The CMS COVID guidelines for nursing homes have shifted from emergency pandemic memos to permanent rules written into the Code of Federal Regulations. As of 2026, facilities that participate in Medicare or Medicaid must run an infection prevention program that covers COVID-19 along with influenza and RSV, educate residents and staff about the COVID-19 vaccine and offer it, report respiratory virus data weekly through CDC’s National Healthcare Safety Network, and protect residents’ rights to visitors and to refuse testing or vaccination. The COVID-specific checklists that governed daily operations during the pandemic no longer apply.
What Expired and What Stayed
The QSO memos CMS used during the pandemic have been rescinded. QSO-20-39-NH, which governed visitation, expired on May 1, 2023.1CMS.gov. Expired – Nursing Home Visitation COVID-19 (Revised) QSO-20-38-NH, which set specific outbreak testing cadences, expired in May 2023. QSO-23-10-NH, which imposed enhanced enforcement penalties for infection control failures, expired on July 30, 2025. The federal staff vaccination mandate ended in May 2023.
What replaced them is the permanent framework in 42 CFR Part 483, Subpart B.2CMS.gov. Nursing Homes CMS also updated the Long-Term Care surveyor guidance effective February 24, 2025, folding pandemic lessons on barrier precautions and vaccination into Appendix PP, the manual surveyors use during every standard survey.3CMS.gov. Revised Long-Term Care Surveyor Guidance The practical effect: facilities are no longer following COVID-only rules, but COVID-19 is now a permanent part of how they’re inspected.
The Infection Control Program
Under 42 CFR 483.80, every nursing home must maintain an infection prevention and control program designed to prevent the spread of communicable disease among residents, staff, volunteers, and visitors. The rule doesn’t single out COVID-19. It covers every infectious threat and requires the program to follow accepted national standards.4eCFR. 42 CFR 483.80 – Infection Control
The program has to include a surveillance system that catches possible infections before they spread, written policies for standard and transmission-based precautions, isolation protocols that are the least restrictive possible given the infectious agent, rules that keep sick staff away from direct resident care when transmission is likely, an antibiotic stewardship system, and recordkeeping for incidents and corrective actions. Every facility must also designate at least one infection preventionist with training in nursing, medical technology, microbiology, epidemiology, or a related field, plus specialized infection control training. That person must work at least part-time on-site and sit on the facility’s quality assessment committee.
CDC now publishes a Respiratory Virus Toolkit for nursing homes that bundles COVID-19, influenza, and RSV guidance together. It recommends multiplex testing for symptomatic residents, spells out when to move to facility-wide masking, and lists the PPE staff should wear entering the room of a resident with a suspected respiratory infection. For suspected COVID-19, that means an N95 or higher, gown, gloves, and eye protection.5Centers for Disease Control and Prevention. Viral Respiratory Pathogens Toolkit for Nursing Homes
Vaccine Education and Offer
The staff vaccination mandate is gone. What replaced it is the “educate and offer” requirement at 42 CFR 483.80(d)(3). Facilities must educate every resident, every resident representative, and every staff member about the benefits, risks, and potential side effects of the COVID-19 vaccine before offering it, then offer the vaccine or help the person access it.4eCFR. 42 CFR 483.80 – Infection Control
Documentation is part of the rule. Each resident’s medical record has to show that education was provided and whether the vaccine was administered, refused, or medically contraindicated. Updated benefit-and-risk information must be given before each additional dose in a multi-dose regimen. Staff records must show the same education-and-offer trail. Refusal is always the resident’s or staff member’s right, and it must be respected and documented without penalty.
One visible change for families: effective July 30, 2025, CMS removed COVID-19 vaccination measures from individual nursing home profile pages on the Care Compare website.6CMS.gov. Revised Updates to Nursing Home Care Compare Facilities still report vaccination data to NHSN, but you won’t see a facility-level vaccination rate when you compare nursing homes online.
Testing and Outbreak Response
Because the pandemic-era testing mandate expired in May 2023, nursing homes are no longer bound to specific cadences like retesting every three to seven days during an outbreak. Testing now flows from the general obligations in 42 CFR 483.80 and current CDC recommendations.
