Thursday, April 9, 2020

News

• CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week
• COVID-19: Dear Clinician Letter
• COVID-19: Non-Emergent, Elective Medical Services and Treatment Recommendations
• Quality Payment Program: MIPS Extreme and Uncontrollable Circumstances Policy in Response to COVID-19
• Multi-Factor Authentication Requirement Delayed for PECOS, I&A, and NPPES
• Open Payments: Pre-Publication Review and Dispute through May 15

Claims, Pricers & Codes

• Pneumococcal Pneumonia Vaccination: Eligibility Transactions Includes DOS Starting April 13

Events

• Ground Ambulance Organizations: Data Collection for Medicare Providers Call — May 7

MLN Matters® Articles

• Supplier Education on Use of Upgrades for Multi-Function Ventilators
• Second Update to CR 11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) — Revised

Publications

• Civil Rights, HIPAA, and COVID-19
• Medicare Advance Written Notices of Noncoverage — Revised
• Medicare Preventive Services — Revised
• Medicare Preventive Services Poster — Revised

View this edition as PDF (PDF)

News

CMS Approves Approximately $34 Billion for Providers with the Accelerated/Advance Payment Program for Medicare Providers in One Week

The Centers for Medicare & Medicaid Services (CMS) has delivered nearly $34 billion in the past week to the health care providers on the frontlines battling the 2019 Novel Coronavirus (COVID-19). The funds have been provided through the expansion of the Accelerated and Advance Payment Program to ensure providers and suppliers have the resources needed to combat the pandemic.

“Health care providers are making massive financial sacrifices to care for the influx of coronavirus patients,” said CMS Administrator Seema Verma. “Many are rightly complying with federal recommendations to delay non-essential elective surgeries to preserve capacity and personal protective equipment. They shouldn’t be penalized for doing the right thing. Amid a public health storm of unprecedented fury, these payments are helping providers and suppliers – so critical to defeating this terrible virus – stay afloat.”

The streamlined process implemented by CMS for COVID-19 has reduced processing times for a request of an accelerated or advance payment to between four to six days, down from the previous timeframe of three to four weeks. In a little over a week, CMS has received over 25,000 requests from health care providers and suppliers for accelerated and advance payments and have already approved over 17,000 of those requests in the last week. Prior to COVID-19, CMS had approved just over 100 total requests in the past five years, with most being tied to natural disasters such as hurricanes.

The payments are available to Part A providers, including hospitals, and Part B suppliers, including doctors, non-physician practitioners, and durable medical equipment (DME) suppliers. While most of these providers and suppliers can receive three months of their Medicare reimbursements, certain providers can receive up to six months.

The CMS Accelerated and Advance Payment Program is funded from the Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) trust funds, which are the same funds used to pay out Medicare claims each day. The advance and accelerated payments are a loan that providers must pay back. CMS will begin to apply claims payments to offset the accelerated/advance payments 120 days after disbursement. The majority of hospitals including inpatient acute care hospitals, children’s hospitals, certain cancer hospitals, and critical access hospitals will have up to one year from the date the accelerated payment was made to repay the balance. All other Part A providers and Part B suppliers will have up to 210 days to complete repayment of accelerated and advance payments, respectively.

It is important to note, this funding is separate from the $100 billion provided in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act appropriation is a payment that does not need to be repaid. The Department of Health and Human Services (HHS) will be providing additional information on how health care providers and suppliers can access CARES Act funds in the coming weeks.

The fact sheet on the accelerated/advance payment process and how to submit a request can be found here: Fact Sheet (PDF). Providers can also contact their Medicare Administrative Contractor for any questions.

