• QSO-20-38-NH
• QSO-20-39-NH

What’s New: Important CMS Updates for Skilled Nursing Facilities:

On Thursday, March 10, 2022, the Centers for Medicare & Medicaid Services (CMS) updated QSO memos 20-38-NH regarding facility testing requirements and 20-39-NH regarding nursing home visitation to include the term “up-to-date.” Please read both documents for full details. DOH has seen these documents and stated CMS is aligning with CDC, which DOH has already done. Please continue to follow all DOH and CDC guidance.  A summary of the revisions is provided below.

Changes to QSO-20-38-NH Interim Final Rule (IFC), CMS-3401-IFC, Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency related to Long-Term Care (LTC) Facility Testing Requirements

CMS replaced the term “vaccinated” with “up-to-date with all recommended COVID-19 vaccine doses” and updated the recommendations for testing individuals within 90 days of recovering from COVID-19. These changes include:

• The definition of “up-to-date” is “a person has received all recommended COVID-19 vaccines, including any booster dose(s) when eligible.”
• The facility must test symptomatic residents and staff regardless of vaccination status immediately and are expected to be restricted from the building pending results.
• The facility must test all staff and residents regardless of vaccination status upon new identification of a COVID-19 positive staff or resident.
• Routine testing of staff who are not “up-to-date” should be conducted based upon the community transmission rates. Staff that are “up-to-date” do not need to be tested. Please note-this has not been signed off on by DOH-please follow current DOH guidance for testing.
• For healthcare personnel (HCP) who work in the facility infrequently, the facility should refer to the CDCs testing guidance.
• If outbreak testing is occurring and a staff member who is not “up-to-date” refused testing, they should be restricted from the building.
• The facility should follow its occupational health and local jurisdiction policies regarding asymptomatic staff who are not “up-to-date” and refuse testing.
• In general, testing is not necessary for those who have recovered from COVID-19 in the last 90 days. However, if testing does occur, CMS recommends an antigen test be used because some people remain nucleic acid amplification test (NAAT) positive but not infectious during this time. Please follow current DOH guidance on testing those who have recovered from COVID-19 in the last 90 days.

Changes to QSO-20-39-NH Nursing Home Visitation – COVID-19

CMS replaced the term “vaccinated” with “up-to-date” and deleted the term “unvaccinated.” They also updated visitor screening and quarantine criteria. Updates include the following:

• The definition of “up-to-date” is “a person has received all recommended COVID-19 vaccines, including any booster dose(s) when eligible.”
• Visitors who have a positive viral test for COVID-19, symptoms of COVID-19, or currently meet the criteria for quarantine should not enter the facility until they meet the criteria used for residents to discontinue transmission-based precautions (quarantine).
• Outdoor visitation is preferred when the resident and/or visitor are not “up-to-date” with all recommended COVID-19 vaccinations.
• If a resident’s roommate is not “up-to-date,” or immunocompromised (regardless of vaccination status), visits should not be conducted in the resident’s room.
• Visitors should wear face coverings or masks and physical distance when around other residents or HCP regardless of vaccination status.
• In areas of low-to-moderate transmission, the safest practice is for residents and visitors to wear face coverings or masks and physically distance, particularly if either of them is at increased risk for severe disease or are not “up-to-date” with all recommended COVID-19 vaccine doses.
• Residents, regardless of vaccination status, can choose not to wear face coverings or masks when other residents are not present and have close contact (including touch) with their visitor.
• Residents (or their representative) and their visitors, who are not “up-to-date” with all recommended COVID-19 vaccine doses, should be advised of the risks of physical contact prior to the visit.
• If an ombudsman or Protection and Advocacy person (PA) is planning to visit a resident who is in transmission-based precautions or quarantine, or a resident who is not “up-to-date” with all recommended COVID-19 vaccine doses in a nursing home in a county where the level of community transmission is substantial or high in the past seven days, the resident and ombudsman should be made aware of the potential risks of visiting and the visit should take place in the resident’s room.
• If a resident leaves the facility, upon their return nursing homes should take the following actions: Please continue to follow DOH guidance for testing
  • Screen residents upon return for signs and symptoms of COVID-19
    • If the resident or family member reports possible close contact to an individual with COVID-19 while outside of the nursing home, test the resident for COVID-19, regardless of vaccination status. Place the resident on quarantine if the resident is not “up-to-date” with all recommended COVID-19 vaccine doses.
  • A nursing home may also opt to test residents, who are not “up-to-date” with all recommended COVID-19 vaccine doses, without signs or symptoms if they leave the nursing home frequently or for a prolonged length of time, such as over 24 hours.
  • Facilities might consider quarantining residents, who are not “up-to-date” with all recommended COVID-19 vaccine doses, and leave the facility if, based on an assessment of risk, uncertainty exists about their adherence or the adherence of those around them to recommended infection prevention measures.

CMS also notes that there are exceptions to quarantine, including for residents who are up-to-date with all recommended COVID-19 vaccine doses

Questions?

Contact:

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