Legislative Update
Health Facilities Association of Maryland

CMS Revises Visitation Guidance for Skilled Nursing and Rehabilitation Centers
Before the COVID-19 pandemic, among my highest priorities was to visit Marylanders in need and their professional care teams in nursing homes and on assisted living campuses. I look forward to safely resuming these visits to meet with those receiving and providing long-term and post-acute care.

Yesterday afternoon, the Centers for Medicare and Medicaid Services (CMS), working in alignment with the Centers for Disease Control and Prevention (CDC), issued new visitation guidance for skilled nursing and rehabilitation centers. This is good news and a critical advancement of policy guidance. 
Again, yesterday’s CMS move is great news. We have long written about the need for visitation in our sector, along with the tragic and understandable tension between government orders to protect people from COVID-19 and the need for residents and patients to have visits from loved ones.
Given the increasing vaccination rates, we have advised nursing home leaders to increase compassionate care visits while maintaining protocols. On February 11, 2021, in advance of new orders from Governor Hogan and MDH, we sought increased visitation and observation latitude in state orders given vaccination rates in our sector. In recent weeks we have been working on individual cases with specific centers (thank you all) to increase compassionate care visits. Over the last many months, we have written and advised on both the necessity of visitation and the need to protect people from the virus. The language from the February 11 MDH orders will aid in the implementation of the CMS guidance here in Maryland: 
The 2/11 Nursing Home Matters Order, see page 9 (section 9A), relevant section bolded:
As of March 1, 2021, the following subsection applies to each individual nursing home:
  1. All nursing homes should follow the Centers for Medicare & Medicaid Services (CMS) guidance on nursing home visitation regarding COVID-19 (QSO-20-39-NH) or as updated by CMS. Either MDH or a local health department may direct a facility to a more restrictive set of conditions at any point.
That said, it will be important that Maryland (MDH) guidance is clear and consistent relative to this point in the CMS guidance (on page 3):
  • Facilities should allow indoor visitation at all times and for all residents (regardless of vaccination status), unless certain scenarios arise that would limit visitation due to a high risk of COVID-19 transmission, including:
  • “Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated until they have met the criteria to discontinue transmission-based precautions”
The Bottom Line: Federal and state orders and guidelines over the last year rightfully limited visitation, nursing homes complied with those government orders, and lives were saved. The CMS guidance issued yesterday is excellent news. It will be important for skilled nursing and rehabilitation centers to allow indoor visitation and increase compassionate care visits.
As always, we continue to advise the sector:
  • People first, quality counts.
  • Be prepared to deploy people and PPE around your organization.
  • Our sector MUST double our efforts on infectious disease protocol, staffing, PPE, observation, and testing.
  • Train, train, and train teams again on infectious disease protocol.
  • Recognize that COVID-19 fatigue is an issue across the county, not just in our sector.
  • Overcommunicate with residents, patients, families, staff, and government partners.
  • Sound alarms early.
  • Know that WE WILL get through this and that you are saving lives!
  • Work with your hospital partners, and coordinate with local and state regulatory partners.
  • Take and document your action; keep a timeline.
  • CLICK HERE for the Dr. Katz Video, and please see the Donning and Doffing Checklist we have been sharing.

Be well,
Joe DeMattos
President and CEO

The Health Facilities Association of Maryland (HFAM) is the oldest and largest nationally affiliated long-term and post-acute care association in the state. HFAM represents over 170 skilled nursing centers and assisted living communities in Maryland, as well as nearly 80 associate businesses that offer products and services to health care providers. Our members provide services and employ individuals in nearly every jurisdiction in the state.

Thousands of Marylanders across the state depend on the high-quality care and services that our members offer every day. HFAM skilled nursing and rehabilitation center members provide the majority of post-acute and long-term care to Marylanders in need: 6 million days of care across all payer sources annually, including more than 4 million Medicaid days of care and one million Medicare days of care.

Visit our website to learn more.