CMS Nursing Home Testing Rule Takes Effect Today

Posted on September 2, 2020 by Jonathan Lips

As all nursing homes are now aware, CMS last week issued an Interim Final Rule requiring facilities to test staff and residents for COVID-19.

  The rule also requires laboratories conducting COVID-19 testing – including nursing homes that conduct point-of-care antigen testing – to report patient-level results of those tests on a daily basis.

MDH will address the new rule in today’s COVID-19 long-term care call from 3:30 – 4:30 pm, so please be sure to participate in that event. Click here for WebEx online event using computer audio. The event password is WeeklyCall1. Phone lines are limited, but to participate by phone dial 1-408-418-9388 with Access Code: 126 587 5466.

While we have covered this issue extensively over the past few days, we wanted to include a brief recap for readers who may not receive our daily COVID-19 updates.

Most important of all: the rule will be effective today – September 2 – upon its publication in the Federal Register.  We have updated our Summary of New CMS COVID-19 Testing Requirements to reflect that effective date.  We will also post a Frequently-Asked-Questions resource to the LeadingAge MN COVID-19 webpage by the close of business today.

Under the new rule, facilities are required to test both residents and staff in accordance with the parameters set out in QSO- 20-38-NH.   “Facility Staff” is defined broadly, to include employees, consultants, contractors, volunteers, and caregivers who provide care and services to residents on behalf of the facility, and students in the facility’s nurse aide training programs or from affiliated academic institutions.

Facilities can meet the testing requirements through one or both of two diagnostic testing methods:

• A molecular laboratory test (RT-PCR) through arrangement with an offsite laboratory. Laboratories that can quickly process large numbers of tests with rapid reporting of results (e.g., within 48 hours) should be selected to rapidly inform infection prevention initiatives to prevent and limit transmission.
• An antigen test using the rapid point-of-care diagnostic testing devices that CMS is distributing to all nursing homes that hold a CLIA Certificate of Waiver. 

The rule requires testing in three scenarios: (i) symptomatic individual identified; (ii) outbreak (new case arises in facility); and (iii) routine testing.  While CMS does not recommend routine testing of residents unless the resident leaves the facility regularly, it does require routine testing of staff. Facilities should begin testing all staff at a frequency based on the county COVID-19 positivity rate reported in the past week. CMS breaks the community COVID activity levels and testing frequency into three buckets:

• Low: Monthly testing in counties with less than 5% positivity
• Medium: Weekly testing in counties with 5-10% positivity
• High: Bi-weekly testing in counties with greater than 10% positivity

Facilities must utilize CMS data to identify positivity rates, and we have prepared this Tip Sheet: Determining Covid-19 Positivity Rate In Your County (08/31/20) to assist members in locating that data.

Facilities conducting point-of-care COVID-19 antigen tests under a CLIA Certificate of Waiver will be required to report data for all point-of-care tests the facility completes, at an individual patient level, within 24-hours of results being known. 

QSO- 20-38-NH includes detailed guidance on documentation facilities must complete to demonstrate timely compliance with the testing requirements, and strong documentation will be very important, especially if there are cases where circumstances, such as limited lab capacity, impair a facility’s ability to comply with the new requirements. As noted in a separate article in this week’s newsletter, Surveyors will inspect nursing homes for adherence to the new testing requirements and deficient practices will be cited at new tag F886.

We know members have many questions about these new requirements and how to operationalize them, and we will continue to provide new information on a daily basis. Our team has begun the work of creating additional tools and templates to support you, and we will share them with you as soon as possible.

Please contact Jon Lips or Kari Everson with any and all questions, comments and concerns, and we will incorporate those into our work with CMS and MDH.