Health Law Daily CMS issues Coronavirus protection, prevention guidance for hospitals and nursing homes
Thursday, March 5, 2020

CMS issues Coronavirus protection, prevention guidance for hospitals and nursing homes

By Rebecca Mayo, J.D.

CMS has announced that it is suspending survey activity to focus on COVID-19 and has issued guidance for hospitals and nursing homes to prevent and protect patients from spreading infection.

In three new Letters to State Survey Agency Directors, CMS has announced steps it has begun taking to respond to the threat of the 2019 Novel Coronavirus (COVID-19). CMS has suspended non-emergency inspections to allow inspectors to focus on the most serious health and safety threats, including infectious diseases and abuse. Guidance for infection control and prevention has been provided for hospitals and nursing homes. CMS encourages facilities to monitor the websites of Centers for Disease Control (CDC) and local public health departments for additional information.

CMS surveys. CMS announced that survey activity will be limited, and immediate jeopardy complaints and allegations of abuse and neglect will be considered top priority. CMS will also prioritize complaints alleging infection control concerns, statutorily required recertification, revisits necessary to resolve current enforcement actions, and initial certifications. Surveys will also be done of facilities/hospitals that have a history of infection control deficiencies at the immediate jeopardy level within the last three years and facilities/hospitals/dialysis centers that have a history of infection control levels at lower levels than immediate jeopardy (CMS Letter to State Survey Agency Directors, Ref: QSO-20-12-All, March 4, 2020).

CMS included protocols for surveys done of facilities with a COVID-19 confirmed or presumptive positive case. Much of the file and report review is recommended to be done offsite, so facilities are encouraged to coordinate with the surveyors to provide that information. Interviews and observation of resident care done onsite should be done with proper protective equipment and should span no more than two days if possible. CMS also provided an infection prevention, control and immunization checklist that assigns tasks to surveyors and facility staff to complete to ensure proper precautions are taken.

Hospitals. Hospitals should screen patients immediately upon arrival to the healthcare facility to determine if visitors or patients have a fever or symptoms of a respiratory infection, if they have traveled internationally within the last 14 days to restricted countries or whether they have had contact with someone known or suspected of having COVID-19. Respiratory hygiene and cough etiquette should be implemented for patients, supplies should be provided, and they should be isolated in an examination room with the door closed. Medically stable patients may wait in their personal vehicle or outside the facility where they can be contacted by mobile phone when it is their turn to be evaluated. CMS provides further information relating to restricting visitors, transferring patients to other facilities, releasing them to self-isolate at home (CMS Letter to State Survey Agency Directors, Ref: QSO-20-13-Hospitals, March 4, 2020).

Nursing homes. Nursing home staff should be trained on infection control and prevention. Frequent monitoring for potential symptoms of respiratory infection may be required throughout the day and facilities should maintain a person-centered approach to care by communicating effectively with patients, patient representatives and/or their family, and understanding their individual needs and goals of care. Similar to hospitals, nursing home facilities should screen visitors to determine if they have travelled internationally within the past 14 days to restricted countries, if they have signs or symptoms of a respiratory infection, or if they have had contact with someone with or under investigation for COVID-19. Staff should also be screened and any providers or staff with signs or symptoms of a respiratory infection should immediately stop work, put on a face mask, and self-isolate at home. They should then notify the facility’s infection preventionist. Residents with suspected or confirmed infection with COVID-19 may not need to be transferred to a hospital immediately if the facility can follow the infection prevention and control practices recommended by the CDC. CMS also provides information relating to limiting visitors and accepting residents diagnosed with COVID-19 from a hospital (CMS Letter to State Survey Agency Directors, Ref: QSO-20-14-NH, March 4, 2020).

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