  
have or likely have COVID-19.  
Forty-one percent of  White 
beneficiaries in nursing homes 
Source: OIG  analysis of Medicare data,  2021.  
had or likely had COVID-19  in   Note: These categories are based  on  data from nursing  home assessments,  which  
combine  race  and  ethnicity in one  question.   This information  is intended to be  
self-reported,  but a  caregiver or staff may respond if the beneficiary  cannot.  
Data Snapshot:  COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes   3  
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  2020.   See appendix for more detailed information  for each group.   
The mortality rates for each of these four groups increased in 2020, but to different extents.  
Asian beneficiaries in nursing homes had the greatest increase,  with 27 percent dying in 2020 
compared with 17 percent the previous year.  The mortality rates for Hispanic beneficiaries in 
nursing homes and Black beneficiaries in nursing homes both reached  23 percent in 2020, up 
from 15 percent in 2019.  The mortality rate of White beneficiaries grew less relatively, increasing  
to 24 percent in 2020 from 18 percent the previous year.   
For beneficiaries in nursing homes,  age  does not appear  to be a factor in  rates of COVID-
19  infections.  All age groups of  Medicare beneficiaries in nursing homes had similar infection 
rates in 2020.   Just over 2  in 5 beneficiaries in each age groupunder 65 years, 65 to 74 years, 
75 to 84 years, and 85 years and olderhad or likely had COVID-19.   See appendix for more 
detailed information  for each group.   
Mortality rates were different across the age groups, but all increased  during the pandemic.   In 
2020, the mortality rates ranged from 12  percent in the youngest group to 30  percent of the 
oldest.  Before the pandemic, mortality ranged from 8 percent to 23 percent.   
 
Source: OIG  analysis of Medicare data,  2021.  
Gender also does not appear to be a factor in  rates of  COVID-19  infections.  Forty-three  
percent of female Medicare  beneficiaries in nursing homes had or likely had COVID-19  in 2020.  
The rate was  similar  for male beneficiaries41  percent.    
Again, mortality rose for both females and males during the pandemic.  In 2020, the mortality 
rate for female beneficiaries in nursing homes reached 21 percent, up from the pre-pandemic 
Data Snapshot:  COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes   4  
During  2020, OEI-02-20-00490  
  rate in 2019 of 16 percent.  The mortality rate for male beneficiaries increased to 24 percent  
from 19  percent.  
Dually eligible beneficiariesthose  enrolled in both Medicare and  Medicaidwere much 
more likely than Medicare-only beneficiaries to  contract  COVID-19.  Fifty-six  percent of  
dually eligible beneficiaries in nursing homes had or likely had  COVID-19  in 2020,  compared to  
29  percent of Medicare-only beneficiaries.   
Although each groups mortality rate rose  during the pandemic, the increase was greater for 
dually eligible beneficiaries.   Specifically,  26  percent of dually eligible beneficiaries in nursing  
homes died  in 2020, up from 19 percent  the previous year.  Meanwhile, the mortality rate for 
their Medicare-only counterparts  grew to 19 percent from 16  percent.   Previous research has 
shown that  dually eligible beneficiaries are generally poorer and sickerhaving low-incomes 
and multiple chronic conditions to managecompared to other Medicare beneficiaries.9    
 
Conc lusion  
 
The COVID-19 pandemic has been devastating for Medicare beneficiaries in nursing homes.  
Two  in five  Medicare beneficiaries in nursing homes either had or likely had the disease in 2020.  
From March through June, and again in November and December, the number of cases grew  
dramatically.  Some  Medicare beneficiaries in nursing homes seemed to be at greater risk than 
others.  Specifically, Black beneficiaries, Hispanic beneficiaries, and Asian beneficiaries were more 
likely than White beneficiaries to have or  likely have COVID-19.  Further, dually eligible 
beneficiaries had  significantly  higher rates of  COVID-19 infections than Medicare-only 
beneficiaries.  In addition, overall mortality for Medicare beneficiaries in nursing homes 
increased by almost a third in 2020.  Each month in 2020 had a higher mortality rate than the 
corresponding month in 2019.      
The toll  that the COVID  pandemic has taken on Medicare beneficiaries in nursing homes 
demonstrates the need  for increased action to  mitigate the effects of the ongoing pandemic 
and to avert such tragedies from occurring in the future.  OIG is committed to  understanding  
and helping to protect nursing home residents from the impacts of  COVID-19.  We recognize 
that CMS  is also committed to protecting nursing home  residents.   
 
