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New Mandate for Nursing Homes: Test Residents and Staff for COVID-19 or Face Fines

By Jason Bloome

Nursing home deaths account for more than 35% to 40% of the total estimated 216,000 COVID-19 deaths nationwide. In a new order announced on August 24, 2020, by the Centers for Medicare & Medicaid Services (CMS), nursing homes will now face fines for not adequately testing staff and residents for COVID-19. Previously, CMS had recommended widespread testing of COVID-19 in nursing homes, but this announcement marks the first time nursing homes will face financial penalties for not testing when there are signs of COVID-19 symptoms among staff and residents.

The new mandate requires nursing homes, as a requirement for participating in the Medicare program, to test all residents and staff for COVID-19 when there is an outbreak or when residents show symptoms of the infection or face fines exceeding $400 per day or $8,000 for an instance of noncompliance. The frequency of testing will be determined “by the degree of community spread” within the facility and the surrounding community, and state surveyors will inspect nursing homes to ensure compliance. Nursing homes will be given a one-time three-week grace period to begin reporting data.

In July, CMS required weekly testing in nursing homes where the positivity rate was above 5%, but these requirements are subject to change under the new guidelines.

To meet the need for increased testing, the Department of Health and Human Services (HHS) announced it will distribute by the end of September point-of-care (PoC) rapid antigen testing units to all of the nation’s 14,000 nursing homes. HHS has invoked the Defense Production Act to expedite the manufacture and shipment of the PoC testing units.

Although PoC tests are usually less sensitive than the gold-standard polymerase chain reaction tests, and as a result have a higher chance of false negatives, health care leaders and industry experts welcome the rapid tests for quicker results in a time when so many third-party labs have long turn-around times. The use of PoC tests by all nursing homes overrides state directives that restrict or ban the use of such tests.

The federal government will pay for the initial array of the PoC tests and related supplies, but subsequent costs will be paid by the nursing homes. Funds for the manufacture and distribution of the PoC tests is included as part of $5 billion set aside for nursing homes in the CARES Act.

— Jason Bloome is owner of Connections-Care Home Consultants (carehomefinders.com), an information and referral agency for care homes for the elderly in Southern California.