CMS Memo: QSO-23-01-ALL: The Importance of Timely Use of COVID-19 Therapeutics

Memorandum Summary

  • Providers and suppliers, especially those delivering care in congregate care settings, should ensure their patients and residents are protected against transmission of COVID-19 within their facilities, as well as receiving appropriate treatment when tested positive for the virus.
  • Further, all providers and suppliers should continue to implement appropriate infection control protocols for COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html) and Influenza (https://www.cdc.gov/flu/professionals/infectioncontrol/index.htm).
  • This memo discusses the importance of the timely use of available COVID-19 therapeutics, particularly for high-risk patients who test positive for the virus.

Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/importance-timely-use-covid-19-therapeutics.

CMS Memo: QSO-23-02-ALL: Revised Guidance for Staff Vaccination Requirements

Memorandum Summary

  • CMS is committed to taking critical steps to protect vulnerable individuals to ensure America’s health care facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
  • On November 5, 2021, CMS published an interim final rule with comment period (IFC). This rule establishes requirements regarding COVID-19 vaccine immunization of staff among Medicare- and Medicaid-certified providers and suppliers.
  • CMS is revising its guidance and survey procedures for all provider types related to assessing and maintaining compliance with the staff vaccination regulatory requirements.
  • This memorandum replaces memoranda QSO 22-07-ALL Revised, and QSO 22-09-ALL Revised, and QSO 22-11-ALL Revised to consolidate the information into a single memorandum. The guidance in this memorandum applies to all states.

Please view the latest CMS memo regarding revisions to SSF program at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/revised-guidance-staff-vaccination-requirements.

Revised Reporting Requirements for Facility Reported Incidents

As noted in the CMS memo QSO-22-19-NH Revised Long-Term Care Surveyor Guidance: Revisions to Surveyor Guidance for Phases 2 & 3, Arbitration Agreement Requirements, Investigating Complaints & Facility Reported Incidents, and the Psychosocial Outcome Severity Guide, CMS revised the guidance in Chapter 5 and related exhibits of the State Operations Manual (SOM) to strengthen the oversight of nursing home complaints and Facility Reported Incidents (FRIs). Beginning October 24, 2022, nursing homes will be required to submit the following information:

FRI – Initial Report

When reporting FRIs to the state agency, nursing homes must provide as much information as possible, to the best of its knowledge at the time of submission of the report, so the state agency can initiate action necessary to oversee the protection of nursing home residents. Initial reports must be reported immediately but not later than two hours if the allegation is abuse or the incident resulted in serious bodily injury, or not later than 24 hours if the allegation is not abuse or the incident did not result in serious bodily injury. “Serious bodily injury” means an injury involving extreme physical pain; involving substantial risk of death; involving protracted loss or impairment of the function of a bodily member, organ, or mental faculty; requiring medical intervention such as surgery, hospitalization, or physical rehabilitation; or an injury resulting from criminal sexual abuse.

Information to include in the initial report:

