CMS Revises Memo on Infection Control and Prevention of COVID-19

WASHINGTON, D.C. (April 24, 2020)—The Quality, Safety, and Oversight Group of the Centers for Medicare & Medicaid Services (CMS) revised a memo addressing guidance for infection control and prevention concerning COVID-19 in home health agencies (HHAs) and religious nonmedical health care institutions (RNHIs). The memo was originally released on March 10, 2020 and was revised April 23, 2020. Even though it is titled for home health agencies and RNHIs, there is additional information about CMS waivers and regulations, CDC guidance for optimizing personal protective equipment and return to work criteria for health care personnel with confirmed or suspected COVID-19.

In addition to HHAs, hospices may find this memo of interest, as it includes recommendations for visitation in residential facilities not certified by Medicare (i.e., assisted living facilities and independent living facilities). NAHC understands more guidance is coming from CMS that is specific to hospices but that information has not yet been released.

In this revised memo, CMS also adds guidance for RNHCIs related to addressing potential and confirmed COVID cases and mitigating transmission including screening, treatment, and transfer to higher level care (when appropriate).

Regarding HHA access to residents in assisted living and independent living facilities, CMS states the following:

CMS does not regulate these facilities, as they are subject to state jurisdiction. HHAs are encouraged to coordinate with assisted living/independent living facilities to assure services related to direct clinical care can be provided in an appropriate and safe manner. HHAs serve an important role in providing essential healthcare services in a variety of community-based settings, including assisted and independent living facilities. However, if the HHA staff are appropriately wearing PPE, and do not meet criteria for restricted access, they should be allowed to enter and provide services to the patient. Visit CMS guidance here. HHA personnel should participate in any screening activity that the facility requires. If access is restricted, HHAs should communicate with the facility administration, including the state or local health department when indicated, on the nature of the restriction and timing for gaining access to HHA patients. This communication is essential for maintaining surveillance and preventing the spread of infection while also ensuring access of patients to essential home care services. HHAs should ensure they follow the CDC guidelines for restricting access for health care workers found here, and engage in discussions with facility administration regarding adherence to CDC guidance when restrictions are imposed absent a directive from the State or Local health department that is specific for that facility.

CMS also addressed the use of telehealth in HHAs and waivers applicable to HHAs in the questions and answers below. For more detailed information on these two topics, providers should access the NAHC Home Health FAQ: Telehealth, NPP, and CoP Waivers document.

Q: Is there flexibility for the use of telehealth in HHAs during the COVID-19 Public Health Emergency (PHE)?

A: On March 30, 2020, CMS released an interim final rule that expands access to telehealth services in home health agencies during the PHE. For more information, visit the Coronavirus Waivers & Flexibilities website here.

Q: Are waivers to HHA requirements being considered during the COVID-19 PHE?

A: Yes, CMS announced the release of several blanket waivers intended to provide flexibilities for HHAs during the public health emergency for COVID-19. For example, CMS is waiving onsite visits for supervision, and allowing for additional time to complete and submit OASIS data. Individual waiver requests will be reviewed by CMS on a case-by-case basis. For more information, visit the Coronavirus Waivers & Flexibilities website here.