CDC’s New Guidance for Health Care Workers

Last Friday the Centers for Disease Control and Prevention (CDC) issued new guidance for several COVID-19 pandemic infection control recommendations in health care delivery settings. The new guidance does away with the vaccination status of health care workers when determining whether to screen them for COVID-19, quarantine those workers, or employ “source control” measures such as…

Flu Shot: Encourage Preferred Vaccines for Patients 65+

It’s time to talk with your patients about flu shots. The CDC recommends annual flu shots for everyone 6 months and older by the end of October or as soon as possible each flu season. You can give flu and COVID-19 vaccines at the same visit. New for this flu season: Patients 65 and older should get…

Monkeypox Prevention and Control

Monkeypox Fact Sheet The World Health Organization declared the monkeypox outbreak a global health emergency, as the number of confirmed cases has increased to over 30,000 across 88 countries, with more than14,000 cases in the U.S. On August 4, 2022, President Biden declared monkeypox a national public health emergency. Although patients infected with monkeypox may…

Eligible Patients Can Receive Free 2nd COVID Booster

On April 6, the Center for Medicare & Medicaid Services (CMS) announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna COVID-19 vaccines without cost sharing, as it continues to provide coverage for this critical protection from the virus. People with Medicare pay nothing to receive a COVID-19 vaccine, and there is no applicable copayment, coinsurance, or deductible. People with Medicaid coverage can also get COVID-19 vaccines, including boosters, at no cost.

The CDC recently updated its recommendations regarding COVID-19 vaccinations. Certain immunocompromised individuals and people ages 50 years and older who received an initial booster dose at least 4 months ago are eligible for another booster to increase their protection against severe disease from COVID-19. Additionally, the CDC recommends that adults who received a primary vaccine and booster dose of Johnson & Johnson’s Janssen COVID-19 vaccine at least 4 months ago can receive a second booster dose of a Pfizer-BioNTech or Moderna COVID-19 vaccine.

The COVID-19 vaccine, including the booster doses, is the best defense against severe illness, hospitalization, and death from the virus. CMS continues to explore ways to ensure maximum access to COVID-19 vaccinations. More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients is available at https://www.cdc.gov/vaccines/covid-19/vaccination-provider-support.html and through the CMS COVID-19 Provider Toolkit.

People can visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby.

Eligible Patients Can Receive Free 2nd COVID Booster

On April 6, the Center for Medicare & Medicaid Services (CMS) announced it will pay for a second COVID-19 booster shot of either the Pfizer-BioNTech or Moderna COVID-19 vaccines without cost sharing, as it continues to provide coverage for this critical protection from the virus. People with Medicare pay nothing to receive a COVID-19 vaccine,…

CDC Proposes Updates to Controversial 2016 Opioid Prescribing Guidelines

On February 10, 2022, the Centers for Disease Control and Prevention (CDC) issued new proposed guidelines for prescribing of opioids for acute, sub-acute and chronic pain. The clinical practice guideline updates and expands the CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016, and provides evidence-based recommendations for clinicians who provide pain care, including those prescribing opioids, for outpatients age 18 years and older with acute pain (duration less than 1 month), subacute pain (duration of 1–3 months), or chronic pain (duration of 3 months or more).

The guideline explicitly EXCLUDES sickle cell disease-related pain management, cancer pain treatment, palliative care, and end-of-life care.

The clinical practice guideline includes recommendations for primary care clinicians (including physicians, nurse practitioners, and physician assistants) as well as for outpatient clinicians in other specialties (including those managing dental and postsurgical pain in outpatient settings and emergency clinicians providing pain management for patients being discharged from emergency departments).

This voluntary clinical practice guideline provides recommendations and does not require mandatory compliance; and the clinical practice guideline is intended to be flexible so as to support, not supplant, clinical judgment and individualized, patient-centered decision-making.

As part of the guideline issuance, CDC is asking interested persons or organizations to submit written views, recommendations, and data. In order to be considered, written comments must be received on or before April 11, 2022.  Instructions for submitting comments and various materials are available HERE; the revised guideline and other supporting materials are located in the “Enhanced Content” box in the lower right hand corner of the page.

A major area of concern associated with the 2016 guideline was the emergence of misapplication of the guideline by various state and local governments. In 2018 the National Association for Home Care & Hospice (NAHC) was invited to testify before the House Energy & Commerce Committee regarding hospice disposal of controlled substances.

As part of his testimony, NAHC’s representative Dr. John Mulder of the Trillium Institute and Faith Hospice in Michigan, commented on the misapplication of the 2016 CDC guideline by states that have resulted in delayed treatment for pain experienced by individuals receiving palliative or hospice care. In 2019, CDC issued a Media Statement  on the 2016 guideline cautioning against:

  • Misapplication of recommendations to populations outside of the Guideline’s scope;
  • Misapplication of the Guideline’s dosage recommendation that results in hard limits or “cutting off” opioids;
  • Abrupt tapering or sudden discontinuation of opioids; and
  • Misapplication of the Guideline’s dosage recommendation to patients receiving or starting medication-assisted treatment for opioid use disorder.

