CMS: Licensed Nursing Homes Don’t Need Approval to Transfer Residents Amid COVID-19 Cohorting

The federal government on Monday released updated guidance indicating that nursing homes do not need any additional approval before transferring or discharging residents for the purposes of creating separate spaces for residents with COVID-19 and those without the infection.

In a Monday memo to state survey agencies (SSAs), Centers for Medicare & Medicaid Services (CMS) official David Wright emphasized that the raft of waivers issued over the last month ensures that long-term care operators can discharge or transfer residents to other licensed properties without further approval.

“In general, if two or more certified LTC facilities want to transfer or discharge residents between themselves for the purposes of cohorting, they do not need any additional approval to do so,” Wright, director of CMS’s Quality and Safety Oversight Group, wrote. “However, if a certified LTC facility would like to transfer or discharge residents to a non-certified location for the purposes of cohorting, they need approval from the State Agency.”


Operators can also send residents to certain emergency care sites staffed by federal and state employees as directed by the Federal Emergency Management Agency (FEMA) without any additional approval “as long as transfer is not inconsistent with a state’s emergency preparedness or pandemic plan, or as directed by the local or state health department.”

State survey agencies conduct both routine and emergency inspections of the nation’s 15,000 nursing homes on behalf of CMS. Since the beginning of March, CMS and the SSAs have rearranged their survey priorities to focus primarily on infection control issues amid the ongoing spread of COVID-19.

CMS on April 2 directed nursing homes to begin setting up separate units and buildings for residents with COVID-19, while also using specific teams of staffers within each group to prevent the spread of the disease.


“Long-term care facilities should separate patients and residents who have COVID-19 from patients and residents who do not, or have an unknown status,” CMS wrote earlier this month. “To this end, long-term care facilities should work with state and local community leaders to identify and designate facilities dedicated to patients and residents with known COVID-19-positive and those with suspected COVID-19, ensuring they are separate from patients and residents who are COVID-19-negative.”

That guidance followed earlier actions that waived requirements around discharges and permitted nursing home operators to use a variety of non-resident rooms — such as dining areas and conference space — to facilitate separation.