Additional data analysis may help CMS  in its efforts.  The analyses in this report demonstrate the  
value of using Medicare data to understand the extent to which nursing  home residents 
nationwide have been affected by the pandemic, who  they were, and what characteristics are 
associated  with greater risk.  CMS currently relies on data  from the CDCs National  Healthcare 
Safety Network (NHSN) Long-Term Care Facility  COVID-19 module, which are self-reported by 
nursing homes.  Adding Medicare  claims data  could strengthen and broaden CMSs analyses.  
Unlike the NHSN, claims data cover the entire year and include demographic information about  
each beneficiary as well as information about the beneficiarys conditions and care needs.  These 
data are important to understanding the effects of the pandemic and, moving forward, could 
play an integral part in understanding health disparities within the nursing home population and  
preparing for and dealing with future public health crises.     
Data Snapshot:  COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes   5  
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  Meth odology  
 
We based this study on an analysis of data from several sources including: (1) the Minimum 
Data  Set (MDS); (2) the Medicare Enrollment Database; and (3) Medicare Parts A, B, and C claims.  
We obtained the data from CMSs Integrated Data Repository and focused our analysis on 
Medicare beneficiaries residing in nursing homes in 2020.    
Identification of Medicare Beneficiaries Residing in Nursing Homes 
We used the MDS to identify individuals who resided in nursing homes.10   The MDS includes 
assessments completed by the nursing home for each individual residing  in these facilities.  
Nursing homes must complete these assessments periodically  for all residentsincluding  
beneficiaries receiving Medicare or Medicaid.  Using each residents unique identifier, we  
matched the data from the MDS to the Medicare Enrollment  Database to  identify the residents 
who were enrolled in Medicare.11   Next, we identified the Parts A, B, and C claims for these  
Medicare beneficiaries.   
We considered a beneficiary a nursing home resident starting from the date of the first MDS 
assessment  at the facility until the date that the  beneficiary leaves the facility to go home or 
dies.  Therefore, a beneficiary who resided in a nursing home and entered a hospital  for 
treatment is still considered a nursing home resident during the time spent in the hospital.12  
Analysis of  Beneficiaries Who Had or Likely Had COVID-19  
We determined the extent to which Medicare beneficiaries residing in nursing homes were  
diagnosed as having or likely having  COVID-19 in 2020.   
We considered a beneficiary who had a diagnosis code of B97.29 or U07.1 on a claim to have a  
diagnosis of COVID-19.  The CDC designated B97.29 as an interim code to identify confirmed  
cases of COVID-19 prior to April 1, 2020.13   It later established U07.1 as the unique code to  
identify confirmed cases of the disease effective April 1.  Further, we considered a beneficiary  
who had a diagnosis code of  Z20.828 on a claim to likely have COVID-19.   The CDC designated 
Z20.828 to report suspected, possible, or probable cases of  COVID-19 prior to April and  
onward.14    
We calculated the total  number of Medicare beneficiaries in nursing homes who had or likely 
had COVID-19 in 2020.  These counts include the beneficiaries who were diagnosed  with 
COVID-19 or likely COVID-19 in a nursing home as well as those diagnosed in other care 
settings after being transferred from the  nursing home.  For each Medicare beneficiary in a  
nursing home, we determined if the beneficiary was diagnosed with COVID-19, likely COVID-19, 
or neither.   If a beneficiary is diagnosed at one point with likely COVID-19 and later diagnosed  
with COVID-19, we considered  that beneficiary to be diagnosed with COVID-19  as opposed to  
likely COVID-19.   
 
