CurrentimperialinsurancecompanyofutahPolicy N/A

COVID-19 guidance for long-term care facilities

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Operational recommendations from CMS/CDC adopted by Imperial Health Plan to help long-term care and nursing homes mitigate COVID-19 spread, covering infection control, screening, PPE, staffing, testing coordination, and cohorting; applies to long-term care facilities and their staffs, residents, and local/state partners.

Policy Summary

Payerimperialinsurancecompanyofutah

PolicyCOVID-19 guidance for long-term care facilities

Policy CodePolicy N/A

Change TypeInformational / Operational guidance

Effective DateApr 2, 2020

Last ReviewApr 2, 2020

Next Review DateN/A

Key ActionImplement symptom screening and temperature checks for every individual entering the facility and assess residents daily.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

dailyresident symptom and temperature checks

facemaskstaff facemask requirement

14 daysisolation period for unknown-status admissions

since Mar 13, 2020visitor prohibition

Operational Criteria for Long-Term Care Facilities

Operational criteria

Immediate actions and operational criteria recommended for long-term care facilities:

Ensure compliance with CMS and CDC infection control guidance, including adherence to appropriate hand hygiene and use of the CMS self‑assessment checklist.

Coordinate with state and local health departments to determine and address facility needs for personal protective equipment (PPE) and COVID‑19 tests; note that Medicare is covering COVID‑19 testing when furnished to eligible beneficiaries by certified laboratories and laboratories may enter facilities to conduct testing.

Implement symptom screening and temperature checks for every individual entering the facility (residents, staff, visitors, vendors, outside healthcare workers), limit access points, and ensure screening stations at all accessible entrances; assess every resident daily for symptoms and temperature.

Require facility personnel to wear facemasks for the duration of the state of emergency while in the facility; use full PPE per CDC guidance when caring for residents with known or suspected COVID‑19 and, if transmission occurs in the facility, use full PPE for care of all residents regardless of diagnosis or symptoms.

Encourage residents to cover nose and mouth (tissues or cloth/non‑medical masks) when staff are in their rooms; reserve medical facemasks for residents who are COVID‑19‑positive or assumed COVID‑19‑positive; patients who must leave the facility regularly (e.g., hemodialysis) should wear facemasks when outside their rooms.

Use separate staffing teams and practice consistent assignment to the extent possible to limit staff crossing units and reduce the number of different staff interacting with each resident.

Work with state and local leaders to designate separate units or facilities for COVID‑19‑positive, COVID‑19‑negative, and unknown‑status residents; COVID‑19‑positive units/facilities must maintain strict infection control and testing protocols and may require capacity for higher‑intensity care.

When possible, isolate admitted or readmitted residents with unknown COVID‑19 status in the COVID‑19‑positive facility (or designated area) for 14 days; inform residents and families about limitations on access and procedures for placement in alternative facilities.

COVID-19 Test Coverage Codes

COVID-19 test coveragemixed

Medicare coverage for COVID-19 testing by certified laboratories (no specific codes provided in document)

Provider Billing and Testing Actions

Billing Rule

Medicare coverage for COVID-19 testing — allow certified labs on-site and coordinate testing

Medicare is covering COVID-19 testing when furnished to eligible beneficiaries by certified laboratories; laboratories may enter facilities to conduct testing. Facilities should coordinate with state and local health departments to determine and address needs for PPE and COVID-19 tests, and permit certified laboratories to enter the facility to perform testing when appropriate. Screening (symptoms and temperature) should continue for all individuals entering the facility, and patients/residents who enter should be tested for COVID-19 when testing is available.

Permit certified laboratories to enter the facility to conduct COVID-19 testing as described in CMS guidance.
Coordinate with state and local health departments to identify needs for PPE and COVID-19 tests.
Continue symptom screening and temperature checks for all individuals entering the facility; test patients/residents when testing is available.

Key Definitions

Long-term care facilities — definition and brief descriptor of nursing homes / long-term care facilities.

TermLong-term care facilities (also known as nursing homes)

DefinitionFacilities that serve as both healthcare providers and full-time homes for vulnerable Americans.

RoleCritical component of the healthcare system providing both medical care and residential services to vulnerable populations.

Related guidanceSubject to CMS and CDC recommendations including visitor prohibitions (implemented March 13, 2020), infection control, and screening.

Scope of guidanceOperational recommendations apply to facility staff, residents, and coordination with state/local health authorities to mitigate COVID-19 spread.

Policy Summary

Payerimperialinsurancecompanyofutah

PolicyCOVID-19 guidance for long-term care facilities

Policy CodePolicy N/A

Change TypeInformational / Operational guidance

Effective DateApr 2, 2020

Last ReviewApr 2, 2020

Next Review DateN/A

Key ActionImplement symptom screening and temperature checks for every individual entering the facility and assess residents daily.

SourceLink

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COVID-19 guidance for long-term care facilities

Customize your policy alerts

Sign up for all imperialinsurancecompanyofutah policy alerts

Know when imperialinsurancecompanyofutah releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Operational Criteria for Long-Term Care Facilities

Operational criteria

Immediate actions and operational criteria recommended for long-term care facilities:

Ensure compliance with CMS and CDC infection control guidance, including adherence to appropriate hand hygiene and use of the CMS self‑assessment checklist.

Use separate staffing teams and practice consistent assignment to the extent possible to limit staff crossing units and reduce the number of different staff interacting with each resident.

Provider Billing and Testing Actions

Billing Rule

Medicare coverage for COVID-19 testing — allow certified labs on-site and coordinate testing

Permit certified laboratories to enter the facility to conduct COVID-19 testing as described in CMS guidance.
Coordinate with state and local health departments to identify needs for PPE and COVID-19 tests.
Continue symptom screening and temperature checks for all individuals entering the facility; test patients/residents when testing is available.

Key Definitions

Long-term care facilities — definition and brief descriptor of nursing homes / long-term care facilities.

TermLong-term care facilities (also known as nursing homes)

DefinitionFacilities that serve as both healthcare providers and full-time homes for vulnerable Americans.

RoleCritical component of the healthcare system providing both medical care and residential services to vulnerable populations.

Related guidanceSubject to CMS and CDC recommendations including visitor prohibitions (implemented March 13, 2020), infection control, and screening.

Scope of guidanceOperational recommendations apply to facility staff, residents, and coordination with state/local health authorities to mitigate COVID-19 spread.