Member Article

On April 27, 2021, the Center for Medicare & Medicaid Services (CMS) announced revised guidance for Nursing Home Visitation. CMS issued its initial guidance in March 2020, via memorandum QSO-20-14-NH. Under this memorandum, all visitation by visitors and non-essential health care personnel was restricted, except for situations involving compassionate care, such as end-of-life. In May 2020, CMS released updated visitation guidance under Nursing Home Reopening Recommendations,providing new guidance on visitation to as states and local governments progressed through the phases of reopening.

Under CMS’ new memo, the first revision to visitation guidance is in the “Core Principles of COVID-19 Infection Prevention.” The core principle of a face covering or mask has been updated to be in accordance with CDC guidance on the subject. Next, the guidance on outdoor visitation has been updated to take into consideration an individual’s quarantine status when evaluating whether an outdoor visit is appropriate or not. Third, the guidance on indoor visitation has been updated to be in line with current CDC guidance.. The CDC Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination provides the current guidance. Under that updated guidance, indoor visitation should be permitted except under the following circumstances.[1]

1.         Indoor visitation for unvaccinated residents should be limited solely to compassionate-care situations if the COVID-19 county positivity rate is above 10 percent and fewer than 70 percent of residents in the facility are fully vaccinated;

2.         Indoor visitation should be limited solely to compassionate-care situations, for:

a. Vaccinated and unvaccinated residents with SARS-CoV-2 infection until they have met criteria to discontinue Transmission-Based Precautions.

b. Vaccinated and unvaccinated residents in quarantine until they have met criteria for release from quarantine.

3.         Facilities in outbreak status should follow guidance from state and local health authorities and CMS on when visitation should be paused.

a. If visitors are allowed during this time, they should be counseled about their potential to be exposed to SARS-CoV-2 in the facility if they are permitted to visit.

In addition to the above guidance on indoor visitation, communities should remind visitors to physically distance from other residents and staff while visiting a skilled nursing facility.

Finally, CMS has updated its guidance on communal activities and dining. CMS is following CDC guidance, which provides that “residents who are fully vaccinated may dine and participate in activities without face coverings or social distancing if all participating residents are fully vaccinated; if unvaccinated residents are present during communal dining or activities, then all residents should use face coverings when not eating and unvaccinated residents should physically distance from others”[2]. Facilities can look to the Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination for additional details and guidance on communal dining and activities.

If you or your organization may be impacted by these changes, revised requirements or are interested in learning how to comply with these changes, please contact Dinsmore’s health care practice attorneys.

[1] CDC COVID-19 (2021, April 27) Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-after-vaccination.html

[2] CMS Updates (2021, April 27) Nursing Home Visitation – COVID-19 https://content.govdelivery.com/attachments/INSDH/2021/04/30/file_attachments/1795276/QSO%2020-39-NH%20Visitation%20REVISED.pdf