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

COVID-19: Dear Clinician Letter

CMS posted a letter to clinicians that outlines a summary of actions CMS has taken to ensure clinicians have maximum flexibility to reduce unnecessary barriers to providing patient care during the unprecedented outbreak of COVID-19. The summary includes information about telehealth and virtual visits, accelerated and advanced payments, and recent waiver information.
Letter (PDF)

COVID-19: Non-Emergent, Elective Medical Services and Treatment Recommendations

CMS recently updated recommendations to postpone non-essential surgeries and other procedures to conserve critical health care resources and limit exposure of patients and staff to COVID-19. Developed in collaboration with medical societies and associations, the recommendations outline a tiered approach for state and local officials, clinicians, and delivery systems to consider to prioritize services and care to those who require emergent or urgent attention to save a life, manage severe disease, or avoid further harms from an underlying condition.
Recommendations 

Quality Payment Program: MIPS Extreme and Uncontrollable Circumstances Policy in Response to COVID-19

CMS is offering multiple flexibilities to provide relief to clinicians responding to the 2019 Novel Coronavirus (COVID-19) pandemic. In addition to extending the 2019 Merit-based Incentive Payment System (MIPS) data submission deadline to April 30 at 8 pm ET, the MIPS automatic extreme and uncontrollable circumstances policy will apply to MIPS eligible clinicians who do not submit their MIPS data by the April 30 deadline.

If you are a MIPS eligible clinician and do not submit any MIPS data by April 30, you will not need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. You will be automatically identified and will receive a neutral payment adjustment for the 2021 MIPS payment year. Note: We updated the Participation Status Tool, so you can see if the policy is automatically applied.

We are also reopening the MIPS extreme and uncontrollable circumstances application for individuals, groups, and virtual groups. An application submitted by April 30, citing COVID-19 will override any previous data submission.

For More Information:

• Quality Payment Program COVID-19 Response Fact Sheet
• Contact qpp@cms.hhs.gov or 866-288-8292 (Customers who are hearing impaired can dial 711 to be connected to a TRS communications assistant)

Multi-Factor Authentication Requirement Delayed for PECOS, I&A, and NPPES

In an effort to reduce provider burden, CMS delayed Multi-Factor Authentication (MFA) requirements for the following systems:

• Provider Enrollment, Chain, and Ownership System (PECOS):  MFA is delayed until further notice.
• Identity and Access Management System (I&A): You have a 360-day grace period to set up MFA after your first login. By September 30, 2021, you are required to use MFA to successfully access the system. Set up the appropriate surrogacy and employer connections to ensure access.
• National Plan and Provider Enumeration System (NPPES): You have a 360-day grace period to set up MFA after your first login. By September 30, 2021, you are required to use MFA to successfully access the system.

Open Payments: Pre-Publication Review and Dispute through May 15

Open Payments Pre-Publication Review and Dispute is available through May 15. During this time, covered recipients can review and if necessary dispute their attributed data prior to the annual Open Payments data publication:

• Register in the Open Payments System; see the Registration Quick Reference Guide (PDF)
• Participation is voluntary and not required under the statute

Review and dispute actions can be completed within the Open Payments system through December 31, 2020:

• Disputes initiated by the May 15 deadline will be reflected in the June 2020 data publication
• Disputes initiated after the pre-publication review and dispute period will be reflected in a later system data refresh

Open Payments COVID-19 Update:

• CMS cannot extend the pre-publication review and dispute period, but covered recipient review and dispute actions can be completed within the Open Payments system throughout the calendar year.
• We understand the health care community is working tirelessly to respond to the COVID-19 pandemic and appreciate the dedication of health care providers during this time. We remain committed to ensuring covered recipients are aware of and take advantage of their opportunity to review their data and dispute it if needed.
• Read the Open Payments Pre-Publication Review and Dispute COVID-19 Announcement.

Claims, Pricers & Codes

Pneumococcal Pneumonia Vaccination: Eligibility Transactions Includes DOS Starting April 13

Starting April 13, CMS beneficiary eligibility transactions will return the Pneumococcal Pneumonia Vaccination (PPV) Date(s) of Service (DOS) for HCPCS codes 90670 and 90732 when a beneficiary has already received the service. Eligibility transactions will also return the related National Provider Identifier (NPI): Institutional NPI for Part A or rendering NPI for Part B to help you better coordinate care. See the MLN Matters Article (PDF) for more information.

