CMS Waives Rules for Long-Term Care Transfers to Create COVID-Specific Nursing Homes, Expands Testing Coverage

The federal government this week released a slew of new waivers aimed at stopping the spread of the novel coronavirus, with specific guidance allowing nursing home operators to create dedicated facilities for COVID-19 residents.

As leaders in multiple states raised alarms about the danger of admitting infected residents into nursing homes, the Centers for Medicare & Medicaid Services (CMS) removed several key roadblocks to separating coronavirus patients from those without the disease.

CMS will allow long-term care operators to transfer patients within facilities — or to other facilities — “solely for the purposes of cohorting and separating residents with and without COVID-19,” according to a fact sheet released over the weekend.

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“This is consistent with recent CDC guidance, and helps residents with COVID-19 by placing them in units or facilities that are prepared to care for them,” CMS noted. “It also helps residents without COVID-19 by placing them in units or facilities without other COVID-19 residents, thus helping to protect them from being infected.”

Operators can also continue to receive reimbursements for care provided to COVID-positive patients at alternate sites, which will be considered “under arrangements.”

“The transferring LTC facility need not issue a formal discharge in this situation, as it is still considered the provider and should bill Medicare normally for each day of care,” CMS noted. “The transferring LTC facility is then responsible for reimbursing the other provider that accepted its resident(s) during the emergency period. “

Following the lead laid out in several individual state Medicaid waivers, CMS also approved the temporary certification of non-skilled nursing facilities to be used as emergency COVID-19 care sites, as well as waiving certain conditions of participation and certification requirements for opening a nursing facility if states identify a need for a new site to open quickly.

“CMS believes this will also provide another measure that will free up inpatient care beds at hospitals for the most acute patients while providing beds for those still in need of care,” the agency noted.

Additionally, long-term care facility operators can now use a variety of non-resident rooms — including dining rooms, activity areas, and conference space — to provide care on a temporary basis “to help with surge capacity.”

The updated guidance also waives certain training and certification requirements for nurse aides in an attempt to ease the workforce strain on operators.

To support the identification of COVID-19 cases, CMS will allow lab companies to receive reimbursements for tests performed at nursing homes or in individual Medicare beneficiaries’ homes.

“We hope that this will encourage more testing of our nursing home residents who are amongst the most vulnerable,” CMS administrator Seema Verma said on a Monday night press call. “We know that over 150 nursing homes have been affected. By increasing testing we can isolate those patients that have been infected and keep other residents healthy.”

The remarks came as Verma unveiled a new crop of waivers that apply to other industries, including hospitals and home health agencies. Under the “Hospitals Without Walls” initiative, for instance, hospital providers can transfer uninfected patients to ambulatory surgical centers, inpatient rehabilitation hospitals, hotels, and dormitories.

CMS also built on recent its expansion of telehealth coverage to include 80 more approved services, including remote patient monitoring — such as monitoring a person’s blood oxygen level using a pulse oximeter.

“Telehealth visits include emergency department visits, initial nursing facility and discharge visits, home visits, and therapy services, which must be provided by a clinician that is allowed to provide telehealth,” CMS noted in a fact sheet. “New as well as established patients now may stay at home and have a telehealth visit with their provider.”

COVID-19 infections have spread rapidly through nursing homes across the country, with an initial outbreak in Kirkland, Wash. killing more than a quarter of the facility’s residents in less than three weeks.

Skilled nursing leaders in New York raised serious concerns last week about state-level guidance preventing operators from rejecting residents solely based on a COVID-19 diagnosis, or requiring a test as a condition of admission. Officials in California had also told nursing home operators to prepare for the eventual need to admit COVID-19 residents.

The American Health Care Association, which represents a wide swath of the nation’s nursing homes, followed suit this past weekend with a joint statement condemning such orders from CEO Mark Parkinson and chief medical officer David Gifford.

“This approach will introduce the highly contagious virus into more nursing homes,” Parkinson and Gifford said. “There will be more hospitalizations for nursing home residents who need ventilator care and ultimately, a higher number of deaths. Issuing such an order is a mistake and there is a better solution.”

Parkinson and Gifford also called on leaders to facilitate the great separation of nursing home residents with and without confirmed COVID-19 diagnoses.

“Governors and public health officials should be directing nursing homes to create as many segregated units as possible right now. They should also explore asking nursing homes to move residents from one nursing home to another to create dedicated COVID-19 facilities that can accept hospital discharges,” Parkinson and Gifford said. “As a profession, we have made these recommendations, but we need state officials to waive regulations that limit our actions.”

AHCA on Monday updated its official guidance regarding admissions from hospitals, advising operators to assume every incoming resident has COVID-19 unless he or she specifically tests negative for the virus.

The trade group advised its members to begin making plans to create separate units, wings, or floors designed exclusively for accepting new residents, while also advising operators to suspend admissions if they do not have sufficient staffing or quantities of personal protective equipment (PPE).

Salmon Health and Retirement, an operator in Massachusetts, has already begun the process of clearing one of its facilities to eventually serve as a COVID-19-specific facility — with plans to begin accepting coronavirus patients as soon as this coming Thursday.

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