We also calculated the total number of  Medicare beneficiaries residing in  nursing homes who 
died during this period.  These counts include the beneficiaries who died in the nursing home as 
Data Snapshot:  COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes   6  
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  well  as those who died  in the hospital  or other health care settings, such as hospice, after being 
transferred from the nursing home.   We calculated for each month the number of Medicare 
beneficiaries diagnosed  as having or likely having COVID-19.  We also calculated the number of  
Medicare beneficiaries residing in nursing homes  who died.  We used the date of death from the 
Social Security Administration, which is contained in the Medicare Enrollment Database, to  
identify those beneficiaries who died.    
Next, we compared the number of  all  Medicare beneficiaries in nursing homes  in 2019  and the 
number of  all  Medicare beneficiaries in nursing homes who died  in  2019.  We did the same for 
2020.  We also calculated similar statistics per month to identify any trends.   
  
Analysis of  Beneficiary Characteristics 
We described the Medicare beneficiaries residing in nursing homes who  had or likely had  
COVID-19 in 2020.  To do so, we analyzed the information on age, gender, and Medicare 
eligibility (e.g., Medicare-only, dually eligible for Medicare and Medicaid)  from the Medicare 
Enrollment Database.   We analyzed race and ethnicity information from the MDS.15    
For each characteristic, we determined the extent to which Medicare beneficiaries in nursing 
homes who  had or likely had COVID-19 differed from other Medicare beneficiaries in nursing  
homes.  In addition, for each characteristic, we compared the percentage  of Medicare 
beneficiaries in nursing homes who died in 2020 to those who died in the 2019.  
Limitations  
This study determines the number of Medicare beneficiaries residing in nursing homes who had  
or likely had COVID-19 based on Medicare claims data; it does not include a review  of medical  
records.  It also determines the number of Medicare beneficiaries who died; it does  not  include a  
review of death certificates  nor determinations about whether COVID-19 was the cause of death  
for these beneficiaries.   The race and ethnicity categories used in this report are based on data  
from nursing home assessments, which combine race and ethnicity in one question.  This 
information is intended to be self-reported, but a caregiver or staff may respond  if the 
beneficiary cannot.  
 
Standards  
 
We conducted this study in accordance with the Quality Standards for Inspection  and Evaluation  
issued by the Council  of  the Inspectors General on Integrity and Efficiency.   
 
 
 
 
 
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  Appendix A    
 
Beneficiary Characteristics  
Exhibit A-1: COVID-19 Rates  by Race and Ethnicity of  Nursing Home 
Beneficiaries  
Number of 
Beneficiaries  Percentage Who 
Race/Ethnicity  
in Nursing  Had  or  Likely Had  Percentage  
Homes   COVID-19   Who Died*  
Asian   48,691   47%   27%  
Black   354,241   51%   23%  
Hispanic   139,995   49%   23%  
White   2,241,441   41%   24%  
Source:  OIG  analysis of Medicare data,  2021.  
*This  refers to  the percentage of  Medicare  beneficiaries in nursing  homes  who died  from  any cause.   
These categories  are based on  data from nursing home assessments, which combine race and ethnicity in one  
question.  This information is intended to be  self-reported,  but a  caregiver or staff may respond if the  
beneficiary cannot.  
 
Exhibit A-2:  COVID-19 Rates by  Age  of Nursing Home Beneficiaries  
Number of 
Age  
Beneficiaries  Percentage Who 
in Nursing  Had  or  Likely  Had  Percentage  
Homes    COVID-19   Who Died*  
Under 65 years   282,397   44%   12%  
65 to 74 years   709,973   42%   16%  
75 to 84 years   956,507   42%   21%  
85 years and  older   1,127,874   42%   30%  
Source:  OIG  analysis of Medicare data,  2021.  
*This  refers to the percentage of  Medicare  beneficiaries in nursing  homes  who died  from  any cause.   
 
