CMS Discontinues Prior Guidance on Visitation Restrictions and Rescinds COVID-19 Focus Infection Control Survey Procedures

On February 4, 2022, the Centers for Medicare and Medicaid Services (CMS) issued important updated guidance in a memo (QSO-21-08-NLTC) regarding how acute and continuing care facilities—including hospitals, ambulatory surgical centers, end-stage renal disease facilities, home health agencies, and hospices—manage infection control procedures in light of the COVID-19 public health emergency.

First, CMS rescinded the prior guidance, issued originally on March 23, 2020, and updated on December 30, 2020, regarding use of the focused infection control survey tool developed to emphasize specifically infection prevention and control practices for combating COVID-19.  This tool was determined to no longer be necessary as health care facilities have incorporated COVID-19 management into their infrastructure and operations.  CMS instructed surveyors and accrediting organizations to return to existing standard survey processes and assess COVID-19 infection prevention as part of those activities.  It should be noted that the guidance states that the focused infection control survey tool may still be used by surveyors on a targeted, case-by-case basis as needed.

Takeaway: CMS has not removed the requirement to have COVID-19 infection control procedures in place; rather, it has merely changed the survey process for verifying these procedures.   Acute and continuing care facilities should continue to maintain appropriate COVID-19 infection control procedures.

Second, CMS stated that while visitation restriction policies were used to mitigate COVID-19 infection, it recognized “that restricting visitation from family and other loved ones has taken a physical and emotional toll on patients.”  CMS determined that at this time, continued federal guidance on visitation restrictions for acute and continuing care facilities is no longer necessary.  CMS instructed facilities to consult with state and local public health officials to determine if modifications to visitation and screening are appropriate on a case-by-case basis, allowing for more prescriptive state health requirements.  However, the agency emphasized that such requirements may impose only reasonable limits on visitation insofar as they involve public health precautions and should be consistent with regulations such as 42 CFR 482.13(h),  42 CFR 483.420(a)(9) and 42 CFR 418.110(e), which give patients a federal right to receive visitors at any time, subject to minimal restrictions.

Takeaway: In light of this guidance, blanket restrictions on visitation at acute and continuing care facilities are questionable, especially if not imposed in conjunction with state health requirements.