HHSC COVID-19 Nursing Facility (NF) FAQs
The Texas Health and Human Services Commission (HHSC) is committed to sharing pertinent COVID-19 information with all NFs via a regularly updated Frequently Asked Questions (FAQs) document.
With each update, information in this FAQ document will be arranged by date, and if guidance changes from previous FAQs, it will be preceded with an asterisk (*). Questions regarding these FAQs can be directed to Long-term Care Regulatory Policy, Rules & Training at PolicyRulesTraining@hhsc.state.tx.us.
To search for a specific topic within this FAQ, click on the magnifying glass on the right side of the screen.
NF Frequently Asked Questions
Do NFs need to report to HHSC when there is a case of COVID-19 in the facility?
Yes. NFs should report any presumptive or confirmed case of COVID-19 in a resident, employee, or visitor to HHSC as a self-reported incident. Presumptive is defined as someone who has been exposed and is pending a test result. The reports should be made via TULIP or called into 1-800-458-9858 and include all information a facility would include in any self-reported incident.
Can NF residents go outdoors on facility property (to the gazebo or within the fenced area of the property, for example) so long as there are 10 people or fewer?
Answer: CMS recommends the cancelation of all group activities. However, residents can go outside within a protected area – defined as an area restricted only to NF residents and staff – if fewer than 10 people are in that area and they are all practicing social distancing (at least six feet between each person). See QSO-20-14-NH
Can residents receive visitors and visit on NF property but only outside?
Answer: No. On March 19, 2020, Governor Abbott issued an executive order stating people shall not visit NFs or retirement or long-term care facilities unless to provide critical services. PL 20-11.
Can NFs prohibit staff (drivers, for example) from wearing masks while they work? What about staff who are personally immunocompromised?
Answer: NFs should not discourage staff from wearing personal protective equipment. CMS guidance issued Apr. 2 states that for the duration of the state of emergency all NF personnel should wear a facemask while they are in the facility. See QSO-20-14-NH, *CMS COVID-19 Long-Term Care Facility Guidance and CDC guidance.
Should a NF readmit a resident who has been hospitalized when the resident is released from the hospital?
Answer: Yes. A NF should readmit a resident after hospitalization. If the resident was diagnosed with COVID-19, the individual should be admitted under transmission-based precautions for COVID-19. If a NF is unable to comply with the requirements for transmission-based precautions, readmission must wait until these precautions are discontinued. CDC has released Interim Guidance for Discontinuing Transmission-Based Precautions or In-Home Isolation for Persons with Laboratory- confirmed COVID-19.
If a NF resident tests positive for COVID-19, how do we handle staff quarantine?
Staff in the high- or medium-risk category should undergo active monitoring, including restriction from work in any health-care setting until 14 days after their last exposure.
Staff in the low-risk category should perform self-monitoring with delegated supervision until 14 days after the last potential exposure.
Staff who adhere to all recommended infection prevention and control practices should still perform self-monitoring, with delegated supervision as described under the low-risk exposure category.
Staff in the no identifiable risk category do not require monitoring or restriction from work.
Staff who have a community or travel-associated exposure should undergo monitoring as defined by the applicable risk category.
Can we have group games for residents if they are more than 6 feet apart in NFs?
Answer: CMS recommends the cancelation of all group activities. However, activities that consist of fewer than 10 people and that follow all social distancing and recommended hygiene practices are acceptable. See QSO-20-14-NH.
Can NFs still have volunteers?
Answer: No. Per Governor Abbott’s March 19 executive order, access to NFs can be granted only to people providing critical services, including staff, and they all must be fully screened for any fever or respiratory symptoms. See QSO-20-14-NH and PL 20-11.
Can we make exceptions to the rules when it’s emotionally hard for family members to not visit?
Answer: No. Per gubernatorial executive order, CMS, and HHSC, only individuals providing critical services, including staff, should be allowed in the facility. NFs should offer alternate means of communication such as phone calls, video calls, or other means of electronic communication. If possible, the resident can also be taken to a window so their family members can see them. See QSO-20-14-NH, Provider Letter 20-11, Abbott Executive Order.
Do end-of-life circumstances apply to anyone receiving hospice services?
Answer: No. While HHSC emergency rules do list hospice workers as essential, the rules also say NFs must also comply with any more restrictive direction issued by executive order or another applicable authority. Since CMS does not use the term “hospice” when describing allowable visitation in end-of-life situations, facilities should decide on a case-by-case basis when a resident is near the end of life and follow CMS and CDC guidance for visitation. See QSO-20-14-NH and CDC guidance.
Do NFs need to call ahead to the hospital if they are transferring a resident with respiratory symptoms?
Answer: Yes. NFs should work closely with local hospitals and health authorities to share all information needed to protect residents, health care workers, and hospital patients.
Where can I get my COVID-19 Medicaid questions answered?
The form attached to PL 20-11 is confusing. Should NFs admit residents
from the hospital if they are suspected or confirmed to have COVID-19?
Should NF residents be confined to their rooms?
Answer: If a resident is under transmission-based precautions, the individual should
be confined to his or her room. CMS has also directed the following:
Cancel communal dining and all group activities, such as internal and external group activities.
Implement active, daily screening of residents and staff for fever and respiratory symptoms.
Remind residents to practice social distancing and perform frequent hand hygiene.
Is it okay for family members to do laundry for residents and leave it at the
front door? If so, how do they get the laundry?
Answer: It is not recommended. NFs are required to have policies and procedures in place for staff to handle, store, process, and transport all linens and laundry in accordance with national standards to produce hygienically clean laundry and prevent the spread of infection to the extent possible. See guidance in CMS SOM Appendix PP, F880.
If there is a fire or an emergency medical situation, do emergency
responders need to be screened before entering a NF?
Answer: The required screenings do not apply to emergency services personnel entering the facility in an emergency such as a fire or a resident requiring lifesaving actions. See CDC guidance, CMS QSO-20-14-NH, CMS COVID-19 Long-Term Care Facility Guidance and CMS SOM Appendix PP, F880.
Are vendors that inspect, test, and maintain fire systems considered essential, and should they be granted entry into a NF?
Answer: Yes. These are considered essential services, and these vendors should be granted access to the facility if they are properly screened and follow all appropriate CDC guidelines for transmission-based precautions. See CMS QSO-20-14-NH, *CMS COVID-19 Long-Term Care Facility Guidance and CDC guidance.
How do nursing facilities get personal protective equipment (PPE)?
Answer: Providers should work with their local health departments and emergency
management if they need PPE:
Public Health Region - https://www.dshs.state.tx.us/regions/default.shtm
Local Public Health Organizations - https://www.dshs.state.tx.us/regions/lhds.shtm
Texas Division of Emergency Management - https://tdem.texas.gov/
Where do NF providers go for COVID-19 information?
The Centers for Disease Control and Prevention
The Centers for Medicare and Medicaid Services
The Texas Department of State Health Services
The Health and Human Services Commission
*CMS COVID-19 Long-Term Care Facility Guidance