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CMS Issues New Wave of Infection Control
Guidance Based on CDC Guidelines to Protect Patients and Healthcare Workers
from COVID-19
Guidance
will aid clinicians in various healthcare settings to prevent and mitigate
the spread
Under the
leadership of President Trump, the Centers for Medicare & Medicaid
Services (CMS) has issued a series of updated guidance documents focused on
infection control to prevent the spread of the 2019 Novel Coronavirus
(COVID-19) in a variety of inpatient and outpatient care settings. The
guidance, based on Centers for Disease Control and Prevention (CDC)
guidelines, will help 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 designed
to empower local hospitals and healthcare systems, helping them to rapidly
expand their capacity to isolate and treat patients infected with COVID-19
from those who are not. Critically, the guidance released today includes new
instructions for dialysis facilities as they work to protect patients with
End-Stage Renal Disease (ESRD), who, because of their immunocompromised state
and frequent trips to health care settings, are some of the most vulnerable
Americans to complications arising from COVID-19. The guidance is part of the
unprecedented array of temporary regulatory waivers and new policies CMS
issued on March 30, 2020 that gives the nation’s healthcare system maximum
flexibility to respond to the COVID-19 pandemic.
“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 longstanding infection control requirements,” said CMS
Administrator Seema Verma.
The guidance is
particularly timely for dialysis facilities. Dialysis facilities care for
immunocompromised Americans who require regular dialysis treatments and are
therefore particularly susceptible to complications from the virus. Today’s
updated guidance has multiple facets, including the option of providing Home
Dialysis Training and Support services – to help some dialysis patients stay
home during this challenging time – and 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 (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, 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 (EMTALA) 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 will 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, guidance discusses recommendations
to mitigate transmission including screening, restricting visitors, cleaning
and disinfection, and closures, and addresses issues related to supply
scarcity, and Federal Drug Administration (FDA) recommendations. In addition,
CMS encourages ASCs and other outpatient settings to partner with others in
their community to conserve and share critical resources during this national
emergency.
Updated guidance for
ICF/IIDs, and PRTFs include practices related to screening of visitors and
outside health care 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.
To view the latest updates
to these CMS guidance documents on infection control, go to: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
For information on the
COVID-19 waivers and guidance, and the Interim Final Rule, released on March
30, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.
These actions, and earlier
CMS actions in response to COVID-19, are part of the ongoing White House
Coronavirus Task Force efforts. To keep up with the important work the Task
Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete
and updated list of CMS actions, and other information specific to CMS,
please visit the Current Emergencies Website.
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Wednesday, April 8, 2020
CMS Issues New Wave of Infection Control Guidance Based on CDC Guidelines to Protect Patients and Healthcare Workers from COVID-19
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