  • Facility name, address, and contact information of the reporter (including email address and after hours phone number if not in the facility);
  • Type of allegation (physical abuse, sexual abuse, mental/verbal abuse, deprivation of goods and services by staff, neglect, misappropriation of resident property or exploitation, injury of unknown source, suspected crime);
  • Date and time when staff became aware of the incident, name of staff person to whom the information was reported, and name of person who made the allegation;
  • Date and time administrator was notified of the incident and by whom;
  • Alleged victim(s) name, date of birth, and current location;
  • Alleged perpetrator(s) name, position, contact information;
  • When and where the incident occurred and names of any witnesses;
  • Brief description of the incident;
  • Describe any type of injury (bruise, scratch, laceration, puncture wound, fracture, bleeding, redness on the skin, etc.);
  • Describe any changes in resident behavior indicating a change in the resident’s normal baseline (crying, expressions or displays of fear, cowering, anger, withdrawal, difficulty sleeping, etc.);
  • Describe all steps taken to immediately ensure protection of resident(s), such steps could include:
  • Immediate assessment of the alleged victim and provision of medical treatment as necessary;
  • Evaluation of whether the alleged victim feels safe and if he/she does not feel safe, taking immediate steps to protect the resident, such as a room relocation and/or increased supervision;
  • Immediate notification to the alleged perpetrator’s (if a resident) and/or the alleged victim’s physician and the resident representative when there is injury, a significant change in condition or status, and/or a need to alter treatment significantly;
  • If the alleged perpetrator is facility staff, removal of the alleged perpetrator’s access to the alleged victim and other residents and assurance that ongoing safety and protection is provided for the alleged victim and other residents;
  • If the alleged perpetrator is a resident or visitor, removal of the alleged perpetrator’s access to the alleged victim and, as appropriate, other residents and assurance that ongoing safety and protection is provided for the alleged victim and other residents;
  • Other measures the facility is taking to prevent further potential abuse, neglect, exploitation, and misappropriation of resident property.
  • Notification to law enforcement (if applicable), including date/time, agency name, report number, and name/title of person who reported to law enforcement;
  • Other agencies notified (Ombudsman, Adult Protective Services), including date/time and agency name.

Follow-up Investigation Report

Within five business days of the incident, the facility must provide in its report sufficient information to describe the results of the investigation, and indicate any corrective actions taken if the allegation was verified. It is important that the facility provide as much information as possible, to the best of its knowledge at the time of submission of the report. The facility should include any updates to information provided in the initial report and the following additional information, which should include, but are not limited to, the following:

  • Additional/updated information (any additional outcomes to the resident(s) such as physical or mental harm, whether it was reported to the resident’s representative);
  • Steps taken to investigate the allegation including a summary of interview(s) with the resident/responsible party, witnesses, alleged perpetrator, other residents in contact with the AP, staff responsible for oversight and supervision of residents and the AP;
  • If available, include summary of hospital/medical progress notes, discharge summaries, law enforcement reports, and death reports;
  • Provide a brief conclusion of the investigation and indicate if the findings were verified, not verified, or inconclusive and how this was determined;
  • Provide in detail all corrective actions taken;
  • Describe any action(s) taken as a result of the investigation or allegation;
  • Describe the plan for oversight of implementation of corrective action, if the allegation is verified;
  • As a result of a verified finding of abuse, such as physical, sexual or mental abuse, identify counseling or other interventions planned and implemented to assist the resident;
  • If systemic actions (e.g., changes to facility staffing patterns, changes in facility policies, training) were identified that require correction, identify the steps that have been taken to address the systems;
  • If the allegation was reported to law enforcement or another state agency, where applicable and if available, what is the status or provide conclusions of their investigation.
  • Name of the facility individual primarily responsible for conducting the investigation;
  • Name of person submitting report, date and time of submission, and contact number/email address.

Please note: We are in the process of developing forms for initial reporting and for follow-up reporting that all Missouri LTC homes (including state-licensed only) will be able to utilize for FRIs. We will release these forms at a later date and will also schedule a webinar to discuss this information. Please review the memo in its entirety and reach out to your regional office with any questions.

https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/revised-long-term-care-surveyor-guidance-revisions-surveyor-guidance-phases-2-3-arbitration

CMS Memo: QSO-20-39-NH: Nursing Home Visitation – COVID-19 (Revised 9-23-22)

CMS has issued updated visitation guidance to reflect the new CDC guidance, released September 23, related to face coverings and masks. The safest practice is for residents and visitors to wear facing coverings or masks, however, the facility could choose not to require visitors to wear face coverings or masks while in the facility if the nursing home’s county COVID-19 community transmission is not high, except during an outbreak.

Please review the memo in its entirety at https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf.

