On Wednesday, April 9, 2020, the Centers for Medicare and Medicaid Services (“CMS”) hosted a call entitled “COVID-19 with Nursing Homes.” CMS leadership aimed to provide updates on the agency’s latest guidance, joined by leaders in the field interested in sharing best practices with their peers.

CMS was represented on the call by Jean D. Moody-Williams, RN, MPP, the Acting Director of the Center for Clinical Standards and Quality. Ms. Moody-Williams began the call by detailing the guidance and actions CMS has already taken, including the April 2, 2020 long-term care (“LTC”) facility recommendations released with the CDC, the March 23, 2020 announcement of infection control surveys and guidance regarding the prioritization of survey activities, and the March 13, 2020 guidance advising nursing homes to restrict visitors.  Ms. Moody-Williams advised that CMS is still conducting infection control surveys and encourages nursing homes to utilize the Self-Assessment Infection Control checklist included in the March 23 prioritization guidance.

Ms. Moody-Williams also stated that while CMS recognizes the volume of residents with whom nursing homes are dealing and the unique circumstances and challenges this pandemic presents, CMS strongly recommends nursing homes set aside time to observe and train their workers to ensure compliance with the April 2 recommendations. The key points of the April 2 guidance include complying with the infection control guidance, implementing symptom screening, ensuring staff appropriately use PPE, separating staff teams for COVID-19-positive patients, and separating COVID-19-positive and unknown status patients from COVID-19-negative patients by facility or unit. The guidance also urges state and local leaders to consider the needs of LTC facilities with respect to PPE and COVID-19 tests, especially considering Medicare is now covering the cost of tests. Ms. Moody-Williams also noted that CMS has issued additional waivers relevant to nursing homes, including waivers allowing transfers of patients based on COVID-19 status to other facilities and waiving requirements related to hospitalization, minimum data sets, and staffing data submissions.

In terms of next steps, Ms. Moody-Williams advised that the CDC is working with state health departments to contact nursing homes to assess status, learn from infection control, and share best practices from the field. She also noted that CMS is working on Q&As regarding the relaxed minimum data set requirements, including the impact on billing and reimbursement.

The call also had guest speakers to provide insight on what is happening on the ground. The first speaker was a representative from Minnesota Association of Geriatrics Inspired Clinicians (“MAGIC”) who advised early planning is key, particularly in designating COVID-19-positive dedicated facilities, floors, and dedicated isolation. The MAGIC representative also discussed the key things working in Minnesota, including early closure to visitors, limited interfacility travel by therapists, hospice personnel, and providers, and provider calls to discuss operational difficulties and to check in on patients. The MAGIC representative noted that the telehealth visits were very well-received by patients.

The second speaker was a representative from an LTC center in Virginia. She emphasized that facilities in the area were engaging in unprecedented resource sharing. She detailed what was working for them as well, in addition to the above, including quarantining new admissions for whom they did not have negative COVID-19 test; eliminating non-essential staff and creating dedicated staff, including exclusivity agreements with contracted and on-call staff and providers; providing iPads for visitors and physicians and window visits, Skype, and FaceTime for family; and finding creative solutions for group activities, such as “six-foot bingo” in which the players stay six feet away from each other.

CMS noted that any questions can be sent to covid-19@cms.hhs.gov.

This article is not an unequivocal statement of the law, but instead represents our best interpretation of where things currently stand.  This article does not address the potential impacts of the numerous other local, state and federal orders that have been issued in response to the COVID-19 pandemic, but which are not referenced in this article.