The Centers for Medicare and Medicaid Services (“CMS”) issued revised guidance yesterday afternoon regarding nursing home visitation.1 The substantive revisions to the visitation guidance are summarized below:
- CMS notes that outdoor visitation is still preferred even when the resident and visitor are fully vaccinated against COVID-19. (NOTE: Fully vaccinated refers to a person who is ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine.)
- Regardless, facilities should allow indoor visitation at all times and for all residents (regardless of the vaccination status of the resident or the visitor), except under the following scenarios that would limit indoor visitation for:
- Unvaccinated residents, if the nursing home’s COVID-19 county positivity rate is >10% and <70% of residents in the facility are fully vaccinated;
- Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue Transmission-Based Precautions; or
- Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine.
- CMS provides that when a new case of COVID-19 among residents or staff is identified, a facility should immediately begin outbreak testing and suspend all visitation, until at least one round of facility-wide testing is completed. Visitation can resume based on the following criteria:
- If the first round of outbreak testing reveals no additional COVID-19 cases in other areas (e.g., units) of the facility, then visitation can resume for residents in areas/units with no COVID-19 cases. However, the facility should suspend visitation on the affected unit until the facility meets the criteria to discontinue outbreak testing. (NOTE: Outbreak testing is discontinued when testing identifies no new cases of COVID-19 infection among staff or residents for at least 14 days since the most recent positive result.)
- If the first round of outbreak testing reveals one or more additional COVID-19 cases in other areas/units of the facility (e.g., new cases in two or more units), then facilities should suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing.
- If subsequent rounds of outbreak testing identify one or more additional COVID-19 cases in other areas/units of the facility, then facilities should suspend visitation for all residents (vaccinated and unvaccinated), until the facility meets the criteria to discontinue outbreak testing.
- CMS notes that compassionate care visits and visits required under federal disability rights law should be allowed at all times, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate or an outbreak.
- Visitors should not be required to be tested or vaccinated (or show proof of such) as a condition of visitation.
- Federal and state surveyors are not required to be vaccinated and must be permitted entry into facilities unless they exhibit signs or symptoms of COVID-19. Surveyors should adhere to the core principles of COVID-19 infection prevention, and adhere to any COVID-19 infection prevention requirements set by state law.
Nursing home providers will need to ensure compliance with the revised CMS guidance to avoid potential deficiencies and sanctions. Providers should also consider the development of or amendment to their policies and procedures to address visitation and ensure that residents and visitors comply with such visitation policies and adhere to the core principles of COVID-19 infection prevention consistent with the CMS guidance.
If you have any questions regarding CMS’ nursing home visitation guidance and/or would like assistance in developing or amending your visitation policies, please do not hesitate to contact us. Thank you, and stay well.
1 QSO-20-39-NH Revised 3/10/2021 (https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf)