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New DOH Nursing Home Testing and Visitation Guidance Aligns with CMS

The Department of Health (DOH) issued new guidance last week on nursing home visitation and testing. The new guidance, Dear Administrator Letter (DAL) 22-09, generally aligns with Centers for Medicare and Medicaid Services (CMS) guidance on testing and visitation issued earlier this month, except that it continues the New York State Health Advisory requiring visitors to present negative COVID-19 test results. The new guidance explicitly "supersedes and replaces" the November 2021 DOH visitation DAL.

Notably, the new DOH guidance reiterates CMS statements recognizing that nursing homes “serve as a home for long-stay residents and quality of life should be balanced with risks for transmission.” As a result, both regulatory agencies note that "consideration could be given to allowing residents who are up to date with all recommended COVID-19 vaccine doses to not use source control when in communal areas of the facility." However, DOH states that "residents at increased risk for severe disease should still consider continuing to practice physical distancing and use of source control.” Finally, the DOH guidance emphasizes that “[m]aintaining masking of staff and visitors and identifying COVID-19 positive individuals are of critical importance.”

LeadingAge NY members are urged to read the document in its entirety; however, for your convenience, the following are some highlights:


  • Continues the State's visitor testing requirements.
  • Reiterates CMS guidance that requires visitors who test positive or meet criteria for quarantine to be excluded until they meet the same criteria for discontinuing transmission-based precautions (TBP) that are used for residents. The criteria for residents can be found here. In pertinent part, they are:
    • For residents who are exposed to COVID-19 and not up-to-date or not recently recovered, discontinue TBP after day 10 following the exposure (day zero) if they do not develop symptoms, or after day seven following the exposure (day zero) if a viral test is negative for COVID-19 and they do not develop symptoms.
    • For residents who are infected with COVID-19, discontinue TBP after at least 10 days and up to 20 days from the day that symptoms appeared, longer if severely immunocompromised.
  • Directs facilities to avoid large gatherings where physical distancing cannot be maintained.
  • Permits facilities to restructure their visitation policy to support physical distancing, such as by asking visitors to schedule their visits in staggered time slots and/or by limiting the number of visitors in the facility or a resident’s room at any time.
  • Provides that if a resident's roommate is not up-to-date with all recommended COVID-19 vaccine doses, or is immunocompromised (regardless of vaccination status), visits should not be conducted in the resident’s room, if possible.


  • Reiterates CMS guidance that routine testing must be conducted of staff who are not “up-to-date” in their vaccinations. Staff who are up-to-date do NOT have to be routinely tested. The definition of "up-to-date" can be found here.
  • Requires routine staff testing no less frequently than the intervals indicated in Table 2 of the CMS guidance, based on the Centers for Disease Control and Prevention's (CDC) "Community Transmission Levels" (please note that this is different from community levels for the general public). “Community Transmission Levels” have four different colors – red, orange, yellow, and blue. Facilities should have a policy to check the CDC Community Transmission Level for their county at regular intervals.
  • Provides that if the Community Transmission Level declines, the facility should continue testing staff at the higher frequency level until the level of community transmission has remained at the lower activity level for at least two weeks.
  • Refers facilities to CDC guidance concerning routine testing of staff who work in the facility infrequently. According to the CDC guidance, this means that they should be tested no more than three days before their shift (including the day of their shift).
  • States that testing is not generally necessary for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 90 days.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383