CMS offers new guidance regarding protective masks and screening, treatment of COVID-19 coronavirus

The Centers for Medicare and Medicaid Services has issued new guidance for healthcare workers to protect themselves against the spread of the COVID-19 novel coronavirus.

One item relates to supplementing its guidance to home-health agencies and dialysis facilities. The other regards protective masks.

On the mask front, CMS sent a memorandum to State Survey Agencies, which are responsible for inspecting nursing homes and other healthcare facilities serving Medicare and Medicaid beneficiaries. The memo clarifies the application of CMS policies in light of recent Centers for Disease Control and Prevention and Food and Drug Administration guidance expanding the types of face masks healthcare workers may use in situations involving COVID-19 and other respiratory infections.

These policies, said CMS, are proactive steps and part of the White House Task Force's efforts to ensure that a maximum supply of face masks and respirators are available for healthcare providers to treat patients safely, without exposing themselves or others to COVID-19.

The memo aligns CMS policy with recent changes to CDC and FDA face mask and respirator guidance in light of ongoing supply demands. To help reduce the burden on healthcare facilities, the CMS memo implements CDC guidance by saying face masks, which protect the wearer from splashes and sprays, are an acceptable temporary alternative to respirators, which filter the air, for most medical services until the demand for respirators lessens.

Due to the updated CDC guidance on allowable face masks and respirators, CMS is also alerting state surveyors that they are not required – on a temporary basis – to validate the date of a facility's last annual test of the fit of N95 masks worn by workers in Medicare- and Medicaid-certified facilities. CMS is temporarily suspending surveyor validation of the test to minimize the discarded masks associated with such testing.

The FDA also approved a CDC request for an emergency-use authorization to allow healthcare workers to use certain industrial respirators during the coronavirus outbreak in healthcare settings. The FDA concluded that respirators approved by the National Institute for Occupational Safety and Health, but not currently meeting the FDA's requirements, may be effective in preventing healthcare workers from airborne exposure to serious or life-threatening disease, including COVID-19.

This FDA approval allows healthcare personnel to use the NIOSH-approved respirators not currently regulated by the FDA. As a result, in addition to N95 respirator masks, healthcare personnel have other masks at their disposal in order to safely treat patients without exposing themselves or others to COVID-19.

HOME HEALTH, DIALYSIS GUIDELINES

CMS also supplemented its guidance to home health agencies and dialysis facilities with the memoranda developed from frequently asked questions the agency has received about interacting with patients amid the outbreak.

The guidance offers actionable information to healthcare workers on the screening, treatment and transfer procedures to follow when interacting with patients. This action, again, is part of the broader effort by the White House Task Force.

The guidance, said CMS, is an enhancement of the agency's health and safety requirements and aims to help control and prevent the spread of infection. In particular, the new guidance advises all Medicare-enrolled dialysis facilities to identify high-risk patients prior to appointments or upon arrival, and immediately begin screening for fever or symptoms of a respiratory infection, such as a cough and sore throat, international travel within the last 14 days to restricted countries, and contact with someone with known or suspected COVID-19.

The guidance also recommends screening visitors for potential exposure to the virus, gives detailed instructions for dealing with staff who have either been exposed or are showing signs of illness, and offers a list of frequently asked questions that include responses to help safely treat patients in this setting.

The guidance to home health agencies echoes recommendations set forth by the CDC, with specific considerations for when it is safe to treat patients at home, when patients should be considered for hospitalization and recommendations for family member exposure, when evaluating and caring for patients with known or suspected coronavirus.

CMS is recommending home-health agencies remain vigilant, regularly monitor patients for any symptoms of the virus and communicate effectively with patients, family members and other caregivers, so that the entire care team understands a patient's individual needs and goals of care. CMS's guidance ends with a frequently asked question section offering answers with information it hopes will ensure safe, quality care in the face of the disease.

THE LARGER TREND

According to newly updated numbers from John Hopkins, the U.S. has now surpassed 1,000 confirmed cases of COVID-19, placing it eighth on the list of most-affected countries. In descending order, only China, Italy, Iran, the Republic of Korea, Spain, France and Germany have more.

Worldwide, 4,369 people have died from the coronavirus as of this morning. Twenty-three deaths have occurred in Washington State. Only a handful of successful recoveries have been recorded at this point.

China, the epicenter of the coronavirus, continues to be the most affected country, with almost 81,000 confirmed cases so far.

ON THE RECORD

"CMS is working in lockstep with the CDC, FDA, and other Trump Administration partners to protect both patients and the dedicated healthcare workers who are battling the spread of Coronavirus," said CMS Administrator Seema Verma. "Today we provided practical information to state inspectors and healthcare facilities on the range of facemasks that can be temporarily used. CMS has been rapidly adapting our guidance to strengthen our nation's defense against Coronavirus, and today's action is no exception. We're working to make sure the healthcare system has the equipment it needs to keep patients and healthcare workers safe."

As for workers in home health and dialysis facilities, Verma said the guidance "will help providers identify patients who may have contracted the disease and minimize further transmission. It will also equip them to get these patients the medical care they need in order to recover."
 

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com