The following answer was provided by CMS on April 24, 2020 in QSO-20-28-NH:

No. For patients hospitalized with COVID-19, decisions about discharge from the hospital should be based on their clinical status, the ability of the accepting facility to meet their care needs and the infection control requirements specified below. Decisions about hospital discharge are distinct from decisions about discontinuation of Transmission-Based Precautions.

For patients with known or suspected COVID-19, decisions about discontinuing Transmission-based Precautions can be based on either a test-based or non-test-based strategy as outlined here. Test-based strategies are preferred but not required and might not be possible due to limitations on availability of testing.

If the patient has not met criteria for discontinuing Transmission-based Precautions, they should be transferred to a facility with the ability to adhere to infection prevention and control recommendations for the care of COVID-19 residents including placement in a unit or area of the facility designated to care for COVID-19 residents.

If the patient has met the criteria for discontinuing Transmission-based Precautions but has persistent symptoms (e.g., persistent cough), they should ideally be placed in a single room, be restricted to their room, and wear a face mask during care activities until they have returned to baseline or until 14 days after illness onset, whichever is longer.

If the patient has met the criteria for discontinuing Transmission-based Precautions and does not have persistent symptoms, they do not require additional restrictions.

Patients hospitalized for non-COVID-related illnesses whose COVID-19 status is not known can be transferred to a nursing home without testing. However, to ensure they are not infected,nursing homes should place them in Transmission-Based Precautions in a separate observation area or in a single room until 14 days have elapsed since admission.

We note that on April 2, 2020 CMS released “COVID-19 Long-Term Care Facility Guidance” which stated that, “patients and residents who enter facilities should be screened for COVID-19 through testing, if available.” This language is meant to highlight that a test- based strategy is preferred when making decisions about discontinuing Transmission-Based Precautions for residents with COVID-19, but it is not a requirement to test residents prior to admission.

CMS wants to ensure that everyone who needs nursing home care after a hospitalization can be admitted to a facility that can meet their care needs. This also helps free up hospital beds so others can receive the acute care they need.

More information about preventing and controlling the transmission of COVID-19 can be found on the Center for Disease Control and Prevention (CDC) website for FAQs.

‍