The Centers for Medicare and Medicaid Services has issued a series of updated guidance documents focused on infection control to prevent the spread of the COVID-19 novel coronavirus in a variety of inpatient- and outpatient-care settings.
The guidance, based on Centers for Disease Control and Prevention guidelines, is designed to 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 meant to empower local hospitals and healthcare systems, and help them rapidly expand their capacity to treat patients infected with COVID-19 and isolate them from those who are not.
Critically, the guidance includes new instructions for dialysis facilities as they work to protect patients with end-stage renal disease, who, because of their immunocompromised state and frequent trips to healthcare settings, are some of the most vulnerable to complications arising from COVID-19.
The guidance is part of an array of temporary regulatory waivers and new policies CMS issued on March 30, 2020 that gives the nation’s healthcare system more flexibility to respond to the coronavirus pandemic.
WHAT’S THE IMPACT?
The guidance is particularly timely for dialysis facilities, which care for immunocompromised patients who require regular dialysis treatments – and are therefore particularly susceptible to complications from the virus.
The updated guidance has multiple facets, including the option of providing home-dialysis training and support services – to help some dialysis patients stay home at this time – and the 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, psychiatric hospitals, ambulatory surgical centers, community mental health centers, comprehensive outpatient rehabilitation facilities, outpatient physical therapy or speech pathology services, rural health clinics, federally qualified health centers, intermediate care facilities for individuals with intellectual disabilities, and psychiatric residential treatment facilities.
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 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 is meant to 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, the guidance covers recommendations to mitigate transmission, including screening, restricting visitors, cleaning and disinfection, and closures, and addresses issues related to supply scarcity, and Federal Drug Administration recommendations. CMS also encourages ASCs and other outpatient settings to partner with others in their community to conserve and share critical resources during the national emergency.
Updated guidance for ICF/IIDs and PRTFs include practices related to screening of visitors and outside healthcare 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.
ON THE RECORD
“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 long-standing infection control requirements,” said CMS Administrator Seema Verma.
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