CMS Memo: QSO-22-19-NH: Revised Long-Term Care Surveyor Guidance: Revisions to Surveyor Guidance for Phases 2 & 3, Arbitration Agreement Requirements, Investigating Complaints & Facility Reported Incidents, and the Psychosocial Outcome Severity Guide

  • Clarifications and technical corrections of Phase 2 guidance issued in 2017 in certain areas, such as abuse and neglect, admission, transfer, and discharge, and improving care for individuals with mental health or substance use disorder needs, Payroll Based Journal, visitation, and inaccurate diagnoses of schizophrenia.
  • New guidance for Phase 3 requirements which went into effect in November 28, 2019, including guidance related to Infection Preventionist requirements.
  • Guidance for other Phase 3 requirements, such as Trauma Informed Care, Compliance and Ethics, and Quality Assurance Performance Improvement (QAPI). The revisions can be found in Appendix PP of the SOM.
  • Arbitration requirements and guidance which went into effect in September 16, 2019. Changes in the Psychosocial Severity Guide.
  • Revised guidance in Chapter 5 and related exhibits of the State Operations Manual (SOM) to strengthen the oversight of nursing home complaints and Facility Reported Incidents (FRIs).

Effective date: The effective dates for all requirements is October 24, 2022. The implementation date for the Chapter 5 revised guidance will be announced at a later date. CMS will establish a target implementation date for State Agencies (SAs) depending on the status of the PHE, and/or unique circumstances occurring in the SAs. The Implementation date will be communicated through the listserv.

SLCR will be providing a high-level overview of the requirements at the annual Provider Meetings; however, we encourage all homes to view the QSEP trainings below developed by CMS prior to the Provider Meetings. The trainings are titled:

Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/revised-long-term-care-surveyor-guidance-revisions-surveyor-guidance-phases-2-3-arbitration.

CMS Memo: QSO-22-17-ALL: Surveys for Compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements

  • CMS is committed to taking critical steps to protect vulnerable individuals to ensure America’s health care facilities are prepared to respond to the Coronavirus Disease2019 (COVID-19) Public Health Emergency (PHE).
  • Survey oversight of the staff vaccination requirement for Medicare and Medicaid-certified providers and suppliers will continue to be performed during initial and recertification surveys, but will now only be performed in response to complaints alleging non-compliance with this requirement, not all surveys. Under prior guidance, all surveys included oversight of the staff vaccination requirement.
  • CMS will revise QSO 22-11 to ensure deficiency determinations reflect good faith efforts implemented by providers and suppliers and incorporate harm or potential harm to patients and residents resulting from any non-compliance.

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/surveys-compliance-omnibus-covid-19-health-care-staff-vaccination-requirements.

CMS Memo: QSO-22-15-NH & NLTC & LSC

Update to COVID-19 Emergency Declaration Blanket Waivers for Specific Providers

  • CMS continues to review the need for existing emergency blanket waivers issued in response to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
  • Over the course of the COVID-19 PHE, skilled nursing facilities/nursing facilities (SNFs/NFs), inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end-stage renal disease (ESRD) facilities have developed policies or other practices that we believe mitigates the need for certain waivers.
  • Applicable waivers will remain in effect for hospitals and critical access hospitals (CAH).
  • CMS will end the specified waivers in two groups:
    • 60 days from issuance of this memorandum
    • 30 days from issuance of this memorandum

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/update-covid-19-emergency-declaration-blanket-waivers-specific-providers.

CMS Memo: QSO-20-38-NH: Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements REVISED 03/10/2022

  • CMS is committed to taking critical steps to ensure America’s healthcare facilities continue to respond effectively to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
  • On August 25, 2020, CMS published an interim final rule with comment period (IFC). This rule establishes Long-Term Care (LTC) Facility Testing Requirements for Staff and Residents. Specifically, facilities are required to test residents and staff, including individuals providing services under arrangement and volunteers, for COVID-19 based on parameters set forth by the HHS Secretary. This memorandum provides guidance for facilities to meet the new requirements.
  • Replaced the term “vaccinated” with “Up-to-date with all recommended COVID-19 vaccine doses” and deleted the term “unvaccinated.”
  • Updated the recommendations for testing individuals within 90 days after recovering from COVID-19.

