CMS Issues Updated COVID-19 Infection Control Guidance for Various Inpatient and Outpatient Settings

On April 8, 2020, the Centers for Medicare & Medicaid Services (CMS) issued updated infection control guidance, based on Centers for Disease Control and Prevention (CDC) guidelines, to prevent the spread of COVID-19 in various inpatient and outpatient care settings. The guidance is part of the array of temporary waivers and policies CMS issued on March 30, 2020 that seek to mobilize healthcare providers with flexibility to respond to the COVID-19 pandemic.

Importantly, CMS’s updated infection control guidance includes multiple facets designed to assist dialysis facilities in protecting immunocompromised patients who require regular dialysis treatments. These include the option to utilize Home Dialysis Training and Support services (to allow some dialysis patients the option to stay home during the pandemic) as well as the establishment of Special Purpose Renal Dialysis Facilities (SPRDFs), which can allow dialysis facilities to isolate vulnerable or infected patients.

Although a significant portion of CMS’s updated guidance relates to dialysis facilities, the guidance also addresses 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 includes 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: appropriate medical screening and treatment to screen and identify COVID-19 patients; the use of alternate testing sites; completion of medical screening exams via telehealth technology; triage protocols and the use of appropriate qualified staff to redirect patients to alternate locations, and appropriate medical screening examinations performed at alternate screening locations, which are not subject to EMTALA during the COVID-19 national emergency.

For outpatient clinical settings, such as ASCs, FQHCs, and others, the guidance discusses recommendations such as restricting visitors, cleaning and disinfection, and closures to mitigate transmission.

The guidance also addresses issues related to supply scarcity, confirming that State and Federal surveyors should not cite healthcare facilities for not having certain supplies (e.g., PPE such as gowns, N95 respirators, surgical masks, etc.) if they are having difficulty obtaining these supplies for reasons outside of their control.   It is important that facilities document these difficulties, even if in emails or other less formal mechanisms, as support should State or Federal surveyors attempt to take adverse action.

The guidance for outpatient clinical settings also provides information related to Federal Drug Administration (FDA) initiatives to expand access to respirators through emergency use authorizations. In addition, the guidance encourages ASCs and other outpatient settings to partner with others in their community to conserve and share critical resources during this national emergency.

Along the same lines, the updated guidance for ICF/IIDs, and PRTFs includes recommendations related to screening of visitors, staff, and health care service providers, addressing supply scarcity and staff shortages, as well as modifications to community activities to comply with CDC guidelines (e.g., avoid gatherings of more than 10 individuals for high-risk populations and go into the community only for essential activities).

CMS guidance for healthcare facilities related to COVID-19 is compiled and available at the website of the Emergency Preparedness and Responsiveness Operations division of CMS.