CMS Updates Nursing Home Staff Testing Requirements with Eye Toward Rural Providers

The federal government on Tuesday tweaked its methodology for determining required nursing home COVID-19 testing frequencies under, with a specific focus on regions with relatively lower levels of total coronavirus testing information.

In response to concerns from governors of rural states, the Centers for Medicare & Medicaid Services (CMS) changed some definitions of its color-coded county ranking system, which in turn determines how often nursing home operators must test their employees.

“Counties with 20 or fewer tests over 14 days will now move to ‘green’ in the color-coded system of assessing COVID-19 community prevalence,” CMS announced. “Counties with both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10 percent positivity over 14 days — which would have been ‘red’ under the previous methodology — will move to ‘yellow.'”

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The difference between a “red” county and a “yellow” county is substantial: Under new rules announced at the end of August, providers in “red” counties must test their staffers twice weekly, as compared to weekly for “yellow” areas and once per month in the lowest-level “green” counties.

The stoplight system relies on the overall COVID-19 positivity rate in a given county — specifically, the proportion of positives relative to the total number of COVID-19 tests performed. A percentage under 5% earns a county green status; between 5% and 10% is considered yellow, while 10% and above is red.

This calculation proved to be a potential problem for operators in rural areas, as a relatively small number of positives could skew the overall percentage high enough to bump it into the next-highest category, for instance.

“They were concerned that some rural counties had seemingly high comparative positivity rates as a result of low amounts of testing, rather than actual positivity in the community,” CMS said of rural governors. “This resulted in a significant burden for nursing homes being required to conduct staff testing at a higher frequency than necessary.”

Nursing homes face fines exceeding $400 per day or $8,000 per instance for failing to comply with the testing mandate. Routine COVID-19 screening is now also a part of the baseline Medicare and Medicaid requirements of participation for operators.

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