Events

Ground Ambulance Organizations: Data Collection for Medicare Providers Call — May 7

Thursday, May 7 from 2 to 3 pm ET

Register for Medicare Learning Network events.

During this call, learn how to allocate costs, collect data, and report data for the new Ground Ambulance Data Collection System.

A question and answer session follows the presentation; however, you may email questions in advance to AmbulanceDataCollection@cms.hhs.gov with “May 7 Call” in the subject line. These questions may be addressed during the call or used for other materials following the call. For more information, including ground ambulance organizations selected for the first round of reporting, see the Ambulances Services Center webpage, CY 2020 Physician Fee Schedule final rule, and Bipartisan Budget Act of 2018.

Target Audience: Ground ambulance organizations that are Medicare providers, including hospitals, critical access hospitals, skilled nursing facilities, home health agencies, comprehensive outpatient rehabilitation facilities, and hospices.

MLN Matters® Articles

Supplier Education on Use of Upgrades for Multi-Function Ventilators

A new MLN Matters Special Edition Article SE20012 on Supplier Education on Use of Upgrades for Multi-Function Ventilators (PDF) is available. Find out how you can bill for multi-function ventilators described by code E0467 as an upgrade in situations where beneficiaries only meet the coverage criteria for a ventilator.

Second Update to CR 11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) — Revised

A revised MLN Matters Article MM11632 on Second Update to CR 11152 Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) (PDF) is available. Learn about corrected edits to allow proper adherence to Medicare’s interrupted stay policy.

Publications

Civil Rights, HIPAA, and COVID-19

HHS published a bulletin on Civil Rights, HIPAA, and the Coronavirus Disease 2019 (COVID-19) to ensure that entities covered by civil rights authorities keep in mind their obligations under laws and regulations that prohibit discrimination on the basis of race, color, national origin, disability, age, sex, and exercise of conscience and religion in HHS-funded programs.

Medicare Advance Written Notices of Noncoverage — Revised

A revised Medicare Advance Written Notices of Noncoverage Medicare Learning Network Booklet is available. Learn how to:

• Complete the forms
• Collect payment

Medicare Preventive Services — Revised

A revised Medicare Preventive Services Medicare Learning Network Educational Tool is available. Learn about:

• Coding
• Coverage
• Copayment/coinsurance and deductible

Medicare Preventive Services Poster — Revised

A revised Medicare Preventive Services Poster (PDF) Medicare Learning Network Educational Tool is available. Get quick-reference information for your billing office.

CMS news letter link

You are invited to CMS “Office Hours” on COVID-19, Thursday, April 9th from 5:00 – 6:00 PM EST, the next in a series of opportunities for hospitals, health systems, and providers to ask questions of agency officials regarding CMS’s temporary actions that empower local hospitals and healthcare systems to:

• Increase Hospital Capacity – CMS Hospitals Without Walls;
• Rapidly Expand the Healthcare Workforce;
• Put Patients Over Paperwork; and
• Further Promote Telehealth in Medicare

We encourage you to submit questions in advance to partnership@cms.hhs.gov, including “Office Hours” in the subject line. There will also be live Q&A.

Dial-in details below. Conference lines are limited, so we highly encourage you to join via audio webcast, either on your computer or smartphone web browser. You are welcome to share this invitation with your colleagues and membership.

Toll-Free Attendee Dial In: 833-614-0820

Event Plus Passcode: 1881716

Audio Webcast link: https://protect2.fireeye.com/url?k=af5fe56e-f30aecbe-af5fd451-0cc47a6a52de-3f7683676ccf874e&u=https://protect2.fireeye.com/url?k=4a26f334-1672da1f-4a26c20b-0cc47a6d17cc-b5718dd23455dde2&u=https://protect2.fireeye.com/url?k=9e078944-c2528094-9e07b87b-0cc47a6a52de-a5e1651cc58bcffb&u=https://engage.vevent.com/rt/cms2/index.jsp?seid=1851

You can find a copy of the full press release and related materials here:  https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19

To keep up with the important work the White House Task Force is doing in response to COVID-19, please click here: www.coronavirus.gov. For information specific to CMS, please visit the Current Emergencies Website.

