On April 2, 2020, at the direction of the president, CMS issued additional guidance [https://go.cms.gov/2V1QBdM] regarding the mitigation of the spread of COVID-19 in the country’s nursing facilities. The guidance was apparently issue in response to recent onsite observations by CMS and CDC experts in nursing facilities. In short, the guidance addresses five key issues:

1. Nursing facilities should immediately ensure that they are complying with all CMS and CDC guidance related to infection control, with a particular emphasis on CDC’s recommendations regarding hand hygiene and PPE, and CMS’ recent checklist on infection control;
2. State and local governments need to consider the needs of long-term care facilities with respect to supplies of PPE and COVID-19 tests, with a reminder that Medicare covers COVID-19 tests and that labs may enter facilities to conduct testing;
3. Facilities should immediately implement symptom screening for every individual entering the facility with the exception of emergency medical service workers responding to an urgent medical need; in addition, all residents should be assess for symptoms and have their temperatures checked every day;
4. To the extent available, nursing facilities should ensure that all staff are using appropriate PPE; all facility personnel should wear a facemask in the facility, full PPE should be worn if any COVID-19 transmission occurs in a facility, and residents who regularly leave the facility for care (e.g. dialysis) should wear facemasks when outside their rooms;
5. To the extent possible, facilities should use separate staffing teams for COVID-19 positive residents and to work with state and local leader to designate separate facilities or units within a facility to separate COVID-19 negative residents from COVID-19 positive residents and individuals with unknown status.