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/interim-final-rule-ifc-cms-3401-ifc-additional-policy-and-regulatory-revisions-response-covid-19-0.

CMS Memo: QSO-20-39-NH: Nursing Home Visitation – COVID-19 REVISED 03/10/2022

  • CMS is committed to continuing to take critical steps to ensure America’s healthcare facilities are prepared to respond to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE).
  • Visitation Guidance: CMS is issuing new guidance for visitation in nursing homes during the COVID-19 PHE, including the impact of COVID-19 vaccination.
  • Visitation is allowed for all residents at all times.
  • Replaced the term “vaccinated” with “up-to-date with all recommended COVID-19 vaccine doses” and deleted “unvaccinated.”
  • Updated visitor screening and quarantine criteria.

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-visitation-covid-19-revised.

CMS Memo: QSO-22-08-NH: Nursing Home Staff Turnover and Weekend Staffing Levels

  • CMS will begin posting the following information for each nursing home on the Medicare.gov Care Compare website:
    • Weekend Staffing: The level of total nurse and registered nurse (RN) staffing on weekends provided by each nursing home over a quarter.
    • Staff Turnover: The percent of nursing staff and number of administrators that stopped working at the nursing home over a 12-month period.

This information will be added to the Care Compare website in January 2022 and used in the Nursing Home Five Star Quality Rating System in July 2022.

  • Posting Detailed Staffing Data: CMS will begin posting the submitted employee-level staffing data for all nursing homes.
  • Reminder for Nursing Homes to Link Employee Identifiers when they are changed due to the changes in the facility’s staffing data systems.

Please see the full memo for details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-staff-turnover-and-weekend-staffing-levels.

Guidance for the Interim Final Rule – Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination

https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/guidance-interim-final-rule-medicare-and-medicaid-programs-omnibus-covid-19-health-care-staff-1

The guidance in this memorandum specifically applies to the following states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming.

Please read the memo in its entirety. Some key points in the memo:

Within 30 days after the issuance of the memorandum, if a facility demonstrates:

  • Policies and procedures are developed and implemented for ensuring all facility staff, regardless of clinical responsibility or resident contact are vaccinated for COVID-19, including all required components of the policies and procedures specified below (e.g., related to tracking staff vaccinations, documenting medical and religious exemptions, etc.); and
  • 100% of staff have received at least one dose of COVID-19 vaccine or have a pending request for, or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the CDC, the facility is compliant under the rule.

Within 60 days after the issuance of the memorandum if a facility demonstrates:

  • Policies and procedures are developed and implemented for ensuring all facility staff, regardless of clinical responsibility or resident contact are vaccinated for COVID-19, including all required components of the policies and procedures specified below (e.g., related to tracking staff vaccinations, documenting medical and religious exemptions, etc.); and
  • 100% of staff have received the necessary doses to complete the vaccine series (i.e., one dose of a single-dose vaccine or all doses of a multiple vaccine series) or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the CDC, the facility is compliant under the rule.

 Within 90 days and thereafter following issuance of the memorandum, facilities failing to maintain compliance with the 100% standard may be subject to enforcement action.

Visitation in Long-Term Care Facilities (RCF, ALF, ICF and SNFs)

SLCR has received several questions recently regarding visitation in long-term care facilities. All previous guidance provided by DHSS regarding visitation is no longer in effect. No state waivers are in place regarding regulatory or statutory requirements related to visitation. Section 198.088.6(K), RSMo states, “Each resident admitted to the facility may communicate, associate and meet privately with persons of his choice, unless to do so would infringe upon the rights of other residents.” State regulations also require facilities to follow appropriate infection control procedures. To balance these two requirements, all long-term care facilities (RCF, ALF, ICF and SNF) should follow CDC guidance related to visitors: https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html#anchor_1631030962190. The CDC guidance points facilities to CMS’ memo for additional information related to visitation. Certified facilities are required to follow CMS guidelines. Although state licensed only facilities are not required to follow the requirements in QSO 20-39 NH, DHSS highly encourages them to use the memo and FAQs as a standard of practice to ensure safe visitation occurs in their long-term care community.

