September 2, 2020
Effective today, Wednesday, September 2, 2020, the CMS interim final rule on testing goes into effect. There are still a number of unanswered questions surrounding the testing and reporting requirements, but WHCA has been in continued contact with RCS (which is working with CMS Seattle), and some issues have become clearer. In addition, over the course of the next few days, additional information will be made available. We will continue to keep you informed through our COVID-19 member alerts. Here is what we know as of this morning.

Testing Begins Monday, September 7, 2020
CMS’s QSO 20-38-NH memo requires facilities to monitor their county positivity rate every other week (e.g., first and third Monday of every month) and adjust the frequency of performing staff testing according to the table on page 5 of QSO 20-38. In September, the first Monday is September 7 and the third Monday is September 21. Facilities would start with these dates for monitoring. Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency. The facility would start September 7. We have confirmed this start date with RCS, and we have that confirmation in writing. The next monitoring check date would be September 21. Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency. County prevalence rates can be found here beginning September 7, and should be reviewed the first and third Monday of each month. The CMS county prevalence data is the only data that should be used to determine the positivity rate in your county. A thorough summary of testing and reporting requirements is available here
If You Have Not Received an Antigen Testing Machine
Staff testing should not be delayed due to the failure of CMS to provide you with an antigen testing machine. Depending upon the county positivity data that will be made available on September 7, 2020, you may have to begin testing on Monday, September 7. If you have not yet received an antigen testing machine, or you have not received adequate testing supplies for the machines, you should begin making arrangements now to conduct PCR testing of staff, contractors, and volunteers beginning next week. A step-by-step guide to beginning a testing program is available here.
Don’t Assume That You Are Exempt
Just because you have not received an antigen testing machine or you are unable to secure PCR testing that will return results with 48 hours does not mean you are off the hook. You will need to document your attempts to secure PCR testing. The attempts to secure PCR testing (and supplies), the results of which will be available within 48 hours, should be multiple, not a single instance. In addition, if you are unable to secure timely testing with results within 48 hours, you should reach out to your local health jurisdiction (LHJ), the Department of Health (DOH), and RCS to inform each agency of your efforts and your inability to receive testing and/or supplies. All contacts to the LHJ, DOH, and RCS should be adequately and fully documented in order to avoid survey citations and civil monetary penalties.
CLIA Reporting Requirements
Facilities conducting tests under a Washington Department of Health Medical Test Site (CLIA certificate of waiver) are subject to regulations that require laboratories to report data for all testing completed, for each individual tested. However, at this time it is our understanding those reporting mechanisms are not in place. DSHS will be working with DOH this week to work out the reporting process to LHJs and DOH and how data elements and information required could be collected and reported given its critical importance to public health efforts. In the interim, maintain a facility log that contains all the reporting information within the HHS Lab Reporting Guidelines. Required data elements are found here. This data must be reported within 24 hours of test completion, on a daily basis, to the appropriate state or local public health department, based on the individual’s residence. Providers need to record within these time frames for facility records until the reporting methodology is established. Continue to report to the Department CRU hotline, ALTSA reporting portal, and CDC NHSN. Continue to notify the LHJ of any outbreak.  
Opportunities to Learn and Ask Questions
Starting today, and through the end of the week, AHCA will offer the opportunity for you to learn more about the testing requirements and to ask questions of national experts. AHCA will host a series of “office hours” with staff experts Dr. David Gifford, Courtney Bishnoi, and Jill Sumner to briefly review the new requirements and guidance and answer any questions providers may have. The office hours are scheduled for September 2, 3, and 4 at 4:00 PM Eastern. Web-ex information is as follows: 
  • Join via web: WebEx Meeting Link  
  • Join via phone: (415) 655-0003 
  • Meeting number (access code): 172 882 5865 
  • Meeting password: mUi2SxhjC56   

How is Routine Testing Supposed to Work? 
Routine testing must be conducted of staff according to the table below based on the facility’s county positivity rate in the prior week. As noted above, county-level positivity rates will be available at the following website starting September 7, 2020. Routine testing of residents is not recommended unless a resident leaves the facility routinely.

