CMS, CDC Again Ask States to Take Lead on Nursing Home COVID-19 Testing as Strategies Could Soon Shift

As part of the federal government’s push toward stricter infection control protocols in nursing homes, officials this week again called on states to take the lead on COVID-19 testing — while also acknowledging that blanket testing strategies may need to change as infection patterns continue to diverge.

Each state must draw up its own testing plan and submit it to the federal government, Centers for Medicare & Medicaid Services (CMS) administrator Seema Verma and Centers for Disease Control & Prevention (CDC) director Robert Redfield wrote in a letter to governors released Monday.

“We are also calling on you to focus your testing on nursing homes and other vulnerable communities,” Verma and Redfield wrote in the letter. “The Trump administration recently announced that the Department of Health and Human Services (HHS) is delivering $11 billion in new funding to states, territories, localities, Indian Health Service facilities, tribes, and urban Indian Health programs to support COVID-19 testing.”


As she has in the past, Verma repeatedly emphasized that testing nursing home residents and staff is ultimately the responsibility of individual facilities and their state governments.

CMS has made a baseline test of all nursing home residents and staff a requirement for starting the process of reopening facilities to visitors.

While the industry has cried foul over a total one-time testing bill of $440 million for all residents and staff members — plus a $1 billion-per-month ongoing cost for weekly staff tests — Verma said that Medicare will cover all resident tests, and that state funding was sufficient to cover staff testing.


“In terms of the testing for their staff, that is something that the nursing home is responsible for,” Verma said Monday. “That being said, we’ve talked to states across the country, and they have testing dollars — the $11 billion that was provided by Congress, that’s already out there — and states are using those dollars.”

States also have the flexibility to amend testing frequencies based on their local conditions, Verma asserted.

“Right now, we’re saying: Go ahead and test all the staff and residents in the nursing home,” she said. “But over time, as cases go down, states could also adjust that. So that may not be a long-term recommendation. It’s going to depend on the situation.”

As the COVID-19 pandemic’s effects on nursing homes drag on, some leaders have called into question the efficacy of focusing testing resources primarily on residents, especially in cases where outbreaks have already been detected. Given the dangers of asymptomatic spread by workers, some experts have begun to argue that the current focus should shift toward routine staff testing, particularly in cases where access is limited.

“The circumstance that a particular facility might be in should be considered as part of the decision about deploying these large-scale testing efforts,” CDC epidemiologist Dr. Nimalie Stone said during a CMS-hosted call with nursing home leaders last week. “For example, the value of doing a snapshot of all the residents in a building that’s already had a known, very large-scale outbreak of COVID — it may not be quite as valuable, because we have to ask the question, well, what are we going to do differently at this point with that data?”

Vivage Senior Living, a provider with nearly 30 facilities in Colorado, saw new case counts fall close to zero in many buildings under a staff-focused strategy, which general medical director Dr. Gregory Gahm told SNN was necessary given the realities of this novel virus: Testing allows physicians to diagnose and treat illnesses, but since tests took days to process and there is currently no effective treatment for coronavirus, a more nuanced approach was necessary.

The CDC and the White House Coronavirus Task Force will soon release more explicit guidance regarding the specific types of testing strategies that should be employed, Verma said.

“There’s surveillance testing, there’s outbreak testing, and then there’s diagnostic testing,” she said. “And the task force and CDC will be putting out guidelines this week that will distinguish between the three.”

CMS publicized the Verma/Redfield letter to states on the same day that Verma announced tougher civil monetary penalties (CMPs) for nursing facilities with patterns of infection-control problems; in certain cases, those fines could reach $20,000 apiece.

The elevated penalties came as CMS and the CDC released the first set of federal data on COVID-19 in nursing homes, which revealed about 26,000 deaths and 60,000 infections among the roughly 80% of nursing facilities that reported information by the first deadline.

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