CMS Issues Guidance to Mitigate the Spread of COVID-19 in Long-Term Care Facilities

On April 2, 2020, the Centers for Medicare and Medicaid Services (CMS), in consultation with the Centers for Disease Control and Prevention (CDC), issued critical guidance to nursing homes and state and local governments to mitigate the spread of COVID-19 in long-term care facilities. While CMS and the CDC have already taken action to address the spread of COVID-19 in long-term care facilities nationwide, CMS and CDC experts have determined that more action is necessary. Therefore, CMS and the CDC are recommending the following immediate actions:

Comply with all CMS and CDC Guidance related to COVID-19.

• Long-term care facilities (e.g., nursing homes) should immediately ensure that they are in compliance with all CMS and CDC guidance related to infection control, including CMS’ Targeted Plan for Healthcare Facility Inspections in light of COVID-19. The infection control guidance includes a self-assessment tool that long-term care facilities should utilize to ensure they have enacted proper policies and procedures to prevent the spread of COVID-19. Facilities should also adhere to prior guidance issued by the CDC regarding appropriate hand hygiene.

State and local governments should consider the needs of long-term care facilities regarding PPE and COVID-19 tests.

• Due to the increased risk to nursing home patients (due to their age) and the rate at which COVID-19 has spread through long-term care facilities, CMS urges state and local leaders to take action to assist in mitigating the spread of COVID-19 in such facilities. Specifically, CMS recommends that state and local health departments work together with long-term care facilities to determine and address their need for PPE and/or COVID-19 tests. Note that Medicare is now covering COVID-19 testing when furnished to eligible beneficiaries by certified laboratories. Moreover, such laboratories are permitted to enter facilities to conduct COVID-19 testing.

Implement symptom screenings for COVID-19.

• All long-term care facilities should immediately implement symptom screening for individuals entering the facility, in accordance with prior CMS guidance regarding COVID-19 in nursing homes. This includes screening the following individuals: residents, staff, visitors, outside healthcare workers, vendors, etc. Facilities should also limit access points and ensure screening stations are set up at every accessible entrance. Further, every resident should be assessed for COVID-19 symptoms and have their temperature checked each day. If COVID-19 tests are available, nursing home residents should be screened by testing.
• Note that Emergency Medical Service (EMS) workers are exempt from the screening requirements when responding to urgent medical needs. Such workers are generally screened separately.

Ensure all staff use appropriate PPE when interacting with residents/patients.

• CMS acknowledges that personal protection equipment (PPE) may not always be available, however, to the extent possible, it urges facilities to ensure all staff utilize appropriate PPE when interacting with residents. CMS recommends all facility personnel wear a facemask while in the facility. Full PPE per CDC guidelines should be utilized when caring for a resident known or suspected to be infected with COVID-19. If COVID-19 transmission occurs in the facility, its personnel should utilize full PPE while caring for all residents. Facilities should advise their residents to cover their mouth and nose (with cloth, non-medical masks or tissue) whenever staff are in their room. Residents should not use medical facemasks unless they are COVID-19-positive. Further, facilities should adhere to CDC guidance on optimization of PPE.

Utilize consistent assignment of staffing teams.

• CMS recommends long-term care facilities to utilize consistent assignment of its staff to mitigate the spread of COVID-19. This means facilities should, to the extent possible, consistently assign the same staff to the same residents. Additionally, facilities should have separate staffing teams for COVID-19-positive and COVID-19-negative residents. Not only will this ensure the staff become more familiar with their patients (making it able to notice emerging condition changes), the number of different staff interacting with each resident will be decreased. Further, facilities should ensure, to the extent possible, that staff do not work across units or floors.
• Facilities should also separate any residents that are COVID-19-positive from other residents. To accomplish this, long-term care facilities should work with state and local governments to designate certain facilities as COVID-19-positive care centers and coordinate care of patients at such sites. COVID-19-positive units and facilities must maintain strict infection control practices and testing protocols. Should certain long-term care facilities need to be designated as a COVID-19-positive care centers, state agencies (e.g., health departments, hospitals and nursing home associations) must ensure coordination among facilities to designate them as such and to provide adequate staff supplies and PPE.

For any questions regarding CMS’ recommendations to state and local governments and nursing homes to mitigate the spread of COVID-19, please contact your regular HLP attorney, or Partners@thehlp.com, or call (212) 734-0128 or (248) 996-8510.