02/03/2022
CMS national nursing home stakeholder call
On Wednesday, officials from the Centers for Medicare & Medicaid Services (CMS) and Centers for Disease Control & Prevention (CDC) provided updates on several changes impacting nursing homes including resident isolation and quarantine guidance, resident testing strategies, visitation guidance, healthcare personnel source control recommendations, and new rapid test kits being sent to nursing homes. These updates can be found in the following webpages:
Evan Shulman with CMS announced that facilities can apply for civil monetary penalty (CMP) funds to be used to improve air flow quality. A facility may request the use of Civil Money Penalty (CMP) Reinvestment funds to purchase portable fans and portable room air cleaners with HEPA filters to increase or improve air quality. A maximum use of $3,000 per facility including shipping costs may be requested. Additional recommendations on air quality can be found in the FAQ document. CMS also informed nursing homes that they will be receiving Celltrion rapid antigen tests. Charlotte Jaeun Kang provided a brief overview of the test kits during the call.
Kara Jacobs Slifka with the CDC announced several changes to the nursing home infection control guidance including:
- Empiric use of Transmission-Based Precautions (quarantine) is recommended for patients who have had close contact with someone with SARS-CoV-2 infection if they are not up to date with all recommended COVID-19 vaccine doses.
- In general, quarantine is not needed for asymptomatic patients who are up to date with all recommended COVID-19 vaccine doses or who have recovered from SARS-CoV-2 infection in the prior 90 days; potential exceptions are described in the guidance. However, some of these patients should still be tested as described in the testing section of the guidance.
- A test-based strategy and (if available) consultation with infectious disease experts is now recommended for determining the duration of Transmission-Based Precautions for patients with SARS-CoV-2 infection who are moderately to severely immunocompromised.
- Included additional examples when universal respirator use could be considered.
Frequently asked questions were answered during the call. Evan Shulman with CMS confirmed that facilities can ask visitors to be tested prior to visit, but stated that the test needed to be offered by the facility AND that the testing must be completed with a rapid test allowing the visit to commence then in 15 minutes. CMS confirmed visits to residents who have roommates should be arranged when the roommate is not in the room or in another designated space, but the visit could occur when the roommate was present if distancing was able to be maintained. CDC confirmed in relation to quarantine, that a healthcare worker who is two weeks following completion of their primary vaccination series – and, therefore, not had long enough time to have received the booster shot – is considered “up to date” but a healthcare worker that is past the timeframe to obtain the booster would not be considered “up to date”.
The updated CDC language for testing HCP is below:
Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic webpage guidance:
Perform SARS-CoV-2 Viral Testing
- Expanded screening testing of asymptomatic HCP without known exposures is required in nursing homes and could be considered in other settings.
- HCP who are up to date with all recommended COVID-19 vaccine doses may be exempt from expanded screening testing.
Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes webpage guidance:
- Expanded screening testing of asymptomatic HCP should be as follows:
- HCP who are up to date with all recommended COVID-19 vaccine doses may be exempt from expanded screening testing.
- In nursing homes, HCP who are not up to date with all recommended COVID-19 vaccine doses should continue expanded screening testing based on the level of community transmission as follows:
- In nursing homes located in counties with substantial to high community transmission, these HCP should have a viral test twice a week.
- If these HCP work infrequently at these facilities, they should ideally be tested within the 3 days before their shift (including the day of the shift).
- In nursing homes located in counties with moderate community transmission, these HCP should have a viral test once a week.
- In nursing homes located in counties with low community transmission, expanded screening testing for asymptomatic HCP, regardless of vaccination status, is not recommended. Per recommendations above, these facilities should prioritize resources to test symptomatic people and all close contacts, as well as be prepared to initiate outbreak response immediately if a nursing home-onset infection is identified among residents or HCP.
Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 webpage guidance:
- In general, asymptomatic HCP who have had a higher-risk exposure do not require work restriction if they are up to date with all recommended COVID-19 vaccine doses and do not develop symptoms or test positive for SARS-CoV-2. The duration of protection offered by booster doses of vaccine and their effect on emerging variants are not clear; additional updates will be provided as more information becomes available.
CMS confirmed for LeadingAge that although it is CDC’s recommendation to have Health Care Personnel (HCP) whom are not up to date with the booster to be routinely tested according to the QSO 20-38-NH memo, CMS confirmed facilities can continue to follow this existing CMS memos which only require unvaccinated staff to be routinely tested until a new memo or guidance is released by CMS. So if a HCP has completed their primary series of vaccinations and have not had their booster, at this time they do not require routine testing. This does not preclude a facility from choosing to move forward with the new CDC recommendation.
The full transcript of the call will be available here.