CMS has developed a Frequently Asked Questions document to address the questions received regarding visitation in Nursing Homes. This additional information is provided to help residents, families and providers ensure that safe visitation can occur. The FAQs can be found on the cms.gov emergencies page here and also in QSO-20-39-NH REVISED.

Nursing Home Visitation Frequently Asked Questions

CMS has developed a Frequently Asked Questions document to address the questions received regarding visitation in Nursing Homes. This additional information is being provided to help residents, families and providers ensure that safe visitation can occur, especially during the holiday season. The FAQs can be found on the cms.gov emergencies page here and also in QSO-20-39-NH REVISED.

CMS Updates to the COVID-19 Public Health Emergency 1135 Blanket Waiver

CMS has updated the COVID-19 Public Health Emergency 1135 Blanket Waiver on 11/29/21.

The only change in this blanket waiver is for nursing homes for Food and Nutrition Services effective 11/26/21. This waiver applies to 42 CFR 483.60(a)(1) and 483.60(a)(2) under Food and Nutrition Services. This is a waiver for the qualifications of the qualified dietitian or other similarly qualified nutrition professional and the director of food services or the grace period.

The following requirements are waived:

  • Dietitians hired or contracted with prior to November 28, 2016, to meet the specified requirements no later than 5 years after November 28, 2016, or as required by state law; and
  • To designate a person to serve as the director of food and nutrition services who, for designations prior to November 28, 2016, meets the specified requirements no later than 5 years after November 28, 2016, or no later than 1 year after November 28, 2016, for designations after November 28, 2016.

Please see the CMS Public Health Emergency Blanket Waiver -11 29 2021.

CMS Memo QSO-22-04-ALL: Vaccination Regulation: Enforcement of Rule Imposing Vaccine Requirement for Health Care Staff in Medicare-and Medicaid-certified Providers and Suppliers is Suspended so Long as Court Ordered Injunctions Remain in Effect

Survey and Enforcement of the Vaccine Requirement for Health Care Staff in Medicare-and Medicaid-certified Providers and Suppliers Suspended While Court Ordered Injunctions are in Effect: The Centers for Medicare & Medicaid Services (CMS) will not enforce the new rule regarding vaccination of health care workers or requirements for policies and procedures in certified Medicare/Medicaid providers and suppliers (including nursing facilities, hospitals, dialysis facilities and all other provider types covered by the rule) while there are court-ordered injunctions in place prohibiting enforcement of this provision.

Please see the full memo or https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/vaccination-regulation-enforcement-rule-imposing-vaccine-requirement-health-care-staff-medicare-and for details.

CMS Memo QSO 20-39-NH: Nursing Home Visitation – COVID-19 (Revised 11-12-2021)

CMS has issued updated visitation guidance for visitation in nursing homes. The new guidance includes that visitation is now allowed for all residents at all times. DHSS will be updating its guidance as well and it will be consistent with the CMS guidance. Long-term care facilities certified for Medicare and Medicaid are required to follow the CMS memo. All long-term care communities (SNF, ICF, ALF and RCF) may utilize the CMS guidance until the DHSS guidance is updated.

Please see the full memo at https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf.

CMS Memo QSO-20-38-NH: Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements

Long-Term Care (LTC) Facility COVID-19 Testing Requirements (QSO 20-38-NH, revised 9/10/2021)

Please read the memo carefully. CMS has revised testing requirements for nursing homes including testing of symptomatic residents and staff, and routine testing of staff. Two major changes are:

  • Facilities now have two options to conduct outbreak testing, through either a contact tracing or broad-based testing approach. See Table 1.
  • Routine staff testing is now based on the facility’s county level of community transmission instead of county test positivity rate. The link to determine county level of community transmission is in the memo. The frequency of testing has also been updated. See Table 2.

