Elevating the Post-Acute and
Long Term Care Profession

March 30, 2021

CDC Releases Revised, Consolidated SNF Guidance. The Centers for Disease Control and Prevention (CDC) issued a new guidance document entitled, "Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes," with yesterday's date. The guidance consolidates two existing guidelines, with a number of revisions. CDC apparently is seeking to cover all relevant topics for SNFs in one document, either directly or through cross-references to other CDC or the Centers for Medicare and Medicaid Services (CMS) materials. We suggest all SNF members read the new guidelines carefully to make sure they are up on CDC's latest recommendations. Many of the provisions are carried over from previous guidance, but a number of new items are listed at the beginning of the document. Several of these that we found particularly significant are:

  • Provisions on leaves of absence that formalize the 24-hour rule for differentiating between readmissions and leaves and that state a preference for not quarantining patients who leave the building, even for visits with family and friends and without regard to vaccination status. CDC includes an exception suggesting consideration of quarantine when "uncertainty exists" about adherence to infection control procedures, which often may be the case.
  • A recommendation for using full personal protective equipment (PPE) throughout the facility when there is even one positive case in staff or residents, instead of only in the area affected by the outbreak. The guidance includes other details about responding to outbreaks.
  • Clarification that residents/admissions who are within 90 days of having COVID-19 do not need to be quarantined or tested. The title of this section refers to health care personnel (HCP) too, but they are not mentioned in the text.
  • Explicit references to sheltering in place for suspected infections and for exposures.
  • A definition of close contact that specifically discounts whether the contact was using PPE.
You may find other items noteworthy on close review.

CMS Confirms Hold on Medicare Claims. We reported in last Friday's News Bites that Congress is in the process of extending the sequester suspension that ends tomorrow. The extension would run until to December 31, 2021. AHCA/NCAL felt CMS would direct the Medicare Administrative Contractors to hold claims pending final action on the legislation. Today CMS confirmed this direction in a MLN Connects notice:

In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize the volume of claims the MACs must reprocess if Congress extends the suspension; the MACs will automatically reprocess any claims paid with the reduction applied if necessary. 

Work Exclusion for COVID-19 Exposure. Members asked about CDC's guidance that allows fully vaccinated staff members to continue working after a significant exposure to COVID-19. Specifically, the question was about the rationale for stopping the exemption 90 days after vaccination. CDC, however, eliminated the 90-day limit earlier this month. The guidance now reads, "[f]ully vaccinated HCP with higher-risk exposures who are asymptomatic do not need to be restricted from work for 14 days following their exposure." Fully vaccinated is defined as, "=2 weeks following receipt of the second dose in a 2-dose series, or =2 weeks following receipt of one dose of a single-dose vaccine," with no mention of a 90-day outer limit.