Recently, CMS held a stakeholder call for nursing home providers with additional information regarding the White House announcement of distribution of COVID-19 point-of-care rapid results testing instruments and supplies to all skilled nursing facilities across the nation, beginning the week of July 20. This is to help facilities test both residents and staff in order to fulfill the CMS guidance that recommends a baseline test and weekly testing thereafter.

During this call, CMS relayed that prioritization for the first group of these testing instruments and supplies will be given to COVID-19 “hot spots” and facilities with three or more positive patients.  Texas, Florida, and Arizona were states specifically mentioned. CMS has devised a list of 1500-2000 facilities, derived from CDC data and other sources, to receive free point-of-care testing instruments that could be distributed as early as next week.  Eventually, more than 15,000 facilities will receive a testing instrument.  Identification of these facilities and prioritization methods will be publicly identified in the future.

Only facilities with a CLIA waiver can receive a testing machine.  Facilities with this waiver will receive a machine and approximately 400 tests initially depending upon the size of the facility.  If facilities do not already have a waiver, information on the application is available here.   Providers may obtain additional tests from the corresponding manufacturer.

The machines being distributed can perform 15-20 tests with results within an hour. Although it is noted that these tests can produce false negatives, the premise is that they would be more beneficial than current lab tests with delayed results. Also, the rapid test cost is under $25.00 compared to $100-$150 for current lab tests.  Per CMS, information regarding machine use training and billing will be provided forthcoming.  The U.S. Department of Health & Human Services foresees that there will be no test supply issue by October.  Also, by this timeframe, twenty million tests are supposed to be available per month.  Further rapid testing information can be found here.

Testing Plan

CDC updated Interim COVID-19 Testing Guidelines for Nursing Home Residents and Healthcare Personnel this month.  These guidelines and any new testing updates can be found on the CDC’s website.

A testing plan for COVID-19 should be developed for nursing facilities. This plan should include the following:

  • Alignment with state and federal requirements for testing residents and Healthcare Professionals (HCP)
  • Process for testing all residents and HCP and volume to complete
  • When to complete testing (i.e routine surveillance, with symptoms, exposure)
  • Test accessibility and agreement with the lab
  • Omit utilization of antibody test results
  • Procedure for addressing residents or HCP who refuse or are unable to be tested

 

 

Tracking Testing Activities

A “line list” or spreadsheet should be developed to track resident names, facility location, health status, testing dates & results, hospitalizations, isolation discontinuation, etc. for all residents with signs or symptoms consistent with COVID-19. A line list can aid to determine potential outbreak causes such as linking symptoms, location, and test results. It is especially important that all information is filled out so that the data can be accurately analyzed.  Also, the line list should be filled out in real-time so that the tool can assist with ongoing management instead of a retrospective look back.

COVID-19 Reporting Requirements

In an effort to increase transparency and support COVID-19 surveillance, CMS added further infection control requirements provisions to launch reporting for suspected or confirmed COVID-19 cases.  These provisions for § 483.80 Infection Control may be found here.

Facilities must submit the data through the NHSN at least once every seven days or can submit multiple times within the week. CMS does not mandate a particular day of the week for data submission but recommends consistency with a certain day of each week using the same collection timeframe.  CMS will pull the information every Monday and share the data publicly. CMS has published FAQs to assist with reporting requirements.

 

Additional Resources:

Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes

 

Contact Proactive for support related to infection prevention and control programming, developing a testing plan, and mock survey assistance.

 

Blog by Kristen Walden, MSN, RN, RAC-CT, Proactive Medical Review

Learn more about Kristen and the rest of the Proactive team.