Medicare Compliance & Reimbursement

With COVID-19 vaccination rates climbing, the Centers for Medicare & Medicaid Services (CMS) revised its guidance on nursing home visits.

“CMS recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents, and their families,” said Lee Fleisher, MD, CMS chief medical officer and director of CMS’ Center for Clinical Standards and Quality in a March 10 release.

Fleisher continued, “That is why, now that millions of vaccines have been administered to nursing home residents and staff, and the number of COVID cases in nursing homes has dropped significantly, CMS is updating its visitation guidance to bring more families together safely.”

Details: “Facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident, or visitor, unless certain scenarios arise that would limit visitation, “CMS says in its updated guidance.

Facilities should limit indoor visitation when the nursing home’s COVID-19 county positivity rate is greater than 10 percent and less than 70 percent of residents in the facility are fully vaccinated, CMS instructs. Nursing homes should also limit visits for residents with confirmed COVID-19 or who are in quarantine.

“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,” CMS says in the updated guidance letter to state survey agencies. Then the nursing home can resume visitation based on specified testing results.

Even if some residents test positive, “while outbreaks increase the risk of COVID-19 transmission, a facility should not restrict visitation for all residents as long as there is evidence that the transmission of COVID-19 is contained to a single area (e.g., unit) of the facility,” CMS says.

Plus: CMS also points to the importance of “compassionate care” visits, offering several examples of when the exceptions referenced above should be overruled.

“Visits for compassionate care, such as an end-of-life situation or a resident in decline or distress should be allowed at all times for any resident (vaccinated or unvaccinated), regardless of the above scenarios,” CMS says in a fact sheet about the guidance. “In addition, facilities and visitors should continue all infection prevention and control practices.”

Resource: Review CMS guidance, including links to the fact sheet and memo to state survey agency directors, at www.cms.gov/newsroom/press-releases/cms-updates-nursing-home-guidance-revised-visitation-recommendations.