 

Table 1: Testing Summary

Testing Trigger

Staff

Residents

Symptomatic individual identified

Staff, vaccinated and unvaccinated, with signs or symptoms must be tested.

Residents, vaccinated and unvaccinated, with signs or symptoms must be tested.

Newly identified COVID- 19 positive staff or resident in a facility that can identify close contacts

Test all staff, vaccinated and   unvaccinated, that had a higher-risk exposure with a COVID-19 positive individual.

Test all residents, vaccinated and unvaccinated, that had close contact with a COVID-19 positive individual.

Newly identified COVID- 19 positive staff or resident in a facility that is unable to identify close contacts

Test all staff, vaccinated and unvaccinated, facility-wide or at a group level if staff are assigned to a specific location where the new case occurred (e.g., unit, floor, or other specific area(s) of the facility).

Test all residents, vaccinated and unvaccinated, facility-wide or at a group level (e.g., unit, floor, or other specific area(s) of the facility).

Routine testing

According to Table 2 below

Not generally recommended

 

Table 2: Routine Testing Intervals by County COVID-19 Level of Community Transmission

Level of COVID-19 Community

Transmission

Minimum Testing Frequency of

Unvaccinated Staff+

Low (blue)

Not recommended

Moderate (yellow)

Once a week*

Substantial (orange)

Twice a week*

High (red)

Twice a week*

+Vaccinated staff do not need to be routinely tested.

 

Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/interim-final-rule-ifc-cms-3401-ifc-additional-policy-and-regulatory-revisions-response-covid-19-0.

CMS Memo QSO-21-19-NH: Interim Final Rule – COVID-19 Vaccine Immunization Requirements for Residents and Staff

Interim Final Rule – COVID-19 Vaccine Immunization Requirements for Residents and Staff

CMS has issued QSO-21-19-NH, which outlines the Interim Final Rule – COVID-19 Vaccine Immunization Requirements for Residents and Staff. This rule establishes Long-Term Care (LTC) Facility Vaccine Immunization Requirements for Residents and Staff. This includes new requirements for educating residents or resident representatives and staff regarding the benefits and potential side effects associated with the COVID-19 vaccine, and offering the vaccine. Furthermore, LTC facilities must report COVID-19 vaccine and therapeutics treatment information to the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN). Please read through the memo carefully for facility actions and effective dates.

See the memo or visit https://www.cms.gov/files/document/qso-21-19-nh.pdf for complete details.

Revised CMS Memos

The Centers for Medicare and Medicaid Services release two revised QSO memos today. Below is a summary of the major revisions in each memo. Please read each in its entirety for all revisions. DHSS guidance will be updated to reflect the revisions in the CMS Visitation memo, however all facilities may begin using this revised guidance immediately.

CMS QSO-20-38-NH Revised – Updated Guidance Regarding Testing
The major revision to this document is regarding routine testing of staff. Routine testing of unvaccinated staff should be based on the extent of the virus in the community. Fully vaccinated staff do not have to be routinely tested. Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency.

CMS QSO-20-29-NH Visitation
The major revision to this document is regarding group activities and communal dining. The CDC has provided additional guidance on activities and dining based on resident vaccination status. For example, residents who are fully vaccinated may dine and participate in activities without face coverings or social distancing if all participating residents are fully vaccinated; if unvaccinated residents are present during communal dining or activities, then all residents should use face coverings when not eating and unvaccinated residents should physically distance from others. See the CDC guidance Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination for information on communal dining and activities.

CMS Memo: QSO-21-15-ALL: Updated Guidance for Emergency Preparedness-Appendix Z of the State Operations Manual (SOM)

CMS has provided updated guidance for the emergency preparation regulations (Appendix Z). This update is effective immediately.

  • Burden Reduction Final Rule Interpretive Guidelines: The Centers for Medicare &Medicaid Services (CMS) is releasing interpretive guidelines and updates to Appendix Z of the State Operations Manual (SOM) as a result of the revisions of the Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (CoPs) (CMS 3346-F) Final Rule.
  • Expanded Guidance related to Emerging Infectious Diseases (EIDs): CMS is also providing additional guidance based on best practices, lessons learned and general recommendations for planning and preparedness for EID outbreaks.

