Centers for Medicare & Medicaid Services (CMS) revised the memo concerning nursing home visitation (QSO-20-39-NH), originally published in September 2020. The visitation memo was revised along with Centers for Disease Control and Prevention’s (CDC) update of guidance for infection prevention and control in health care settings, including nursing homes, on May 8. (See related article.) The bottom line in the updated CDC guidance is that health care providers should consider several factors, notably state and local guidance if it exists, to determine mitigation strategies that will best serve their settings and the individuals they serve.

The updated visitation memo aims to align with the updated CDC guidance and offers the following CMS visitation clarifications and updates:

• Visitation is permitted for all residents at all times, with some rare exceptions, but CMS “still expects facilities to adhere to infection prevention and control recommendations in accordance with accepted national standards.”
• Post visual alerts. CMS adds a new core principle to reduce the risk of transmission – post “visual alerts,” such as signs and posters, at the nursing facility entrance and in strategic places throughout the community to instruct about current infection prevention and control recommendations (e.g. when to use source control).
• Reminder to adhere to CMS regulations when an outbreak investigation begins.  A single new case of COVID-19 will trigger an outbreak. Residents may have visitors during an outbreak investigation, however, it is suggested the visit occur in the resident’s room and that both the resident and the visitor wear source control, if tolerated and maintain physical distance, if possible.
• Staying up-to-date with vaccinations. CMS strongly encourages visitors to stay up to date with their COVID-19 vaccinations and facilities should continue to encourage and educate visitors.
• Sharing meals. The Frequently Asked Questions at the end of the memo include one major revision: a visitor may share a meal with, or feed, another resident.

Please keep in mind with the ending of the public health emergency, CMS advises that states may instruct nursing homes to take additional measures to make nursing homes safer and encourages states to work with both CMS and their local state survey agency on measures they are considering.

CMS also announced that QSO-20-38-NH, concerning staff and resident testing, will be expired on May 11. Nursing facilities should conduct testing by following accepted national standards, such as CDC recommendations. Noncompliance related to COVID-19 testing will be cited at F-tag 880. Routine testing of asymptomatic staff is no longer recommended, though it may be conducted at facility discretion.