Guidance will aid clinicians in various healthcare settings to prevent and mitigate the spread

 Under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) has issued a series of updated guidance documents focused on infection control to prevent the spread of the 2019 Novel Coronavirus (COVID-19) in a variety of inpatient and outpatient care settings. The guidance, based on Centers for Disease Control and Prevention (CDC) guidelines, will help ensure infection control in the context of patient triage, screening and treatment, the use of alternate testing and treatment sites and telehealth, drive-through screenings, limiting visitations, cleaning and disinfection guidelines, staffing, and more.

The guidance is designed to empower local hospitals and healthcare systems, helping them to rapidly expand their capacity to isolate and treat patients infected with COVID-19 from those who are not. Critically, the guidance released today includes new instructions for dialysis facilities as they work to protect patients with End-Stage Renal Disease (ESRD), who, because of their immunocompromised state and frequent trips to health care settings, are some of the most vulnerable Americans to complications arising from COVID-19. The guidance is part of the unprecedented array of temporary regulatory waivers and new policies CMS issued on March 30, 2020 that gives the nation’s healthcare system maximum flexibility to respond to the COVID-19 pandemic.

“CMS is helping the healthcare system fight back and keep patients safe by equipping providers and clinicians with clear guidance based on CDC recommendations that reemphasizes and reinforces longstanding infection control requirements,” said CMS Administrator Seema Verma.

The guidance is particularly timely for dialysis facilities. Dialysis facilities care for immunocompromised Americans who require regular dialysis treatments and are therefore particularly susceptible to complications from the virus. Today’s updated guidance has multiple facets, including the option of providing Home Dialysis Training and Support services – to help some dialysis patients stay home during this challenging time – and establishment of Special Purpose Renal Dialysis Facilities (SPRDFs), which can allow dialysis facilities to isolate vulnerable or infected patients. These temporary changes allow for the establishment of facilities to treat those patients who tested positive for COVID-19 to be treated in separate locations.

In addition to dialysis facilities, the infection control guidance affects a broad range of settings including hospitals, Critical Access Hospitals (CAHs), psychiatric hospitals, Ambulatory Surgical Centers (ASCs), Community Mental Health Centers (CMHCs), Comprehensive Outpatient Rehabilitation Facilities (CORFs), Outpatient Physical Therapy or Speech Pathology Services (OPTs), Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs).

For hospitals, psychiatric hospitals and CAHs, the revised guidance, for example, provides expanded recommendations on screening and visitation restrictions, discharge to subsequent care locations for patients with COVID-19, recommendations related to staff screening and testing, and return-to-work policies.

Similarly, for hospitals and CAHs, the revised guidance on the Emergency Medical Labor and Treatment Act (EMTALA) includes a detailed discussion of: patient triage, appropriate medical screening and treatment; the use of alternate testing sites; telehealth; and appropriate medical screening examinations performed at alternate screening locations, which are not subject to EMTALA, as long as the national emergency remains in force. This step will allow hospitals and CAHs to screen patients at a location offsite from the hospital’s campus to prevent the spread of COVID-19.

For outpatient clinical settings, such as ASCs, FQHCs, and others, guidance discusses recommendations to mitigate transmission including screening, restricting visitors, cleaning and disinfection, and closures, and addresses issues related to supply scarcity, and Federal Drug Administration (FDA) recommendations. In addition, CMS encourages ASCs and other outpatient settings to partner with others in their community to conserve and share critical resources during this national emergency.

Updated guidance for ICF/IIDs, and PRTFs include practices related to screening of visitors and outside health care service providers, community activities, staffing, and more.

CMS will continue to monitor and review the impact of the COVID-19 pandemic on the clinicians, providers, facilities and programs, and will update regulations and guidance as needed.

To view the latest updates to these CMS guidance documents on infection control, go to: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page

For information on the COVID-19 waivers and guidance, and the Interim Final Rule, released on March 30, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers. 

