CMS provided new guidance for long-term care facilities to meet new testing requirements and revised the COVID-19 Focused Survey Tool to assess compliance with the new testing requirements.
A new interim final rule established long-term care facility testing requirements for staff and residents. These requirements include testing residents, staff, and any individuals providing services under arrangement, and volunteers for COVID-19 based on parameters set for by HHS. CMS issued a letter to State Survey Agency Directors providing guidance for facilities to meet the new requirements. The letter also includes a copy of the revised COVID-19 Focused Survey Tool, and the revised survey process, which were both updated to include assessment of compliance with the new testing requirements (CMS Letter to State Survey Agency Directors, Ref: QSO-20-38-NH, August 26, 2020).
Testing requirements. Facilities are required to test residents and staff at routine testing intervals based on the community COVID-19 activity. The testing requirements may be met using rapid point-of-care (POC) diagnostic testing or through an arrangement with an offsite laboratory. Where vendors or volunteers are required to be tested form another source, the facility is required to obtain documentation that the required testing was completed during the timeframe that corresponds to the facility’s testing frequency. Facility staff that is required to be testing includes 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.
Staff with symptoms or signs of COVID-19 must be tested and restricted from the facility pending the results of the test. Residents who have signs or symptoms of COVID-19 must also be tested and transmission-based precautions must be followed in accordance with CDC guidance while the test results are pending. Upon identification of a single new case of COVID-19 infection in any staff or residents, all staff and residents should be tested. Staff and residents who tests negative should be retested every 3 to 7 days until testing identifies no new cases of infection for a period of at least 14 days since the most recent positive result.
The letter also addresses other testing issues and considerations, such as refusal of testing. Facilities must have procedures in place to address staff who refuse testing. Testing must be done in accordance with the appropriate regulations. The facility must obtain an order from a physician, physician assistant, nurse practitioner or clinical nurse specialist in accordance with state law. Collecting and handling specimens must be done correctly and safely to ensure the accuracy of results and prevent any unnecessary exposure. Facilities must maintain proper infection control during specimen collection and use recommended personal protective equipment (PPE).
Revised survey tool. Compliance will be assessed using the COVID-19 Focused Survey for Nursing Homes. Surveyors will ask for the facility’s documentation of testing and review for compliance. They will also review records of those residents and staff selected as a sample as part of the survey process. Surveyors should also observe how the facility conducts testing in real-time, where possible. If the facility is unable to obtain test results within 48 hours or has a shortage of testing supplies, the surveyor should ask for documentation that the facility contacted state and local health departments to assist with those issues.
The COVID-19 Focused Survey for Nursing Homes tool was revised to reflect the new testing requirements implemented in the interim final rule, as well as other updates to help ensure an effective assessment of the facility’s compliance. The survey process was also revised to include the assessment of compliance with the requirements for facilities to designate one or more individuals as the infection preventionist, responsible for the facility’s infection prevention and control program.
MainStory: TopStory CMSLetters CMSNews CMPNews CoPNews Covid19 GCNNews LTCHNews QualityNews
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