ALTSA: NH #2021-036; QSO-20-39-NH REVISED – COVID-19 Visitation and Other Safe Start Plan Updates

ALTSA: NH #2021-036; QSO-20-39-NH REVISED – COVID-19 Visitation and Other Safe Start Plan Updates

On September 17, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a nursing home memorandum, QSO-20-39-NH, regarding visitation guidance. Residential Care Services (RCS) published a nursing home administrator letter (NH #020-070) on September 29, 2020 to provide guidance about the memo.

On April 27, 2021, CMS revised QSO-20-39-NH with updated guidance on infection control, visitation, communal dining and activities. This letter provides an update to NH #020-070.

New information from the QSO memo directs providers to the Centers for Disease Control and Prevention (CDC) website, Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination for guidance on the following:

  • Core principles of COVID-19 infection prevention, which were updated to include new guidance on use of face coverings or masks, and social distancing at least six feet.
  • Indoor visitation guidance.
  • Close contact (including touch) recommendations for fully vaccinated residents.
  • Communal dining and activities, including permitting fully vaccinated resident to dine and participate in activities without face coverings or social distancing if all participating residents are fully vaccinated. If unvaccinated residents are present, all resident should use face coverings when not eating and unvaccinated residents should physically distance from others.

Effective April 30, 2021 Washington state updated the Safe Start for Long Term Care to align the plan with the CDC recommendations for communal dining and activities.

Please continue to follow the Washington state Safe Start for Long-Term Care plan, and the directives of your local health jurisdiction if the local health jurisdiction has requirements additional to the Safe Start plan.

Thank you for your continued commitment to resident health and safety. If you have any questions, please contact Lisa Herke, Nursing Home Policy Program Manager at (509) 209- 3088 or

See letter here




Laura Hofmann, MSN, RN – Director of Clinical and Nursing Facility Regulatory Services
c: 425-231-4804


May 10, 2021