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September 15, 2020


New Policies Coming on State-Supported SNF and Assisted Living Testing, Visitation. In a meeting today with stakeholders, Bridget Harrison of the Governor's Office explained what the state is thinking in terms of melding the pre-existing, state-supported SNF testing program with the Centers for Medicare and Medicaid Services (CMS) requirements under Quality, Safety, and Oversight (QSO) letter 20-38-NH. While nothing is final, Ms. Harrison said the state planned to remove the every-two-week testing frequency from most green counties under the federal county positivity measure. State support would be available for weekly testing for red counties and bi-weekly testing for yellow counties (half of the CMS mandate in each case). On the other hand, Ms. Harrison said the state planned to require weekly testing in counties that are green under the CMS criteria but red under the Ohio Public Health Advisory System. For outbreak situations, the state would offer testing once every two weeks. Ms. Harrison expected that these or similar changes will be completed in the next few days. The program is explicitly transitional, until the situation with point-of-care (POC) testing stabilizes.

Later today, in Governor Mike DeWine's press conference, Director of Aging Ursel McElroy announced that the department intends to reinstate every-two-week testing for assisted living communities, but she did not provide any details. She likewise said the department and stakeholders were working on criteria for indoor visitation at SNFs and assisted living communities. An early-morning meeting is set for tomorrow on both of these topics.

BinaxNOW Cards to Assisted Living, Home Health. Yesterday we reported that SNF members began to receive letters from CMS stating that the Department of Health and Human Services (HHS) is shipping them Abbott BinaxNOW antigen testing cards this week. The Health Department's (ODH's) Rebecca Sandholdt reported that as suggested in the letter, the cards also are going to assisted living communities and also to home health agencies, which are not mentioned. Only providers with Clincial Laboratory Improvement Amendments (CLIA) Certificates of Waiver will receive cards. HHS selected providers to receive the cards first based on county-level positivity and case history.

What is the Time Frame that Triggers Outbreak Testing? The following answer is from AHCA's "COVID-19 Testing Requirements in Nursing Homes Frequently Asked Questions and Quick Links."

Per [Centers for Disease Control and Prevention (CDC)] guidance, the incubation period for COVID-19 is 14 days. This means any individual who has been in the facility within 14 days of developing symptoms and/or receiving a positive COVID-19 test (whichever comes first) would trigger an outbreak investigation.Examples of situations that would trigger an outbreak investigation are below:

  • A staff person or contractor/consultant who developed symptoms of COVID-19 while at work and then tests positive 
  • A staff person or contractor who worked on the 1st of the month, developed symptoms on the 10th of the month and then tested positive on the 15th
  • A resident who has contracted COVID-19 while living at the facility
  • A resident who was admitted from the hospital and had a test obtained in the facility three days after admission and it tests positive. 

Examples of situations that would NOT trigger an outbreak investigation are below:

  • A staff person is away on vacation for 16 days or longer and gets tested upon return before working and tests positive. 
  • A new admission who has a test performed in the hospital, but results come back afteradmission to the SNF. This would not be considered a new case. 
  • A contractor who comes to the building once a month (e.g. the consultant pharmacists)who has not been in the facility for three weeks but reports testing positive 4 days ago. 

A resident admitted with known COVID-19 infection would not trigger an outbreak investigation. If you are unsure whether a situation would warrant an outbreak investigation, we would recommend you contact your local state or local public health agency for guidance.

Family Notification of Positive POC Results in SNFs. Because of reports of false positive results from BD Veritor POC testing units, members have asked whether positives from POC machines trigger the family notification requirements under the ODH order and CMS rule. In both instances, the requirements are activated by a confirmed positive COVID-19 case. The applicable CDC guidelines explain when a positive antigen test such as with a POC unit can be considered confirmed, leading to family notification:

  • When the resident or health care worker testing positive has COVID-19 symptoms.
  • When a resident or health care worker tests positive in an outbreak situation.
  • When an asymptomatic worker tests positive and the positive result is confirmed by a polymerase chain reaction (PCR) test.

SNF 48-Hour Turn-Around Time Messages to ODH. One of the criteria to qualify for an exemption from the weekly or semi-weekly SNF staff COVID-19 testing requirements under QSO 20-38 is to seek ODH's assistance in locating a laboratory that can provide less than 48-hour turn-around time. Today, ODH informed us that any such requests should be sent to CCURT@odh.ohio.gov with the subject line, "CMS 48 turn-around time." As a reminder, the other criteria for the exemption are not having a POC testing device (or not having supplies needed to use it), not being able to locate a qualifying lab on your own, and requesting help from the local health department. All of these criteria must be documented fully.

Report State Test Results Only to ODH Survey Monkey. According to Ms. Sandholdt, SNFs only need to report the positive and negative results of state-supported PCR testing to ODH via the state's Survey Monkey. This would include state-mandated and opt-out testing (including antigen testing) that also is used to meet the CMS requirements, but would not include testing done only to meet those requirements.

Denying Access to Surveyors. Ms. Sandholdt today warned that she was aware of cases in which a facility denied entry to a surveyor because they did not produce negative COVID-19 test results. She pointed out that while ODH has a plan to test surveyors, they cannot be denied entry for not having test results.