CMS Releases Updated Visitation, Citation Guidance for Nursing Homes Amid Coronavirus Spread

UPDATE, Saturday, March 14: Since this article was published, the federal government has implemented stricter guidance for nursing home visits, effectively banning all non-essential visitors with very limited exceptions. Read about the most up-to-date guidance here.

The federal government late Monday released an updated set of guidelines for nursing home operators amid the growing spread of the novel coronavirus, or COVID-19.

In a memo to directors of State Survey Agencies, the Centers for Medicare & Medicaid Services (CMS) is now advising nursing home providers to “actively screen and restrict” visits from anyone who has signs of respiratory illness, as well as people who have had contact with those who appear sick within the past 14 days.


Other criteria for restriction include people who have visited a list of countries determined by the Centers for Disease Control and Prevention (CDC) to have “sustained community transmission,” as well as anyone who resides in a community that has experienced a COVID-19 outbreak.

“CMS is laser focused on protecting patients, no matter where or [sic] they are receiving care,” CMS administrator Seema Verma said in a statement announcing the new guidelines. “We are receiving up-to-the minute information about COVID-19 and are, in turn, making necessary updates to our requirements and sharing that information with our providers throughout the healthcare system. America’s patients and providers should rest secure knowing that we are taking aggressive precautions to safeguard your health.”

The new guidelines also provide information about when operators should “limit” or “discourage” visits from outside people, and updated information about how facilities should approach admitting residents from hospitals affected by COVID-19.


“If possible, dedicate a unit/wing exclusively for any residents coming or returning from the hospital,” CMS noted in the memo. “This can serve as a step-down unit where they remain for 14 days with no symptoms (instead of integrating as usual on short-term rehab floor, or returning to long-stay original room).”

Amid stories of supply shortages, particularly of protective equipment and alcohol-based hand rubs (ABHRs), CMS emphasized that federal and state survey agencies won’t cite operators for running out of certain items — but only “for reasons outside of their control.”

“However, we do expect facilities to take actions to mitigate any resource shortages and show they are taking all appropriate steps to obtain the necessary supplies as soon as possible,” CMS warned. “For example, if there is a shortage of ABHR, we expect staff to practice effective hand washing with soap and water.”

Surveyors can contact officials at local CMS branch offices if they still believe a property should be cited for a lack of necessary supplies.

CMS also issued a directive for operators to remain informed about the latest COVID-19 developments.

“The situation regarding COVID-19 is still evolving worldwide and can change rapidly,” CMS concluded. “Stakeholders should be prepared for guidance from CMS and other agencies (e.g., CDC) to change. Please monitor the relevant sources regularly for updates.”

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