 
Data Snapshot:  COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes   8  
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  Ackn owledgements  
 
Jenell Clarke-Whyte served as the team leader for this study.  Other Office of Evaluation and  
Inspections staff  from the New York  regional office who conducted the study include  Rachel 
Bryan,  Sarah Guyer, Heather Koenig, and  Melanie Tsang.  Office of Evaluation and Inspections 
staff  who provided support include Joe Chiarenzelli.  We would also  like to acknowledge the 
contributions of other Office of Inspector General staff, including Robert Gibbons.  
This report was prepared under the direction of  Jodi  Nudelman, Regional Inspector General for 
Evaluation and Inspections in the New York regional office, and Nancy Harrison and  Meridith 
Seife, Deputy Regional Inspectors General.  
 
Contact  
To obtain additional information concerning this report, contact the Office  of Public  Affairs at  
Public.Affairs@oig.hhs.gov.  OIG reports and other information can be found on the OIG website 
at  oig.hhs.gov.  
Office of Inspector General 
U.S.  Department of Health and Human Services  
330 Independence Avenue, SW 
Washington, DC 20201  
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    EndOnpoiotieds O   verdoses 
 
 
1  OIG,  COVID-19 Portal.  Accessed at  https://oig.hhs.gov/coronavirus/index.asp. U.S. Department of Health and  
Human Services, Office of Inspector General,  Operation CARE: Caring, Awareness, &  Resources for Our Elders.   
Accessed at  https://oig.hhs.gov/fraud/care/index.asp  on March 11, 2021.  
2  OIG,  Onsite Surveys of Nursing Homes During the COVID-19 Pandemic:  March 23May 30, 2020,  
OEI-01-20-00430, December  2020.   
3  OIG Work Plan,  Meeting the Challenges Presented by COVID-19:  Nursing Homes.   Accessed at  
https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000474.asp  on January 29, 2021.  
4  The COVID Tracking Project at The Atlantic,  National Data: Cases.  Accessed at  
https://covidtracking.com/data/national/cases  on March 18, 2021.   The total confirmed and probable  cases  for the  
total population as of  December 31, 2020 is reported  as 19,864,374.   United States Census Bureau,  2020 Census  
Apportionment Results, Table 2. Resident Population for the 50 States, the District of Columbia, and Puerto Rico: 2020 
Census.   Accessed at  https://www.census.gov/data/tables/2020/dec/2020-apportionment-data.html  on May 6, 2021. 
The United States population, including Puerto Rico,  in 2020 as determined by the U.S.  Census was  334,735,155.  
5  Holshe, M.L., et al. (2020). First Case of 2019 Novel Coronavirus in the United States.  New England Journal  of 
Medicine,  382, 929-936.  
6  The COVID Tracking Project at The Atlantic,  The Data: Data by State, Cases: Historical Data.  Accessed at  
https://covidtracking.com/data  on March 11, 2021.   United States Census Bureau,  2020 Census Apportionment Results, 
Table 2. Resident Population for the 50 States, the District of Columbia, and Puerto Rico:  2020  Census.   Accessed at  
https://www.census.gov/data/tables/2020/dec/2020-apportionment-data.html  on May 6, 2021.   The percentage of  
each States population that had contracted COVID-19 was calculated using confirmed and probable case totals as of 
June 30, 2020,  and  the  state population  results of the 2020 Census.  
7  Hispanic refers to beneficiaries identified as  Hispanic or Latino.   
8  For example, CMS found that  Black Medicare beneficiaries and Hispanic Medicare  beneficiaries have experienced 
higher rates of COVID-19 compared to White beneficiaries.   See CMS,  Preliminary Medicare COVID-19 Data Snapshot.  
Accessed at  https://www.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot  on 
May 13, 2021.   Likewise, a recent review  examining the association between COVID-19 infections, hospitalization, and  
mortality and race and ethnicity in the general population concluded that  Black individuals and Hispanic individuals  
experienced disproportionately higher rates  of COVID-19 compared to White individuals.   See Mackey, K., et al (2021).   
Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths.   Annals of Internal  
Medicine,  174(3), 362-373.  
 
