The Centers for Medicare and Medicaid Services (CMS) recently issued guidance in response to questions from the hospital provider community concerning Coronavirus Disease (COVID-19).  CMS provides useful guidance on some of the more mundane, daily administrative aspects of care, while reminding hospitals that the Centers for Disease Control and Prevention (CDC) provides critical guidance for clinical decisions.  Some key elements from CMS, as they relate to essential patient rights such as access to care, visitation, and discharge, include the following:

 1.    Should COVID-19 patients wait for care alongside non-COVID 19 patients?

Basic steps such as facemasks and using an alternate room for COVID-19 patients should be used.  In some situations, using a facemask or moving the patient to an alternate room where they can be isolated from the general population is impractical.  When that happens, CMS suggests that any well-ventilated space that permits six feet of separation and easy access to respiratory hygiene supplies could be sufficient.  In other situations, medically stable patients could wait in their personal vehicle or simply outside the facility’s waiting area.  These patients could be readily contacted on their mobile phone to let them know when it is time to be evaluated.

 2.    What about COVID-19 patients who receive diagnostic or therapeutic interventions?

 CMS warns that some patients, for example intubation patients, create a high risk of COVID-19 transmission.  CMS reminds health care providers that, during the delivery of the appropriate level of care: (1) all providers should wear personal protective equipment, (2) providers should limit the number of personnel with access to the patent to only essential personnel, and (3) the provider should promptly clean and disinfect the treatment area in accordance with the applicable infection control guidelines.

 3.    What about COVID-19 patient visitation rights?

 CMS requires hospitals as a condition of participation to have written policies and procedures that apply to the visitation rights of patients.  A hospital is permitted to limit patient visitation as a clinical restriction for infection control provided that the patient is informed of the restriction, and the hospital has followed an appropriately developed policy.  CMS also suggests that hospitals work collaboratively with local, state, and federal public health agencies on developing appropriate response strategies for preventing and controlling infections across patients, visitors, staff, and other health care providers.

 4.    Are their special concerns for discharging a COVID-19 patient?  

 CMS reminds hospitals that it recently revised its discharge planning rules in 2019 and that the decision to discharge a COVID-19 patients should be made based on the clinical condition of the patient.  The decision of when and where to discharge a patient should include whether transmission-based precautions should be continued, and requires the hospital to communicate all medically necessary information, including communicable diseases, to both the receiving facility and any applicable ambulance transport personnel.  The discharge planning process should also consider if the receiving facility or home discharge location can adequately meet any applicable infection prevention and control recommendations.  The CDC also provides interim guidance on discharging COVID-19 patients to home here.

Christopher P. Dean is a principal at Miles & Stockbridge’s Health Care Practice. He represents hospitals, physicians, physician group practices, and other health care facilities on health care regulatory and traditional business law issues. He is also part of the firm’s Coronavirus Task Force, a cross-disciplinary team that can quickly and efficiently deploy talent from relevant practices to address concerns and issues in real time.

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