These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov.  For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

CMS has been hosting regular calls with a variety of clinicians, hospitals, and other facilities in an effort to keep stakeholders updated on our COVID-19 efforts.  As we know not everyone is available to attend the calls live, we are happy to share that you can access recordings of the calls along with transcripts on the following link: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts. We will continue to host calls and share information through our list serves and media. 

To keep up with the important work of the White House Coronavirus Task Force in response to COVID-19, visit https:/www.coronavirus.gov.  For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

The WV Bureau for Behavior Health  would like to share the following information from ASAM (American Society of Addiction Medicine) regarding COVID-19 in residential facilities:

Infection Control and Mitigation Strategies in Residential Treatment Facilities

Purpose of the document

This document provides guidance to residential addiction treatment programs (ASAM Levels 3.1, 3.3, 3.5 and 3.7), supporting the development of infection control and mitigation procedures to address the COVID-19 pandemic. Although focused on ASAM Level 3 treatment programs with 24-hour clinical staffing, portions of the document may be useful for community living programs such as sober housing.

As community housing programs respond to the epidemic, it is recommended that they consider the overall considerations for residential treatment programs throughout this document. As always, when a person living in the community becomes ill, they should seek medical care.

COVID-19 – INFECTION MITIGATION IN RESIDENTIAL TREATMENT FACILITIES

Resources from Mental Health Technology Transfer Center (MHTTC)
MHTTC main page: https://mhttcnetwork.org/centers/global-mhttc/responding-covid-19
Responding to COVID-19: highlight products and resources can be useful when coping with the effects of widespread public health crises such as:

1. Psychosocial Impacts of Disasters: Assisting Community Leaders
2. Supportive Practices for Mental Health Professionals During Pandemic-Related Social Distancing

 
Recorded Webinars:
Substance Use Disorder Services in the Days of a Pandemic: You Need A Bigger Boat! – https://youtu.be/bRGZO7LaAqo

Upcoming webinars:
Changing the Conversation about Mental Health to Support Students During a Pandemic – April 9, 2020
https://wiche.zoom.us/meeting/register/v5csf-2gpjIuZPbtD8qPghOaNNqgvLyOjQ

Changing the Conversation About Mental Health – How do we Come Back to the New Normal? – April 13, 2020  https://wiche.zoom.us/meeting/register/uJYlcu2oqzwuXiNmGW8gO2vy5y4ovyjkOQ

Resources from Addiction Technology Transfer Center (ATTC) Resources:
Opioid Treatment Programs (OTP) Questions Regarding Sustaining Operations During the Uncertain and Turbulent Times
The American Association for the Treatment of Opioid Dependence (AATOD), American Academy of Addiction Psychiatry (AAAP) and the ATTCs are collecting questions from Opioid Treatment Programs related to sustaining care, providing support and maintaining a safe work environment for staff during these turbulent and uncertain times. We will compile all questions, work with field experts to determine responses, and develop and disseminate a “FAQ” document. https://attcnetwork.org/centers/global-attc/otp-questions-during-challenging-times-form

Compassion Fatigue and the Behavioral Health Workforce Curriculum Infusion Package This 5-part Curriculum Infusion Package (CIP) on Compassion Fatigue and the Behavioral Health Workforce was developed in 2020 by the Pacific Southwest Addiction Technology Transfer Center (PSATTC). Part 1 provides a brief overview of the behavioral health workforce and associated shortages, and introduces the demands on the workforce. Part 2 focuses on compassion fatigue and secondary traumatic stress. Part 3 provides a brief overview of how organizations can help individuals avoid experiencing burnout. Part 4 focuses on actions that behavioral health professionals can take to prevent compassion fatigue. And Part 5 focuses on self-care as an ethical duty in order to manage compassion fatigue.
https://attcnetwork.org/centers/pacific-southwest-attc/news/compassion-fatigue-and-behavioral-health-workforce-curriculum

