CMS Updates Testing and Visitation Guidance, Aligning with Latest CDC Guidance


CMS released revised QSO memos QSO-20-38-NH (Testing) and QSO-20-29-NH (Visitation). Revisions in the testing memo include information on routine testing of asymptomatic staff and updated recommendations for testing individuals who have recovered from COVID-19.  Revisions in the visitation memo include updated guidance for face coverings and masks during visits and the removal of vaccination status as a consideration. These revisions align with the updated CDC guidance​ that was also released on the same date. Many of these changes reflect the tireless work that AHCA members have devoted to advocating for CDC and CMS to update.  

Testing Updates: 

Routine Testing (Staff) 

  • Routine testing for staff for SARS-CoV-2 is no longer required.  

Outbreak Testing (Residents and Staff) 

  • An outbreak investigation would not be triggered when a resident with known COVID-19 is admitted directly into transmission-based precautions (TBPs), or when a resident known to have close contact with someone with COVID-19 is admitted directly into TBP and develops COVID-19 before TBPs are discontinued.  

Reporting Positive Tests 

  • All facility staff should report a positive viral test, symptoms, or a higher-risk exposure to occupational health or another point of contact designated by the facility so they can be properly managed.  

Testing New Admissions 

  • ​Facilities are directed to CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic guidance under Managing admissions and Residents who leave the facility for information on testing of residents who are newly admitted or readmitted to the facility and those who leave the facility for 24 hours or longer. 
    • Admissions in counties where Community Transmission levels are high should be tested upon admission (admission testing at lower levels of Community Transmission is at the discretion of the facility). 
    • Testing is recommended at admission and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test. 
    • They should also be advised to wear source control for the 10 days following their admission.   
    • Residents who leave the facility for 24 hours or longer should generally be managed as an admission. 
Other Considerations 

  • Testing is not necessary for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 30 days
  • Testing should be considered for those who have recovered in the prior 31-90 days
    • If testing is performed, the use of an antigen test instead of a nucleic acid amplification test (NAAT) is recommended. 
Visitation Updates: 

CMS removed references of “up-to-date from the requirements” for outdoor and indoor visitation, removed the requirement to “screen all who enter for visitation exclusions,” and provided the following updates: 

  • Facilities should provide guidance (e.g., posted signs at entrances) about recommended actions for visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or have had close contact with someone with COVID-19.  
  • Visitors with confirmed COVID-19 infection or compatible symptoms should defer non-urgent in-person visitation until they meet CDC criteria for health care settings to end isolation.  
  • For visitors who have had close contact with someone with COVID-19 infection, it is safest to defer non-urgent in-person visitation until 10 days after their close contact if they meet criteria described in CDC healthcare guidance (e.g., cannot wear source control).  
  • During peak times of visitation and large gatherings (e.g., parties, events) facilities should encourage physical distancing. 

CMS included guidance for the use of face coverings and masks during visits as it relates to Community Transmission Level metrics to include: 

  • If the nursing home’s county COVID-19 community transmission is high, everyone in a healthcare setting should wear face coverings or masks.  
  • If the nursing home’s county COVID-19 community transmission is not high, the safest practice is for residents and visitors to wear face coverings or masks; however, the facility could choose not to require visitors wear face coverings or masks while in the facility, except during an outbreak.  
  • The facility’s policies regarding face coverings and masks should be based on recommendations from the CDC, state and local health departments, and individual facility circumstances.  
  • Regardless of the community transmission level, residents and their visitors when alone in the resident’s room or in a designated visitation area, may choose not to wear face coverings or masks and may choose to have close contact (including touch).  
  • Residents (or their representative) and their visitors should be advised of the risks of physical contact prior to the visit.  
  • If a roommate is present during the visit, it is safest for the visitor to wear a face covering or mask. 

CMS indicated in most circumstances, quarantine is not recommended for residents who leave the facility for less than 24 hours (e.g., for medical appointments, community outings with family or friends), except in certain situations described in the CDC’s empiric transmission-based precautions guidance. 
Please note that while CDC and CMS have changed its guidance, the guidance from local and state health departments may be more restrictive. Please check your local or state guidance.