Every American diocesan bishop will travel to Rome over the next four months for meetings with Pope Francis assessing the state of the Church in the U.S.

The U.S. ad limina visit will be not only the first with Pope Francis, but the first since the Church in the US was shaken by a crisis of mistrust in episcopal leadership due to mishandling of sexual abuse allegations against Theodore McCarrick and others.

An "ad limina apostolorum" visit is a papal meeting required for every diocesan bishop in the world to provide an update on the state of one's diocese. The trip to Rome, usually made together with all the bishops from a country or region, also serves as a pilgrimage to "the threshold of the apostles," giving the bishops, who are the successors of the apostles, the opportunity to pray at the tomb of St. Peter and St. Paul.

Ad limina visits typically take place every five years, as the world's more than 5,300 bishops rotate through Rome. However, some countries have gone 10 years without an ad limina visit, as was the case with Taiwan. During Benedict XVI's pontificate, bishops from nearly every diocese in the world visited within seven years.

The last U.S. ad limina was with Benedict XVI in 2011-2012. Since then much has changed in the American landscape, from the Obergefell U.S. Supreme Court decision legalizing gay marriage in 2015 to the heightened tension over immigration debates under President Donald Trump.

The Catholic environment in the US has itself undergone considerable transformation since Pope Francis' trip to the United States in the fall of 2015.

In the last two years alone, Catholics in the US have reeled from the public revelations of McCarrick's sexual abuse, the Pennsylvania grand jury report, letters from Archbishop Carlo Vigano, Bishop Michael Bransfield's serious financial misconduct, and the resulting crisis of mistrust in episcopal leadership.

The first rounds of U.S. bishops to come to Rome come from dioceses in the northeast U.S., the hardest hit by these scandals.

The American ad limina visits are divided into 15 regions. Pope Francis will meet with bishops from New England Nov. 4-8, New York Nov. 11-15, and New Jersey and Pennsylvania Nov. 25-29.

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Bishops from New England began the first round of visits Nov. 4 with a Mass in Santa Maria Maggiore. They are also celebrating a Mass Nov. 5 in the Basilica of St. Paul Outside the Walls, and Nov. 7 in St. Peter's Basilica.

"We feel very keenly today, all of us, the weight of human sinfulness, of infidelity, of scandal, of the sin that weighs down the Church," Archbishop Leonard Blair of Hartford said in his homily during the Mass in Santa Maria Maggiore, according to CNS.

Before meeting the pope, bishops on an ad limina trip also typically visit all of the Vatican dicasteries and can schedule personal meetings with the head of each dicastery to discuss particular matters.

During such visits, bishops' conferences deliver exhaustive reports, called Quinquennial Reports, describing the status of the Church in their country.

Previous to  Francis' pontificate, the meeting of the bishops with the pope included an exchange of speeches from both the president of the bishops' conference and pope, who delivered a speech providing pastoral recommendations and priorities. After the exchange of speeches, the pope then held a short conversation with each bishop individually.

Pope Francis changed the format of these visits to an open group conversation among the visiting bishops, who are allowed to ask questions of the pope for up to two hours. He also added an additional meeting presided over by himself with the bishops and the heads of some of the dicasteries. In past visits, this has included representatives from the Secretariat of State, the Congregation for Clergy, the Pontifical Council for the Promotion of the New Evangelization, and the Dicastery for Laity, Family and Life.

The American ad limina visits coincide with the U.S. Conference of Catholic Bishops' General Assembly and election Nov. 10-13. Bishops from the state of New York will therefore be absent from the General Assembly and will vote remotely from the North American College in Rome.

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Before the end of 2019, Pope Francis will meet with bishops from Washington, D.C., Delaware, Maryland, Virginia, the U.S. Virgin Islands, West Virginia, and the U.S. Military Archdiocese, in addition to New England, New York, New Jersey, and Pennsylvania.

After a short hiatus for Christmas, the Latin rite bishops of the remainder of the territory of the US, and the country's Eastern Catholic bishops, will make their ad limina pilgrimages in 2020, from mid-January through the end of February.