Elevating the Post-Acute and
Long Term Care Profession

March 10, 2021

CMS Opens Up SNF Visitation. As expected, the Centers for Medicare and Medicaid Services (CMS), reacting to now-widespread COVID-19 vaccination of SNF residents, issued a new version of Quality, Safety, and Oversight letter (QSO) 20-39-NH on visitation. The revisions to the QSO strip away most of the existing limitations on routine indoor visitation, especially for fully vaccinated residents. The vaccination status of facility staff and the visitor are irrelevant. The only remaining restrictions are:

  • An unvaccinated resident of a SNF in a CMS red county if the overall vaccination rate among the facility's residents is below 70%.
  • Residents who have COVID-19 or are in quarantine and have not satisfied the time for release, regardless of vaccination status.
  • Outbreaks, but only if they affect more than one unit in the facility or the unit where the resident lives. CMS calls for suspending visitation between the first positive case and completion of the first round of outbreak testing to identify the extent of the outbreak. Vaccination status does not affect the outbreak guidelines.
Except for these circumstances, routine indoor visitation is mandatory in all SNFs. None of the above restrictions apply to compassionate care visits, which is not a change.

The new CMS guidance also explicitly dispenses with distancing and allows physical touching during visits, beyond the narrow exception for compassionate care, but the resident must be fully vaccinated, wear a well-fitting facemask, and perform hand hygeine. Visitors still must wear facemasks, distance from others in the building, submit to screening, and follow other infection prevention and control protocols. CMS added a statement that visitors who have had close contact with a COVID-19-positive person in the past 14 days cannot visit regardless of the visitor's vaccination status.

CMS clarified that SNFs cannot require visitors to be tested or vaccinated, although both are encouraged. Surveyors also are not required to be vaccinated.

CMS and the Centers for Disease Control and Prevention (CDC) will hold a National Nursing Home Stakeholder call tomorrow at 3:30 p.m., presumably on the new visitation and quarantine guidelines. You may register for the call using this link.

CDC Drops Other Shoe on Vaccination Guidance. As we reported earlier this week, CDC released guidance on fully vaccinated members of the public that expressly excluded health care, aside from health care personnel in their private capacities. Today, CDC published "Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination." The first section of the new CDC guidance restates the CMS provisions on visitation in amended QSO 20-39. The second section addresses work restrictions and quarantine. CDC states clearly, "[f]ully vaccinated HCP with higher-risk exposures who are asymptomatic do not need to be restricted from work for 14 days following their exposure." There are exceptions for immunocompromised workers and as required by CDC's travel guidelines.

CDC previously lifted the work restriction for fully vaccinated health care personnel, but the next provision in today's guidance is the big news: "Quarantine is no longer recommended for residents who are being admitted to a post-acute care facility if they are fully vaccinated and have not had prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days." Quarantine is still recommended for patients (vaccinated or not) who have prolonged close contact with someone who has COVID-19.

CDC makes it a point that both testing and personal protective equipment recommendations remain unchanged.

Federal Stimulus Legislation Passes. Today the US House of Representatives passed the Senate version of the American Rescue Plan Act without change. The vote was an almost part-line 220-211, with one Democrat breaking ranks and voting no. President Joe Biden plans to sign the bill Friday, averting termination of expanded jobless benefits on Sunday. We listed a few provisions of the legislation that have significance for long-term services and supports in yesterday's COVID-19 Update and will provide further analysis in the days to come.

Long-Term Care Cases Near Historic Low. This week's Department of Health dashboard for COVID-19 cases in long-term care cases once again showed improvement, which has been the case every week since mid-December. The total of 1,052 current cases is the lowest since the early summer floor of 913 the week of June 24, 2020. The state recorded 188 COVID-19-related deaths in long-term care for the past week, but with the change in how the state recognizes deaths (death certificate review), the timing is not consistent with the case counts.