Long-Term Care Providers: CMS Issues Guidance for Infection Control and Prevention Concerning COVID-19 in Home Health Agencies

Long-term care providers continue to be heavily impacted by the effects of COVID-19. In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) issued a guidance document on March 10, 2020 for infection control and prevention related to COVID-19 in home health agencies (HHAs), as the older population and those who are chronically ill are most at risk of a severe outcome from COVID-19. CMS advises HHAs to monitor the health status of everyone, including employees, patients, and visitors for signs and symptoms of COVID-19 to prevent unnecessary exposure. 

Based on this guidance, while home health certification requires a face-to-face encounter for the initiation of home health services, the face-to-face patient encounter may occur through telehealth in accordance with both Medicare and Medicaid regulations. 42 C.F.R. § 424.22(a)(v)(B); 42 C.F.R. § 440.70(f)(6). HHAs that are not currently doing so should consider this option to minimize any unnecessary exposure to COVID-19. 

The guidance document addresses a series of frequently asked questions and assists HHAs navigating some of the following issues: 

• When should an HHA admit and treat patients with known or suspected COVID-19?
• How should an HHA screen patients for COVID-19?
• How should an HHA monitor or restrict home visits for its health care staff?
• Do all patients with known or suspected COVID-19 infection require hospitalization?
• What are the considerations for determining when patients confirmed with COVID-19 are safe to be treated at home?
• When should patients confirmed with COVID-19 who are receiving HHA services be considered for transfer to a hospital?
• What are the implications of the Medicare HHA Discharge Planning Regulations for patients with COVID-19?
• What are recommended infection prevention and control practices, including considerations for family member exposure, when evaluating and caring for patients with known or suspected COVID-19? 
• Are there specific considerations for patients requiring therapeutic interventions?
• What Personal Protective Equipment (PPE) should home care staff routinely use when visiting the home of a patient suspected of COVID-19 exposure or confirmed exposure?
• When is it safe to discontinue Transmission-based Precautions for home care patients with COVID-19? 

The guidance document also includes protocols for surveyors for coordination and investigation of HHAs with actual or suspected COVID-19 cases. The surveyor must confirm that the case was reported to public health officials, review infection prevention and education practices, and confirm that the HHA has the most recent information provided by the Centers for Disease Control and Prevention (CDC). The surveyor should also notify the CMS Regional Office that the HHA provided services to a patient with a confirmed or suspected COVID-19 case who was either hospitalized and/or medically stable enough to go home, or did not require hospitalization. 

The guidance document also points out that CMS recognizes that there is a shortage of PPE in certain parts of the country. CMS should not cite HHAs for not having certain supplies if the HHA is unable to obtain them due these shortages. However, CMS still expects HHAs to mitigate these shortages, and demonstrate that they are taking all necessary steps to obtain the necessary supplies as soon as practicable. Examples provided include ensuring that staff practice effective handwashing with soap and water if there is a shortage of hand sanitizer, and notifying the local authorities of a shortage of PPE, or identifying the next best care option for patients. 

Quarles & Brady's Health Law Team is continuously monitoring the ever-changing landscape of the COVID-19 pandemic. For more information please contact your Quarles & Brady attorney or:

• Randall R. Fearnow: (312) 715-5194 / randall.fearnow@quarles.com
• Jaya F. White: (312) 715-5242 / jaya.white@quarles.com
• Stephanie M. Moon: (312) 715-5176 / stephanie.moon@quarles.com