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The Centers for Medicare & Medicaid Services (CMS) continues to offer guidance addressing the spread of novel coronavirus 2019 (COVID-19). CMS promulgates industry guidelines and standards applicable to all healthcare facilities participating in its programs, including hospitals and skilled nursing facilities nationwide. As part of its ongoing COVID-19 announcements, CMS is providing background information on COVID-19, the virus’ impact at healthcare facilities throughout the country, and CMS’s waiver of certain regulations and requirements to permit facilities to prioritize patient well-being.

Notably, CMS requires participating facilities to maintain policies and procedures to address infection control and prevent the spread of disease. In furtherance of those infection control mandates, CMS is suspending all non-emergent survey inspections, including annual and complaint inspections, in order to allow providers to focus on serious health and safety threats. Surveys and inspections for infectious disease and abuse related issues will continue. In coordination with the Centers for Disease Control (CDC), CMS has stressed the importance of proactive measures to ensure and advance patient safety and reduce the spread of COVID-19.

Specifically, CMS is still mandating surveys for:

  • All immediate jeopardy complaints (a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death or harm) and allegations of abuse and neglect.
  • Complaints alleging infection control concerns, including facilities with potential COVID-19 or other respiratory illnesses.
  • Statutorily required recertification surveys (Nursing Home, Home Health, Hospice, and ICF/IID facilities).
  • Any revisits necessary to resolve current enforcement actions.
  • Initial certifications.

Training and resources should be devoted to ensure staff awareness of precautionary and preventative measures. Facilities should be mindful of patients with risk factors for the virus and implement measures to monitor and guard against the potential spread to other patients, providers, or visitors. Additional considerations related to patient discharge are also addressed. For instances where COVID-19 is suspected and/or identified, prompt triage and isolation of infectious patients is essential to limit unnecessary exposure. Many states have local Boards of Health that must also be notified. CMS warns that facilities with deficiencies are subject to enforcement actions ranging from requests for correction plans to termination.

Prepare Your Facility – What You Should Do Now

In light of CMS’s continued guidance, centers should review their infection prevention and control policies and procedures for droplet precautions among residents and staff. Prepare your staff with refreshed training on proper hand hygiene and personal protective equipment, and their responsibility to stay home when sick. Reassure staff that it is a similar approach to closures due to weather emergencies – something they are more familiar and comfortable with.

Communication with residents and resident families is also critical.​ Centers should have a communication plan in place for how to quickly and accurately disseminate information to residents, resident families, and other responsible parties. Template letters, a dedicated “communication station,” and a designated “community liaison” are all effective preparation tools. Centers should also be prepared to handle media inquiries. Having a plan in place for the non-clinical aspects of an outbreak that can be quickly executed allows clinical staff to focus on care and the prevention of further spread.

In addition to routine infection control measures, CMS and CDC recommend centers restrict all non-essential visitation:

  • Restrict all visitation except for certain compassionate care situations, such as end of life situations.
  • Restrict all volunteers and non-essential healthcare personnel (HCP), including non-essential healthcare personnel (e.g., barbers).
  • Cancel all group activities and communal dining.
  • Implement active screening of residents and HCP for fever and respiratory symptoms.

Centers should also implement steps to minimize the risk of outbreak created by essential visitors, including day-to-day staff. “Handwashing” stations should be set up at all entrances and common areas with alcohol based hand sanitizers. Centers should ensure they are well-stocked with soap and other infection control equipment. Finally, centers should educate and encourage families and visitors to “visit” through alternative means, such as telephone, Skype, or FaceTime.

For more information, please visit CMS’s website. Buchanan Ingersoll & Rooney has established a COVID-19 response team and stands ready to answer questions or concerns related to facility compliance and practices.

This article, originally published March 9, 2020, was revised and updated March 16, 2020.
For more cutting-edge perspectives on the legal and business implications of COVID-19, visit our COVID-19 resource hub.