The frequency of testing once or twice a week presumes availability of POC testing onsite or when off-site testing turnaround time is less than 48 hours. If the 48 hour turnaround time cannot be met due to community testing supply shortages, limited access, or inability of laboratories to process tests within 48 hours, the facility should have documentation of its efforts to obtain quick turnaround test results with the identified laboratory or laboratories and the facility’s contact with the local and state health departments.

In determining to conduct testing on September 7, September 21, and subsequent first and third Mondays of each month, a facility may want to consider the following steps:

Step One
Compare today’s data with the last set of data. Did your county’s positivity rate increase from the last set of data?

If YES, did the county reach a higher threshold?
  • Yes = Adjust testing to the schedule above for the new threshold.
  • No = Keep testing as you are.

If NO, go to Step Two.

Step Two
Did your county’s positivity rate decrease from the last set of data?
If YES, the County actually reached a lower threshold, continue your current rate of testing and check back in 2 weeks.

Did your county stay at the lower threshold 2 weeks?
  • Yes = Adjust testing schedule to the lower threshold reference above.
  • No = Continue testing as you are.

If NO, the county did not reach a higher or lower threshold, continue testing as you are.
If you have questions on the new skilled nursing testing requirements, please email Elena Madrid or call her at (800) 562-6170, extension 105.
Last night, the US Department of Health and Human Services (HHS) announced that private-pay assisted living/memory care providers will be eligible to apply for CARES Act Provider Relief Funds under the current Phase 2 General Distribution round of funding. Today, HHS, through the Health Resources and Services Administration (HRSA), is announcing assisted living facilities may now apply for funding. This announcement bolsters the Trump administration’s commitment to support health care providers in addressing both the economic harm and additional expenses caused by the coronavirus disease 2019 (COVID-19). This funding was made possible through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act.

“HHS is committed to ensuring America’s healthcare providers have what they need to protect their patients and continue providing care through the pandemic,” said HHS Secretary Alex Azar. “By expanding the Provider Relief Fund to assisted living facilities, we are supporting more frontline providers and helping to protect the nearly 1 million vulnerable older Americans in their care.”

Through its ongoing efforts to support providers in need, HHS is inviting ALFs that may have been previously ineligible to apply for Phase 2 General Distribution funding. ALFs support older adults and people with disabilities with a wide range of assistance for activities of daily living. Nearly 1 million older adults live in an estimated 28,000 assisted living facilities across the U.S. According to the Centers for Disease Control and Prevention (CDC), ALFs and the population they serve are particularly vulnerable to the spread and impact of COVID-19. To combat this risk and better protect their residents, many ALFs have implemented CDC recommendations that have resulted in increased health care related costs to their facilities. HHS is encouraging ALFs to apply for funding to help minimize the financial hardships of these increased expenses caused by COVID-19.

Like other providers applying for Phase 2 funding, eligible assisted living communities will receive two percent (2%) of their annual revenue from patient care and will have until September 13, 2020, to begin their application by entering their Tax Identification Number (TIN) for validation. Please visit the Provider Relief Fund web page which includes previously-recorded Phase 2 application webinars, frequently asked questions, and other information on how to apply through the recently-simplified application process. AHCA/NCAL and Argentum are both pursuing conversations with HHS to provide specific details to help with your potential applications and the possibility of a deadline extension. 
The US Department of Health and Human Services (HHS) announced yesterday that the federal government plans to ship rapid COVID-19 tests to assisted living communities across the country. The tests will come from a supply of 150 million ordered from test maker Abbott Laboratories and are expected to be delivered in the coming two to three weeks. As we learn more about these tests and shipments, we will keep our members informed.

This is an exciting announcement for the assisted living profession and much-welcomed news. Providers have fought for over six months to keep residents safe and stay afloat during this unprecedented crisis. AHCA/NCAL and WHCA continue to advocate on your behalf and offer any assistance we can as these and other developments proceed.
WHCA continues to post resources and information as it becomes available on our website. If you have questions or need additional information, please call the WHCA office at (800) 562-6170.