CMS Revises Memo on Nursing Home Visitors

COVID-19
On Wednesday, March 10th CMS released revisions to QSO memo on visitation (20-39-NH), incorporating vaccination status. The memo improves the ability for nursing home residents to receive visitors. CMS emphasizes the importance of maintaining infection prevention practices, given the continued risk of COVID-19 transmission. CMS's changes were based on new guidance from the Centers for Disease Control and Prevention (CDC).

Providers are strongly encouraged to review the QSO memo. While there are some differences between the new CDC guidance that was also released today, providers must follow CMS guidance and/or state and local guidance. AHCA will continue to review both set of guidance and seek clarity from CMS or CDC on any inconsistencies. We will provide updates as we have more information. If you are uncertain about whether visitation is allowed in a particular circumstance, contact your local/state health officials, and document any outreach you conduct.

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The following is a high-level overview of changes made to CMS visitation guidance. CMS also offers a fact sheet on the revised guidance.

The term fully vaccinated is defined as someone who has received all the required doses of the vaccine and is at or greater than 2 weeks from receiving the last dose.

Visitor Screening – Visitors should be prohibited entry if they have had close contact with someone with COVID-19 infection in the prior 14 days (regardless of the visitor's vaccination status.)

Outdoor Visitation – Is still preferred even if both the resident and their visitors are fully vaccinated.

Indoor Visitation – Providers should allow indoor visitation at all times and for all residents (regardless of vaccination status), except for a few circumstances when visitation should be limited due to a high risk of COVID-19 transmission (note: compassionate care visits should be permitted at all times). These scenarios include limiting 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.
Providers should continue to implement the core principles of COVID-19 infection prevention as outlined in the memo. With the continuation of these practices and if the resident is fully vaccinated, residents can choose to have close contact (including touch) with their visitor while wearing a well-fitting face mask and performing hand-hygiene before and after. Visitors should physically distance from other residents and staff in the facility.

Indoor Visitation During an Outbreak - When a new case of COVID-19 among residents or staff is identified, a facility should immediately begin outbreak testing and suspend all visitation (except that required under federal disability rights law), 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.
  • 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.
Compassionate care visits (definition in the memo remain unchanged) and visits required under federal disability rights law should be allowed at all times, for any resident (vaccinated or unvaccinated) regardless of the above scenarios. Lastly, facilities should continue to consult with their state or local health departments when an outbreak is identified to ensure adherence to infection control precautions, and for recommendations to reduce the risk of COVID-19 transmission. 

Visitor Testing and Vaccination – Visitors are encouraged to become vaccinated when they have the opportunity. While visitor testing and vaccination can help prevent the spread of COVID-19, visitors should not be required to be tested or vaccinated (or show proof of such) as a condition of visitation. 

Compassionate Care Visits – As a reminder, 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. Visits should be done in accordance with infection control core practices. 

Federal and state surveyors and Ombudsman are not required to be tested or vaccinated (or show proof) and must be permitted entry into facilities unless they exhibit signs or symptoms of COVID-19.