Resources from Serious Mental Illness (SMI) Adviser
SMI Adviser Coronavirus Resources: https://smiadviser.org/about/covid

1. Resources on COVID-19 and Serious Mental Illness
2. Education Activities about COVID-19
3. COVID-19 Resources

 Recorded Webinars

1. Managing the Mental Health Effects of COVID-19 – https://education.psychiatry.org/Users/ProductDetails.aspx?ActivityID=7256&utm_source=SMI_Adviser_COVID19_Email&utm_medium=March2020
2. Telepsychiatry in the Era of COVID-19 – https://education.smiadviser.org/Users/ProductDetails.aspx?ActivityID=7257&utm_source=Email&utm_medium=WebinarEmail  

Providers Clinical Support System Resources
Live Clinical Roundtables

1. Cognitive Dysfunction Related to Methamphetamine Use with Josh Blum, MD – Thurs, April 2 – 2:00 PM-3:00 PM https://attendee.gotowebinar.com/register/5331432233149900300
2. Other clinical roundtables are in development. Contact jane@aaap.org to be added to the news distribution list  

Tip Sheet
Click here to download Telehealth Tip Sheet.
 
Recorded Webinars

1. Telepsychiatry’s Role in Medication Assisted Treatment: https://pcssnow.org/event/telepsychiatrys-role-in-medication-assisted-treatment/
2. Use of Buprenorphine in the Management of Opioid Dependence in Underserved Communities: https://pcssnow.org/event/use-of-buprenorphine-in-the-management-of-opioid-dependence-in-underserved-communities/  

Online Trainings

1. Supporting Providers After Overdose Death: https://learning.pcssnow.org/p/SupportingProviders
2. Grief and Managing an Overdose Death: https://pcssnow.org/event/grief-and-managing-an-overdose-death/ • Related resource document: https://pcssnow.org/resource/grief-and-overdose-death-2/
3. Young adult seeking treatment after overdosing: https://pcssnow.org/education-training/training-courses/teenager-seeking-treatment-after-overdosing-part-1/
4. Partnering with Pharmacists: Naloxone Prescribing and Dispensing to Prevent Overdose Deaths: https://pcssnow.org/event/partnering-with-pharmacists-naloxone-prescribing-and-dispensing-to-prevent-overdose-deaths-aoaam/
5. Stress, Relaxation, and Mindful Breathing: A Primer: https://pcssnow.org/education-training/training-courses/9-stress-relaxation-mindful-breathing-primer/

 Initial Patient Contact about Buprenorphine Checklist
https://opioidresponsenetwork.org/ResourceMaterials/Sample-Initial-Patient-Contact-about-Buprenorphine.pdf 

American Osteopathic Academy of Addiction Medicine webinar titled Telemedicine:
Getting Started, Regulations and Privacy Issues.
https://education.aoaam.org/products/telemedicine-getting-started-regulations-and-privacy-issues-3272020#tab-product_tab_overview

Compassionate Fatigue and Self Care Recorded Webinar
Compassionate Fatigue and Self Care: For Helping Professionals Working with Opioid Related Disorders https://opioidresponsenetwork.org/admin/ResourceDetails.aspx?resourceID=9338

Care of Homeless Patients with Opioid Use Disorders – Manual
Adapting Your Practice: Recommendations for the Care of Homeless Patients with Opioid Use Disorders – https://opioidresponsenetwork.org/admin/ResourceDetails.aspx?resourceID=4162

Apr 02, 2020  Press release – CMS – Nursing facilities

Today, at the direction of President Trump, the Centers for Medicare & Medicaid Services (CMS), in consultation with the Centers for Disease Control and Prevention (CDC), issued critical recommendations to state and local governments, as well as nursing homes, to help mitigate the spread of the 2019 Novel Coronavirus (COVID-19) in nursing homes. The recommendations build on and strengthen recent guidance from CMS and CDC related to effective implementation of longstanding infection control procedures.