9  CMS,  People Dually Eligible for Medicare  and  Medicaid.  Accessed at  https://www.cms.gov/Medicare-Medicaid-
Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-
Office/Downloads/MMCO_Factsheet.pdf  on December 17,  2020.  CMS,  Medicare-Medicaid Coordination Office FY 2019  
Report to Congress.  Accessed at  https://www.cms.gov/files/document/mmco-report-congress.pdf  on December 17,  
2020.   Medicare Payment Advisory Commission,  Data book: Beneficiaries dually eligible for Medicare and Medicaid 
January 2018, p. 3.  Accessed at  http://medpac.gov/docs/default-source/data-
book/jan18_medpac_macpac_dualsdatabook_sec.pdf  on December 17, 2020.  
 
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10  We also used the Medicare Parts A and C Skilled Nursing Facility claims to identify additional beneficiaries residing 
in nursing homes, typically for beneficiaries in swing-bed hospital stays when MDS assessments were not readily  
accessible.  
11  We matched the unique  identifier for  each resident from the MDS along with the residents name, sex, and date of  
birth to the Medicare Enrollment Database to confirm the identity of the nursing home resident and  identify those  
who were enrolled  in Medicare.   
12  For  our analysis, if 150 days elapsed since the last MDS assessment and a discharge or date of death  was  not 
noted, a beneficiary is assumed to have been discharged home and is no longer considered a nursing home resident.  
CMS considers that, if a resident has  not had a MDS transaction for 150 days, the resident is assumed to have been 
discharged.   See CMS,  MDS 3.0 Frequency  Report.  Accessed at  https://www.cms.gov/Research-Statistics-Data-and-
Systems/Computer-Data-and-Systems/Minimum-Data-Set-3-0-Public-Reports/Minimum-Data-Set-3-0-Frequency-
Report  on April 21, 2021.  
 
13  CDC,  ICD-10-CM Official Coding GuidelinesSupplement Coding encounters related to COVID-19 Coronavirus 
Outbreak  (February 20, 2020March 31, 2020).  Accessed at  https://www.cdc.gov/nchs/data/icd/interim-coding-
advice-coronavirus-March-2020-final.pdf  on July 20, 2020.   See also, American Health Information Management 
Association (AHIMA),  AHIMA  and AHA FAQ: ICD-10-CM/PCS Coding for COVID-19.  Accessed at  
https://journal.ahima.org/ahima-and-aha-faq-on-icd-10-cm-coding-for-covid-19/  on December 15, 2020.  Since this  
code was not exclusive to the  coronavirus responsible for COVID-19, providers were urged to limit the assignment of  
B97.29 to confirmed cases of  COVID-19.  See also CDC,  ICD-10-CM Official Coding and Reporting Guidelines  (April 1,  
2020,  through September 30, 2020).  Accessed at https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf  
on July 20,  2020.      
14  CDC,  ICD-10-CM Official Coding GuidelinesSupplement Coding encounters related to COVID-19 Coronavirus 
Outbreak  (February 20, 2020-March 31, 2020).  Accessed at  https://www.cdc.gov/nchs/data/icd/interim-coding-
advice-coronavirus-March-2020-final.pdf  on July 20,  2020.  See also CDC,  ICD-10-CM Official Coding and  Reporting 
Guidelines  (April 1, 2020,  through September 30, 2020).  Accessed at https://www.cdc.gov/nchs/data/icd/COVID-19-
guidelines-final.pdf  on July 20, 2020.      
15  During MDS assessment, nursing home residents (or their  representative,  if residents are  unable to respond) select 
one or more categories from six race and  ethnicity optionsAmerican Indian or Alaska Native, Asian,  Black or African  
American, Native Hawaiian or  Other Pacific Islander, White, and Hispanic or  Latino.  See Office of Management and 
Budget,  Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity, Federal Register Vol. 62,  
No. 210, October 30, 1997.  Accessed at https://www.govinfo.gov/content/pkg/FR-1997-10-30/pdf/97-28653.pdf  on 
December 3, 2020.    
Data Snapshot:  COVID-19 Had a Devastating Impact on Medicare Beneficiaries in Nursing Homes   11  
During  2020, OEI-02-20-00490