A new respiratory disease — 2019 Novel Coronavirus (COVID-19) — is spreading globally, and there have been instances of COVID-19 community spread in the United States. Symptoms of COVID-19 may vary. Some people with the illness may be asymptomatic, or may experience mild symptoms similar to the common cold or flu. However, certain people are at a much higher risk of becoming severely or even critically ill from COVID-19, including older adults, and people who have chronic illnesses such as heart disease, diabetes or lung disease. Consequently, long-term care facilities may be especially hard-hit by COVID-19, because residents are at higher risk of serious or critical illness from COVID-19, and because personnel or visitors may be asymptomatic or have very mild symptoms, which, in turn, may increase the likelihood of transmission to vulnerable residents.
The federal government has issued guidance for long-term care facilities to help combat the transmission of COVID-19.
CMS’ COVID-19 guidance for long-term care facilities
On March 13, 2020, the Centers for Medicare and Medicaid Services (CMS) issued new guidance designed to keep long-term care residents safe from COVID-19. The new measures supersede prior CMS guidance with respect to nursing home safety in the face of COVID-19. According to the most recent guidance, nursing homes should, among other things:
- Restrict all visitors, effective immediately, although there are exceptions for certain compassionate cases, like end-of-life care, in which case visitors must be equipped with personal protective equipment (PPE) like masks, and the visit must be limited to a specific room only.
- Restrict all volunteers and nonessential personnel.
- Cancel all group activities and communal dining.
- Implement active screening of residents and health care personnel for fever and respiratory symptoms.
- Screen all staff at the beginning of their shift for fever and respiratory symptoms.
In addition to these precautions, CMS noted that there may be a scarcity of some supplies due to COVID-19, and so “State and Federal surveyors should not cite facilities for not having certain supplies (e.g., PPE such as gowns, N95 respirators, surgical masks and ABHR) if they are having difficulty obtaining these supplies for reasons outside of their control.”
With regard to surveys, it should be noted that on March 4, 2020, CMS suspended all nonemergency inspections, so that surveyors can focus on “serious health and safety threats like infectious diseases and abuse.”
On March 13, 2020, CMS also waived the requirement at Section 1812(f) of the Social Security Act for a three-day prior hospitalization for coverage of a skilled nursing facility (SNF) stay, and provided temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who need to be transferred as a result of the effect of a disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, CMS authorized renewed SNF coverage without first having to start a new benefit period. Further, CMS is “waiving 42 CFR 483.20 to provide relief to SNFs on the time-frame requirements for Minimum Data Set assessments and transmission.”
CDC’S COVID-19 guidance for long-term care facilities
In addition to CMS, the Centers for Disease Control and Prevention (CDC) has also issued guidance to long term care facilities regarding COVID-19. Much of the CDC guidance echoes CMS’s guidance, above, but the CDC guidance also includes a comprehensive checklist for developing a COVID-19 response plan.
Facilities should follow the enhanced infection control recommendations of CMS and the CDC, and should monitor residents and employees carefully for any sign of respiratory illness. Any facilities concerned that a resident, visitor or employee may have COVID-19 should contact their local or state health department immediately for consultation and guidance.
Dana P. Petrillo is counsel at White and Williams LLP. Dana advises and represents healthcare entities, including hospitals, health systems, physician practices, long-term care providers and payers, in a wide variety of complex regulatory, compliance and litigation matters. For more information on White and Williams LLP, please visit https://www.whiteandwilliams.com/.