• As we continue to advise, Maryland post-acute providers can accept hard to place non-Covid-19 hospital transfers now in order to help free-up acute care in hospitals for COVID-19 patients.

• Hard to place patients include those who have high drug costs that are paid for in hospitals, but not in SNFs. We will continue to work with AHCA/NCAL, with our Congressional Delegation, and with the Hogan team for CMS regulatory and financial relief on this front.

• No decisions yet. But in advance of the acute care surge associated with COVID-19, it is important that we inventory SNF capacity to take non-COVID-19 med/surg patients to free-up acute care space. 

• For the future, plan now: we strongly urge SNFs to begin now creating separate wings, units, or floors by moving current residents to handle future full surge admissions from the hospitals and keep current residents separate, if possible.

• Overall effectiveness of the Infection Prevention and Control Program (IPCP) including policies and procedures 
• Standard and Transmission-Based Precautions (with the understanding that certain essential supplies are scarce, and facilities should not be penalized for not having certain supplies if they are unable to obtain them) 
• Quality of resident care practices, including those with COVID-19 (laboratory-positive case), if applicable 
• Surveillance plan 
• Visitor entry and facility screening practices 
• Education, monitoring and screening practices of staff 
• Facility policies and procedures to address staffing issues during emergencies, such as transmission of COVID-19 

• Standard surveys and non-IJ revisits are suspended for three weeks

• ​​​​​​​During this period, the following surveys will be suspended: 
• Standard surveys for nursing homes, hospitals, home health agencies (HHAs), intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and hospices. 
• Life safety code and emergency preparedness elements of standard surveys. 
• Revisits not associated with an IJ. 
• The following enforcement actions will be suspended, until revisits are again authorized: 
• Imposition of Denial of Payment for New Admissions (DPNA), including situations where facilities are not in substantial compliance at 3 months. 
• Imposition of termination for facilities that are not in substantial compliance at 6 months. 
• Per day civil money penalties (CMP) will not accumulate. 
• CMS will not impose any new remedies for prior noncompliance. 
• Note: Enforcement actions for unremoved or new IJs remain and will continue to be issued under normal procedures/guidance. 

• Complaints and facility-reported incidents triaged at the Immediate Jeopardy level will continue

• During this three-week time frame, State survey agencies (SSAs) and CMS will only conduct surveys related to complaints and facility-reported incidents (FRIs) that are triaged at the Immediate Jeopardy (IJ) level, and revisits to verify removal of IJ (including previously cited IJ deficiencies). 
• If the revisit survey determines there is continuing noncompliance, but at a lower level than IJ, surveyors will not conduct another onsite revisit survey. 
• For non-IJ deficiencies, providers may submit a plan of correction (POC) to be held until the end of the three-week period or may delay submission of their POC until the end of this period. 
• Enforcement actions for unremoved or new IJs remain and will continue to be issued under normal procedures/guidance. 

• Perform self-assessments on infection control using surveyor tool
• Use the COVID-19 Infection Control Focused Survey tool contained in the CMS memo (developed with CDC) to perform self-assessment of your facility’s Infection Control plan. This document may be requested by surveyors, if an onsite investigation takes place. 
• CDC recommends that nursing homes notify their health department about residents with severe respiratory infection, or a cluster of respiratory illness (3 or more residents or HCP with new-onset respiratory symptoms within 72 hours).
• Note: Local and state reporting guidelines or requirements may vary.  

• In this memo, CMS provides guidance to restrict visitation in health care facilities such as hospitals, critical access hospitals, psychiatric hospitals, inpatient hospice units, and intermediate care facilities for individuals with developmental disabilities. 
• Nursing homes should continue to refer to QS0-20-14 for visitor guidance. 

• CMS acknowledges that some providers (nursing homes, assisted living facilities, etc.) have significantly restricted entry of staff from other providers who are providing direct care to patients. In general, if the staff is appropriately wearing PPE, and do not meet criteria for restricted access, they should be allowed to enter and provide services to the patient (interdisciplinary hospice care, dialysis, organ procurement, home health, etc.). 
• This does not change existing guidance for nursing homes.  

• For CLIA, surveyors will prioritize immediate jeopardy situations over recertification surveys, and generally use enforcement discretion, unless immediate jeopardy situations arise. 

• A list of confirmed cases sent to CRISP from the Maryland Department of Health (MDH).
• Positive and negative lab results from LabCorp and Quest lab feeds across the region. These results currently originate from ordering physicians that are CRISP participants with executed lab request forms within our system. We are actively working with LabCorp, Quest and hospital based testing centers to provide more comprehensive results.

1. Navigate to the “Add Filter” drop down at the top of the screen.
2. Select the “Diagnosis Description” category.
3. A list of options will appear to the right of the category, select “contains”.
4. Type the term “COVID” into the open field.
5. Return to the “Add Filter” drop down at the top of the screen.
6. Select the “Patient Class” category.
7. A list of options will appear to the right of the category, select “equals”.
8. Select “O: Outpatient” from the drop down.
9. Within the “Custom Filter” field, type the desired name of the custom filter then click “Save”.
10. Once you’ve created the filter, alerts for both positive and negative test results as well as confirmed cases will automatically populate.

• Saved custom filters will always be stored for future use within the “Saved Custom Filter” drop down. There is no need to repeat the aforementioned steps.
• Please note, saved filters are not automatically applied the end users notifications. Upon logging in, the user must select and apply the saved custom filters prior to viewing alerts.

• A list of confirmed cases sent to CRISP from the Maryland Department of Health.
• Positive and negative lab results from LabCorp and Quest lab feeds across the region. These results currently originate from ordering physicians that are CRISP participants with executed lab request forms within our system. CRISP is working with LabCorp, Quest and hospital based testing centers to provide more comprehensive results.