Federal guidelines for staff testing in nursing homes change again to account for low numbers of coronavirus tests in rural counties

By Melissa Patrick
Kentucky Health News

The federal government has revised its coronavirus staff testing rules for nursing homes in an effort to help rural providers maintain compliance. 

"We believe that this is a good thing," Betsy Johnson, president of the Kentucky Association of Health Care Facilities, said in an e-mail.

Betsy Johnson

Johnson explained that the Centers for Medicare and Medicaid Services made the changes in response to concerns that nursing homes in rural counties with low testing volume are being asked to test staffers at a frequency that is based on a positive-test rate that does not reflect the true rate in their community. 

"CMS adjusted color coding/testing frequency for small counties with low testing volume because they were trending artificially high due to low numbers of tests being performed," she said.

The CMS news release said, “This resulted in a significant burden for nursing homes being required to conduct staff testing at a higher frequency than necessary.” 

The updated methodology now includes the number of tests conducted in the county over a two-week period.

“Counties with 20 or fewer tests over 14 days will now move to ‘green’ in the color-coded system of assessing covid-19 community prevalence,” the release said. “Counties with both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10 percent positivity over 14 days — which would have been ‘red’ under the previous methodology — will move to ‘yellow'.” 

“The new, resulting methodology reduces burden while still requiring facilities to conduct testing at a frequency that can detect covid-19 early to keep nursing home residents safe,” the agency concluded.   

As in the earlier guidance, nursing homes in counties with positivity rates less than 5% must test staff once a month; between 5-10%, once a week; and above 10%, twice a week. 

In mid-September Johnson told Kentucky Health News that while nursing homes support increased testing, she worried that overly rigorous testing would cause staff to quit facilities already struggling to keep employees.

"We are concerned," she said, "that we're going to have some staff leave because they just simply either cannot get to the facility to get tested, due to child-care issues or other personal obligations or transportation, or they simply just, you know, get exhausted with it all."

State health cabinet map; for a larger version, click on it.

Johnson said Kentucky's skilled nursing facilities are testing in accordance with the CMS guidelines, using a color-coded map provided by the state that is based on those guidelines. 

State Inspector General Adam Mather told long-term care providers in a Sept. 29 letter that says in compliance with the new CMS guidelines, "counties in RED are to test twice weekly, counties in ORANGE are to test weekly, and counties in YELLOW and GREEN are to test twice monthly."

The Trump administration has sent Kentucky's nursing homes equipment to conduct rapid, point-of-care tests, but for many reasons, including concerns that they are less accurate than laboratory-based tests, Johnson has said most facilities are using the free state provided laboratory tests, which are funded through federal relief funds through the end of the year. 

The state's daily long-term care report on Oct. 2 showed the homes have 700 residents and 494 staff with active cases of the virus and 686 resident and five staff deaths from it, making up 58% of the state's covid-19 deaths.