These concerns, in part, led to issuance of the revised guideline that is currently under review.

CDC Proposes Updates to Controversial 2016 Opioid Prescribing Guidelines

On February 10, 2022, the Centers for Disease Control and Prevention (CDC) issued new proposed guidelines for prescribing of opioids for acute, sub-acute and chronic pain. The clinical practice guideline updates and expands the CDC Guideline for Prescribing Opioids for Chronic Pain— United States, 2016, and provides evidence-based recommendations for clinicians who provide pain care,…

CMS Rescinds Focused Infection Control Survey and Visitor Restrictions for Home Health and Hospice Providers

In January 2021, the Centers for Medicare & Medicaid Services (CMS) implemented a revised COVID-19 Focused Infection Control Survey for Acute and Continuing Care (ACC) for providers which included home health and hospice.  This was the focused survey tool that surveyors would use for hospice and home health agency providers for any type of survey being conducted except a complaint survey where the complaint allegation is not related to infection control. At the same time, CMS clarified guidance for screening of individuals entering a health care facility which would include hospice inpatient units. See previous NAHC Report coverage here. Late on February 4, 2022 CMS revised the memo pertaining to the Focused Infection Control (FIC) survey tool and visitor screening.

CMS developed the FIC survey and tool at the beginning of the PHE to help surveyors and facilities absorb the critical infection prevention and control practices for combating COVID-19. CMS believes ACC facilities, including home health and hospice providers, have incorporated COVID-19 management strategies into their infrastructure and operations, and there is no longer a need to continue the required use of the special FIC survey and tool on a national basis. Therefore, CMS is rescinding the survey requirement to conduct FIC surveys.

State Survey Agencies (SAs) and Accrediting Organizations (AOs) should now return to the existing standard survey processes and continue to assess COVID-19 infection prevention and control elements by focusing on the regulatory requirements, while incorporating lessons learned about infection control oversight during the PHE. For example, the Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule guidance requires home health and hospice providers to develop and maintain approved policies and procedures for minimizing transmission of infectious disease that are established based on nationally recognized standards of practice. Surveyors will assess whether those polices are developed appropriately and followed.

While the contents of the FIC survey tool are generally still applicable, if providers wish to continue use of the tool as a template for their own self-assessment CMS encourages them to carefully review the Centers for Disease Control and Prevention (CDC) guidelines as there have been changes to the recommendations since the original tool and update were released (see the “Additional Resource Links” section in the memo linked above for more information on CDC guidelines).

Regarding visitation restrictions CMS stated it recognizes that restricting visitation from family and other loved ones during the COVID-19 pandemic has taken a physical and emotional toll on patients. While the COVID-19 Public Health Emergency (PHE) remains, CMS finds continued federal guidance on visitation restrictions for ACC providers are no longer necessary, which is consistent with the nursing home guidance in QSO-22-39Facilities should continue to adhere to basic COVID-19 infection prevention principles consistent with national standards of practice.

Providers should note that there may be more prescriptive requirements at the State level for infection control and visitor screening and visitation restrictions. CMS expects health care staff and surveyors (AOs, contractors, Federal, State, and Local) to comply with basic infection control practices such as hand hygiene, wearing masks, and the use of other personal protective equipment, as appropriate for the situation (i.e., standard, contact, airborne, etc).

Surveyors should focus on the regulatory requirements for each provider and supplier type and whether the facility consistently follows processes that are based on national standards of practice. Guidelines produced by the CDC are an example of a source for national standards.

Any COVID-19 infection prevention policy developed by a health care facility to meet the Medicare conditions should be approved by the facility’s governing body, or equivalent group as defined by regulation, before implementation. Health care providers should review their own infection prevention and control policies and practices to prevent the spread of infectious disease and illness, including COVID-19.

Should COVID-19 case rates increase in certain geographic locations, CMS instructs that concerned SAs should strongly consider doing a FIC survey in consultation with the applicable CMS location office.

CMS Rescinds Focused Infection Control Survey and Visitor Restrictions for Home Health and Hospice Providers

In January 2021, the Centers for Medicare & Medicaid Services (CMS) implemented a revised COVID-19 Focused Infection Control Survey for Acute and Continuing Care (ACC) for providers which included home health and hospice.  This was the focused survey tool that surveyors would use for hospice and home health agency providers for any type of survey…

New Sepsis Training Module Now Available

Health care providers now have a new resource at their disposal to help identify and treat sepsis patients in austere environments: a free, 70-minute online training module entitled Disaster Medicine: Sepsis. Please consider sharing the information across your networks. The module provides recommendations to identify and manage sepsis under austere conditions. The training features insights from…