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/updated-guidance-emergency-preparedness-appendix-z-state-operations-manual-som.

CMS Memo: QSO-21-17-NH: Updates to Long-Term Care (LTC) Emergency Regulatory Waivers issued in response to COVID-19

CMS continues to review the need for existing waivers issued in response to the Public Health Emergency (PHE). Over the course of the PHE, nursing homes have developed policies or other practices that we believe mitigates the need for certain waivers.

  • Therefore, CMS is announcing it is ending:
    • The emergency blanket waivers related to notification of Resident Room or Roommate changes, and Transfer and Discharge notification requirements;
    • The emergency blanket waiver for certain care planning requirements for residents transferred or discharged for cohorting purposes.
    • The emergency blanket waiver of the timeframe requirements for completing and transmitting resident assessment information (Minimum Data Set (MDS)).
  • CMS is providing clarification and recommendations for Nurse Aide Training and Competency Evaluation Programs (NATCEPs)

For more details, please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/updates-long-term-care-ltc-emergency-regulatory-waivers-issued-response-covid-19.

Nursing Home Visitation – COVID-19 (QSO 20-39, REVISED 3/10/2021)

Yesterday- CMS, in conjunction with the Centers for Disease Control and Prevention (CDC), updated visitation guidance with emphasis on the importance of maintaining infection prevention practices, given the continued risk of COVID-19 transmission. The new guidance includes the impact of COVID-19 vaccination. DHSS will be updating its guidance as well and it will be consistent with the CMS guidance. Facilities certified for Medicare and Medicaid are required to follow the CMS memo. All long-term care communities (SNF, ICF, ALF and ICF) may utilize the CMS guidance until the DHSS guidance is updated. CMS hosted a Stakeholder Discussion today regarding the new guidance. A transcript of the session will be uploaded to CMS’ website on 3/12/20 at: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.

Key Changes include:

  • Facilities should allow indoor visitation at all times and for all residents (regardless of vaccination status), except for a few circumstances when visitation should be limited due to a high risk of COVID-19 transmission (note: compassionate care visits should be permitted at all times).
  • CMS and CDC continues to recommend facilities, residents, and families adhere to the core principles of COVID-19 infection, including physical distancing (maintaining at least 6 feet between people). This continues to be the safest way to prevent the spread of COVID-19, particularly if either party has not been fully vaccinated. However, they acknowledge the toll that separation and isolation has taken. They also acknowledge that there is no substitute for physical contact, such as the warm embrace between a resident and their loved one. Therefore, if the resident is fully vaccinated, they can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after. Regardless, visitors should physically distance from other residents and staff in the facility.
  • Provides guidance to describe how visitation can still occur when there is an outbreak, but there is evidence that the transmission of COVID-19 is contained to a single area (e.g., unit) of the facility.
  • Notes that compassionate care visits and visits required under federal disability rights law should be allowed at all times, for any resident (vaccinated or unvaccinated).
  • States that while visitor testing and vaccination can help prevent the spread of COVID-19, visitors should not be required to be tested or vaccinated (or show proof of such) as a condition of visitation.

Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination

CDC has released new guidance, related to vaccinated individuals and the need to quarantine in LTCF. The Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination guidance can be used by LTCF. In using this guidance, long-term care communities should carefully think about how they will determine if the person has had prolonged close contact with someone who was positive.

“Quarantine is no longer recommended for residents who are being admitted to a post-acute care facility if they are fully vaccinated and have not had prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days.”

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-after-vaccination.html

 The revised guidance is attached.

CMS Memo: QSO 20-31-ALL: Revised COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes

CMS has revised the criteria requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the quality of care. In addition, CMS has provided Frequently Asked Questions related to health, emergency preparedness and life-safety code surveys.

See the memo for details.