CMS Revises Nursing Home Visitation FAQs to Address Omicron Variant

In light of surging COVID-19 cases occasioned by the highly transmissible Omicron variant and questions from nursing homes regarding whether to limit visitation, the Centers for Medicare and Medicaid Services (CMS) earlier this month revised its visitation Frequently Asked Questions (FAQs) and a generalized infographic to address the issue.

In November 2021, CMS issued a revised memorandum that greatly expanded visitation in nursing homes after it had largely been paused during the COVID-19 pandemic. Of course, that was after the Delta variant had waned and before Omicron had taken hold, driving up daily cases to record levels. Nevertheless, CMS makes clear in the new and revised FAQs that visitation will be permitted and can occur in a manner that does not place other residents at increased risk for COVID-19. Specifically, CMS added three new FAQs that address visitation during Omicron and other situations in which COVID-19 cases are spiking, and modified others to discuss state involvement in visitation questions.

In the new FAQs, CMS notes its concern about the rise in cases occasioned by the Omicron variant, but also notes the deleterious effects of isolation and separation of residents from their loved ones that occurred when visitation was largely prohibited earlier in the pandemic, which resulted in both physical and psychosocial decline. As a result, CMS states that visitation can occur regardless of a visitor’s vaccination status and suggests the following modalities for reducing the risk of COVID-19 transmission:

• Offering visitors surgical or KN95 masks;
• Restricting visitors’ movement in the facility;
• Using outdoor or dedicated indoor visiting space that can be cleaned and sanitized between visits;
• Increasing air-flow and ventilation;
• Physical distancing;
• Frequent hand hygiene; and
• Providing reminders in common areas regarding physical distancing, masking, and hand hygiene.

CMS also urges providers to consult with state or local public health officials for any additional measures that can be employed to reduce the risk of COVID-19 transmission for other residents, especially when outbreaks occur, to determine when modifications to visitation policy would be appropriate. CMS advises facilities to document their discussions with the health department and the actions they took to attempt to control the transmission of COVID-19.

While none of the foregoing is new, it does reflect an acknowledgment of the lessons learned by CMS in restricting visitation for nursing home residents earlier in the pandemic. Certainly, the methods outlined by CMS for limiting transmission, the high uptake of COVID-19 vaccination among nursing home residents, and the relatively mild effects of the Omicron variant have led to a decision by CMS to stay the course on permitting visitation. For nursing homes, maintaining lines of communication with their state public health agency, monitoring case rates in the community and implementing appropriate responsive measures, and above all, documenting their efforts to keep residents safe will continue to be paramount.