Parkinson: Test Nursing Home Staff Weekly Even if Not Required, Develop a Compliance Plan by Next Week

The leader of the largest trade group for U.S. nursing homes on Thursday advised operators to exceed new federal COVID-19 testing mandates whenever possible, while emphasizing the importance of planning for complying with the new regulations as soon as next week.

“I would be testing, once a week, all staff. I would be doing that even before the reg, and I would definitely be doing it with the reg,” American Health Care Association CEO Mark Parkinson said during a virtual event hosted by software provider Netsmart Technologies. “Even if I was in a state that had a low positive rate, I’d be testing staff every week. It will show that you’ve gone above and beyond, and I also think it’s the best way to keep COVID out.”

Parkinson’s comments came one day after the Centers for Medicare & Medicaid Services (CMS) unveiled the new testing frequencies required under a sweeping new interim final rule aimed at boosting COVID-19 surveillance and prevention in nursing facilities.


CMS based the cadences on overall community spread: If a facility is located in a county with a positivity rate of 10% or more, all staff members must be tested twice a week; between 5% and 10%, the mandate drops to once a week, and then down to monthly in counties with COVID-19 infection rates lower than 5%.

Residents must also be offered tests at the sign of potential infection, as well as in the event of a widespread outbreak.

Parkinson, whose organization primarily represents for-profit nursing homes and assisted living facilities, admitted that he’d been fielding texts and e-mails from members upset with the new rules, which could bring fines in excess of $400 per day or $8,000 per instance for non-compliance.


Even more crucially, the staff testing mandate will be part of the baseline requirements for participation in Medicare and Medicaid; failure to comply could thus potentially remove the two most important funding sources for any skilled nursing facility and force closures.

But Parkinson emphasized that in addition to the health and safety aspect, the increased testing requirements will set the sector — devastated by COVID-19 deaths and operational strains over the past six months — on a path toward recovery.

“I think in the medium run, it’s going to prove to be a beneficial thing,” Parkinson said. “I think it’s going to lower COVID in our buildings, and I think it’s going to increase the confidence of the public in coming into our buildings.”

Compliance with the new rules won’t be easy, however, even with the Department of Health and Human Services (HHS) sending point-of-care antigen testing units to the vast majority of facilities across the country. To that end, Parkinson urged providers to develop an airtight operational and compliance plan to meet the new mandates as soon as next week.

“The antigen testing machines themselves are complicated. We do have members that have figured them out, and are routinely testing staff and residents with them, but it’s going to take some effort,” Parkinson said. “And it’s critical for you to get on top of this immediately because this is not simple guidance. This is a requirement of CMS, and if you don’t do it, not only will you possibly get fined, you might even get shut down.”

HHS provided some other direct assistance to nursing homes this week, releasing $2.5 billion of the most recent $5 billion in CARES Act relief funding to nursing facilities on Thursday. Each property across the country should have landed $10,000 apiece — plus $1,450 for each bed — primarily to support testing efforts, according to Parkinson.

More information about the other half of the $5 billion should be forthcoming this week or next, with Parkinson providing additional details about the value-based competition aspect of the second round.

In short, the federal government will seek to link the amount of relief payments to reductions in COVID-19 case counts, graded on a kind of curve to account for widespread variations in the prevalence of the nove coronavirus in different parts of the country.

CMS will sort all of the counties in the United States into three broad categories — low, medium, and high — based on community infection rates, according to the AHCA CEO.

The agency will then use public National Healthcare Safety Network (NHSN) data to compare each facility’s record of curbing new COVID-19 cases against the average performance of nursing homes in each of the three groups.

Nursing homes that have the same or lower numbers of new cases than their group’s baseline will receive an incentive payment of up to $1,000 per bed per month in areas with the highest COVID-19 case rates.

“I think it’s a really exciting program, and frankly, it’s a way to cover some of the testing costs that might not be covered by this tranche of funds that goes out today,” he said.

That said, Parkinson predicted longer-term financial strain for nursing home operators — particularly on the Medicaid side of the house, as state governments struggle to deal with budget shortfalls in the wake of economic contraction and rising demand for Medicaid-funded services.

Even if the fall elections bring increased federal representation for the Democrats, who are more amenable to authorizing additional support for Medicaid from Washington than Republicans, each state is in charge of its own spending decisions on the program — and Parkinson predicted that the coming years could bring cuts in some states looking to balance shrinking budgets.

“The next couple years are going to be really tough,” Parkinson said.

Despite the challenges of the last six months and persistent Medicaid uncertainty, Parkinson described a cautiously optimistic view of the future in which the coronavirus pandemic — at least on the clinical side of nursing home operators — goes down in history as a one-year crisis.

“I think is about a 12-month event on the clinical side,” he said. “It’s then going to take longer to recover, but we’re about halfway through the nightmare in our buildings.”

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