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COVID-19: Impacts and New Guidance for Skilled Nursing Facilities
April 22, 2020
The COVID-19 pandemic has had a disproportionate impact on skilled nursing and assisted living facilities. While the following CMS recommendations and guidelines identify nursing homes as the target recipients, they are applicable to all facilities that receive Medicare and Medicaid funds, and are therefore subject to CMS's oversight.  
CMS previously published recommendations on March 13, 2020 instructing skilled nursing facilities to restrict visitation of all visitors and non-essential health care personnel. On April 2, 2020, CMS issued additional guidelines regarding the prevention of the spread of the virus in skilled nursing facilities. These recommendations and guidelines establish the standard of care a skilled nursing facility must meet in order to prevent the spread of COVID-19 among its residents and staff.
On April 19, 2020, CMS issued a communication about proposed new requirements regarding the reporting of cases, or suspected cases, of COVID-19 among the residents and staff of skilled nursing facilities. These proposed guidelines are intended to aid with the tracking of the outbreak in this vulnerable population, and to assist in the mitigation of the spread of COVID-19 in skilled nursing facilities. Currently, pursuant to 42 CFR 483.30 and CDC guidance, skilled nursing facilities are required to report communicable diseases, healthcare-associated infections, and potential outbreaks to state and local health departments, but not to CMS, CDC, or FEMA. These proposed rules also will require skilled nursing facilities to now report COVID-19 cases, or suspected cases, not only to local and state health authorities, but also to the CDC pursuant to a standardized format and timeframe that will be outlined in the future by CMS and CDC. We will continue to monitor communications by CMS and will provide an alert and summary of these new reporting guidelines once they are published.
The April 19, 2020 CMS communication also addressed proposed requirements regarding skilled nursing facilities to be more transparent with residents and their representatives. These proposed instructions would require skilled nursing facilities to notify residents and their representatives about new developments in the facility regarding new cases of COVID-19 among the residents or staff. These communications will be in addition to the communications the facility will be required to make to the CDC. Skilled nursing facilities will be required to notify patients and their representatives within 12 hours of the occurrence of a single confirmed infection of COVID-19, or three or more residents or staff with new onset of respiratory symptoms that occur within 72 hours. Skilled nursing facilities also will be required to provide weekly updates to residents and their representatives in addition to reporting new and suspected infections. We will provide additional guidance regarding compliance with these new communication guidelines once they are issued, including the interaction between these new instructions and the current limitations on disclosing personal health information pursuant to HIPAA and other laws and regulations.
If you have any questions or need guidance, please contact our COVID-19 Task Force.
Health Care Law Matthew W. Georgitis
336.727.7642 Alexander L. Turner