Twice-Weekly Nursing Home Testing Required in 800 Counties — But Early Hotspots Spared

Nursing homes in more than 800 counties across the country will be required to test workers for the novel coronavirus twice per week under new federal regulations, though the burdens will be much lower in many areas of the country hit hard and early by the COVID-19 pandemic.

The Centers for Medicare & Medicaid Services (CMS) last week released the county-level list of community infection rates — with each county classified as green, yellow, or red depending on COVID-19 positives as of late August — that it will use to determine the required frequency of nursing home staff testing.

The American Health Care Association (AHCA), which represents for-profit nursing facilities, initially publicized the list in a memo to its members last week.


Facilities in the 801 “red” counties, which had COVID-19 infection rates above 10%, must test all staffers twice per week under a new regulation announced late last month. Those counties, home to a total population of more than 55 million people, include large swaths of the South and Midwest.

Major population centers in the red category include Dallas and Bexar counties in Texas and Fairfax County, Va.

Once-weekly testing will be required in the more than 1,000 “yellow” counties, a group that includes such major population centers as Chicago’s Cook County, Houston’s Harris County, and Atlanta’s Fulton County; Southern California counties including Orange, San Bernardino, and Sacramento; and heavily populated areas in Florida such as Palm Beach, Hillsborough, and Orange counties.


The lowest-tier “green” counties, in which nursing home staff must only be tested once per month, total nearly 1,300 and cover a population of more than 142 million people. Multiple early hot zones for COVID-19 infections — including all five boroughs of New York City and Long Island, the entire state of New Jersey, King County, Wash., and the Boston metropolitan area — currently sit in the green category, along with Los Angeles County, the nation’s most populous.

CMS will update the county-level list on the first and third Monday of each month, according to AHCA.

No matter what the official color of a facility’s home county, meeting the new staff-testing requirements is now a requirement for nursing homes’ participation in Medicare and Medicaid, effectively threatening the vast majority of facilities with closure for non-compliance. Individual fines for failing to meet the new standards can exceed $8,000 per instance, CMS announced late last month.

“The provisions in today’s rule on nursing homes represent his expectation that CMS pull every available regulatory lever to maximize nursing home residents’ safety and quality of life,” administrator Seema Verma said in a statement, referring to the president. “These Americans and their families, who have already gone through so much, deserve nothing less.”

The new regulations came on the heels of billions in federal aid and the ongoing distribution of point-of-care testing units to facilities nationwide, an effort set to wrap up sometime this month.

AHCA president and CEO Mark Parkinson has publicly recommended that operators test their staffers once per week regardless of federal edicts or local infection rates.

“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,” Parkinson said last month. “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.”

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