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09/04/2020

Testing Questions Abound as Federal Guidance Contradicts State Testing

Testing Questions Abound as Federal
Guidance Contradicts State Testing

Today, LeadingAge Ohio staff has responded to numerous member inquiries related to testing, as the Centers for Medicare & Medicaid Services (CMS) Quality, Survey & Oversight (QSO) 20-38-NH took effect yesterday. The Interim Final Rule went into effect immediately, expanding the definition of ‘facility staff’ to be tested and requiring new testing intervals for nursing homes nationwide, depending on the prevalence of COVID-19 in the county they are located. The proscribed intervals are at odds with Ohio’s nursing home testing program, which has a goal of testing nursing home residents every 10 days, but to date, has only made it through a single round which took 28 days. The memo comes at a time when Ohio’s state lab capacity is stretched thin, and only beginning to feel the impact of the additional testing of schools and universities as they open classes.

Meanwhile, across Ohio, nursing homes are receiving their point of care testing devices from HHS with little guidance in terms of how to use them. The devices will be manufactured by BD or Quidel, and while they can be used to satisfy the requirements in the QSO memo, providers should familiarize themselves with the limitations of each device (life expectancy of the devices, specificity, etc.). Each requires providers to source supplies specific to their device, and only limited supplies are included with the devices upon delivery. LeadingAge has prepared Antigen Testing A-Z as a tool for decision-making, accessing supplies, etc.

Yesterday morning, LeadingAge Ohio met with Administration officials and impressed upon them the stress and chaos caused by the incongruency between federal and state requirements. Administration officials understood the challenges, but has not yet provided guidance whether the state will end or significantly modify its nursing facility testing program to align CMS requirements. A webinar held today by the Congregate Care Unified Response Team (CCURT) was also silent on the QSO guidance. LeadingAge Ohio is meeting again with the Administration on this topic today, so look for further detail in today’s COVID-19 report.

At this time, LeadingAge Ohio offers the following recommendations to members, to be in compliance with the new federal rule:

Upon identification of a single new case of COVID-19 infection in any staff or residents, all staff and residents should be tested, and all staff and residents that tested negative should be retested every 3 days to 7 days until testing identifies no new cases of COVID-19 infection among staff or residents for a period of at least 14 days since the most recent positive result.

Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency. Reports of COVID-19 county-level positivity rates will be available on this website, see section titled, “COVID-19 Testing”.

CMS directs facilities that the frequency of testing is based on the community COVID-19 activity and County positivity rate in the past week as outlined below:

Low <5% Once a month (Ohio still requires every two week testing)

Medium 5% - 10% Once a week*

High >10% Twice a week*

*This frequency presumes availability of Point of Care testing on-site at the nursing home or where off-site testing turnaround time is <48 hours.

For facilities that have received their antigen machine:

For facilities that have not received their antigen machine

It is possible that local health departments will yet be unfamiliar with the QSO requirements when you call, but nonetheless, it is important that providers be able to document their compliance with the federal requirement.

CMS’ new rules further require, in accordance with the CARES Act, that laboratories – including nursing homes using point-of-care testing – report COVID-19 test results to state and local health departments. Test results include demographic data, such as race and ethnicity information. It is important that facilities using the POC machines report negative test results to their local health departments; a spreadsheet format is acceptable.

It is important for providers to recognize that details on testing are emerging in real-time, and LeadingAge Ohio will endeavor to provide its members with the most up-to-date information possible. Furthermore, LeadingAge Ohio would like to hear from members who have received their POC devises with insufficient supplies, missing part, or other concerns.

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