CDC recommends that nursing homes have access to rapid respiratory virus testing that returns results within 24 hours, and that symptomatic residents be tested for at least SARS-CoV-2 and influenza, with consideration for RSV. Multiplex nucleic acid detection is preferred because it identifies the specific virus and guides both treatment and infection control.5Centers for Disease Control and Prevention. Viral Respiratory Pathogens Toolkit for Nursing Homes When an outbreak is identified on a unit, CDC recommends broad-based testing, unit- or facility-wide masking, and keeping symptomatic residents in their rooms except for medical necessity. Roommates of symptomatic residents are treated as exposed and should mask around others. A symptomatic resident shouldn’t be paired with a new roommate unless both have the same confirmed infection.
Residents can refuse testing under 42 CFR 483.10(c)(6).7eCFR. 42 CFR 483.10 – Resident Rights Staff should explain why the test matters and offer a less invasive collection method, like an anterior nasal swab, but they cannot force it. A resident who refuses during an outbreak is managed as potentially positive, meaning transmission-based precautions apply until the risk window passes.
Visitation Rights Today
Federal regulation gives nursing home residents the right to receive visitors of their choosing at the time of their choosing. This right sits in 42 CFR 483.10(f)(4) and predates the pandemic. Facilities cannot require visitors to show proof of vaccination or a negative COVID-19 test as a condition of entry. They can enforce reasonable infection control measures such as hand hygiene, offering masks during periods of elevated respiratory illness, and screening for symptoms.
When a resident has a confirmed respiratory infection and is on transmission-based precautions, the facility may limit visits to the resident’s room but cannot ban them. The visit should still happen, with PPE offered to visitors. A blanket facility-wide visitation ban isn’t justified when transmission is limited to one unit, and a facility that restricts visits beyond what’s clinically necessary risks a deficiency citation.
The state Long-Term Care Ombudsman keeps immediate access to any resident under federal law, regardless of whether an outbreak is occurring.8ACL Administration for Community Living. Long-Term Care Ombudsman FAQ
NHSN Data Reporting
Starting January 1, 2025, CMS made electronic reporting through NHSN a permanent condition of participation and expanded it beyond COVID-19. Nursing homes now report data on three respiratory viruses: COVID-19, influenza, and RSV. Required elements include facility census, resident vaccination status for all three, confirmed resident cases broken out by vaccination status, and resident hospitalizations with confirmed cases, also by vaccination status.9Centers for Disease Control and Prevention. Nursing Home Data Dashboard
Resident case and vaccination data go to NHSN weekly. Staff COVID-19 vaccination data goes monthly. The final rule also gives the HHS Secretary authority to require additional data elements or increase reporting frequency during a future respiratory illness public health emergency. National and state-level summaries are published on CDC’s Nursing Home Data Dashboard, which covers roughly 15,000 facilities and updates every Thursday.
Enforcement and Star Ratings
State survey agencies inspect nursing homes on behalf of CMS. Infection control deficiencies are cited under F-tag F880, which corresponds to 42 CFR 483.80. Failures to meet the vaccine educate-and-offer rule are cited under F887. Since February 2025, both tags are part of the standard surveyor manual, so surveyors assess them during every standard survey, not just focused infection control surveys.
The automatic 10 and 20 percent penalty enhancements that applied to infection control citations under QSO-23-10-NH ended on July 30, 2025. Standard enforcement now applies. When non-compliance is confirmed, CMS can impose civil monetary penalties scaled to severity, deny payment for new admissions, require a directed plan of correction, or terminate the facility’s participation in Medicare and Medicaid. Termination is rare but remains available for severe or repeated non-compliance.
Infection control citations also affect a facility’s rating on CMS’s Five-Star Quality Rating System. F880 deficiencies fall under the health inspections component, and repeated or serious citations drag the star rating down.10CMS.gov. Five-Star Quality Rating System That rating is public on Care Compare, so infection control problems follow a facility’s reputation.
Raising a Concern
If a facility is restricting visitation without clinical justification, skipping infection control basics, or failing to offer the COVID-19 vaccine, you have a few ways to escalate. The most direct is the state Long-Term Care Ombudsman program, which has authority under the Older Americans Act to investigate complaints on behalf of residents. Ombudsmen can enter facilities, speak privately with residents, and work with leadership to resolve issues. For visitation disputes, this is usually the fastest route.
You can also file a complaint directly with the state survey agency that conducts CMS inspections; a confirmed complaint can trigger a focused survey and the enforcement actions above. For residents in Medicare Advantage or other managed care plans, quality-of-care grievances can go through the plan’s grievance procedure or through the Beneficiary Family Centered Care Quality Improvement Organization. State Ombudsman contact information is available through the Administration for Community Living at acl.gov.