Nursing homes (also known as “skilled nursing facilities” under the Medicare program and “nursing facilities” under Medicaid; or “long-term care facilities”) have become an accelerator for the virus because residents, who are generally vulnerable to complications from the virus, are even more so in an enclosed environment like a nursing home. In one Maryland nursing home, COVID-19 cases grew from one confirmed case one day to 64 confirmed cases the next. Hundreds of facilities across the country are experiencing increased numbers of cases among residents. To address this spread, CMS, which inspects Medicare-participating facilities to ensure compliance with Federal safety rules, has worked hand-in-hand with CDC to provide nursing homes with clear guidance on how they can keep their residents safe. Most recently, on March 13, CMS issued guidance that advised nursing homes to restrict visitors, helping prevent introduction of the virus into these facilities.

Additionally, on March 23, CMS announced new, focused infection control surveys intended to assess facilities’ compliance with infection control requirements to ensure they are prepared to address the COVID-19 threat. In the initial wave of surveys during the week of March 30, CMS found that 36 percent of facilities inspected in recent days did not follow proper hand washing guidelines and 25 percent failed to demonstrate proper use of personal protective equipment (PPE). Both of these are longstanding infection control measures that all nursing homes are expected to follow per Federal regulation. CMS is continuing to conduct targeted infection control inspections to ensure nursing homes are prepared to confront COVID-19 and keep their residents safe.  Finally, Medicare is now covering COVID-19 testing when furnished to eligible beneficiaries by certified laboratories. These laboratories may also choose to enter facilities to conduct COVID-19 testing.

The recommendations announced today include:

• Nursing homes should immediately ensure that they are complying with all CMS and CDC guidance related to infection control.
• As nursing homes are a critical part of the healthcare system, and because of the ease of spread in long term care facilities and the severity of illness that occurs in residents with COVID-19, CMS/CDC urges State and local leaders to consider the needs of long term care facilities with respect to supplies of PPE and COVID-19 tests.
• Nursing homes should immediately implement symptom screening for all staff, residents, and visitors – including temperature checks.
• Nursing homes should ensure all staff are using appropriate PPE when they are interacting with patients and residents, to the extent PPE is available and per CDC guidance on conservation of PPE.
• To avoid transmission within nursing homes, facilities should use separate staffing teams for residents to the best of their ability, and, as President Trump announced at the White House today, the administration urges nursing homes to work with State and local leaders to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown COVID-19 status.

“The Trump Administration is calling on the nursing home industry and state and local leaders to join us by taking action now to ensure the safety of their residents, who are among our most vulnerable citizens. The Administration urges them to carefully review our recommendations, and implement them immediately,” said CMS Administrator Seema Verma.

Today’s recommendations will help State and local governments, and nursing homes, as they consider creative ways to stop the spread of the virus, such as designating units within facilities – or entire facilities – solely for residents with confirmed COVID-19. An example of such an arrangement is in Wilmington, Massachusetts, in which a 142-bed facility has been designated as a solely COVID-19-positive facility. Residents across the region who are infected with COVID-19 can be moved to this facility to receive appropriate care and avoid transmitting the virus within their facilities. This approach also eases the challenges of preventing transmission, like extensive PPE usage and isolation practices, for individual facilities. The Massachusetts arrangement, developed in coordination with the state’s government, is a prime example of the arrangements envisioned in the recommendations announced today.

The recommendations also speak to enhanced screening and transmission prevention practices. Previous CMS guidance, developed with CDC and issued in mid-March, advised nursing homes to restrict all but the most urgent visitors and staff. Today’s guidance builds on this by recommending temperature screenings for all visitors and that all staff utilize adequate PPE when interacting with patients, to the extent PPE is available.

Nursing homes are unique in the healthcare system because, unlike other healthcare facilities, they are full-time homes as well as settings of care. Importantly, nursing home residents, given their advanced age and corresponding health issues, are at particular risk of complications arising from COVID-19. Because they are large concentrations of particularly vulnerable individuals, nursing homes have been a major focus for the Trump Administration in its aggressive efforts to combat the virus.

This action, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov.  For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

### 

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.