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Testing Resources and Q&A

 Resident Testing | Staff Testing | Testing Equipment and Supplies | Resources 

Resident Testing 

Baseline 

Q1: Do we do a baseline COVID test on all residents?  What about assisted living? 
A: It is unclear whether you are required to do a baseline test of all residents, we have forwarded the question to KDADS and national staff.  The new testing rules apply to nursing homes only. 

Follow-up Testing  

Q2: When would we be required to test residents under the new CMS requirements? 
A: Residents with signs or symptoms of COVID-19 must be tested. If even one positive case is identified in a staff person or a resident, it’s considered an outbreak and you must then test all residents and staff.  CMS does not recommend testing asymptomatic residents outside of an outbreak or other abnormal situation. 

Consent 

Q: I think I read or heard somewhere that we must get an order for all upcoming resident covid tests?  Can we have standing orders for these?  
A: Yes, you do need physician order for resident COVID-19 tests, and standing orders are acceptable. QSO-20-38-NH states: In accordance with 42 CFR § 483.50(a)(2)(i), the facility must obtain an order from a physician, physician assistant, nurse practitioner, or clinical nurse specialist in accordance with State law, including scope of practice laws to provide or obtain laboratory services for a resident, which includes COVID-19 testing (see F773).This may be accomplished through the use of physician approved policies (e.g., standing orders), or other means as specified by scope of practice laws and facility policy. 


 Staff Testing 

Testing Frequency 

Q1: What is the official site for what our county status is? 
A: County positivity rates are found here.  CMS guidance directs facilities to check for updated information the first and third Monday of the month. 

Q2: When would we be required to retest staff? 
A: Staff with signs or symptoms of COVID-19 must be tested. If one positive case is identified in a staff person or a resident, it’s considered an outbreak and you must then test all residents and staff.  All staff and residents that tested negative during an outbreak should be retested every 3 days to 7 days until testing identifies no new cases of COVID-19 infection among staff or residents for a period of at least 14 days since the most recent positive result.  Outside of an outbreak situation, you are required to do surveillance testing of staff according to the CMS chart found in QSO-20-38-NH. 

Consent  

Q1: What if staff refuse to consent to testing? 
A: Staff that have signs and symptoms of COVID-19 and refuse to test are prohibited from entering the facility until the return to work criteria are met. When there is an outbreak and staff refuse to test, the staff member should be restricted from the facility until the procedures for the outbreak testing have been completed. 

Q2: What if staff refuse routine testing?  
A: In this situation QSO-20-38-NH states that: The facility should follow its occupational health and local jurisdiction policies with respect to any asymptomatic staff who refuse routine testing. We do not at this point know what, if any, policies we have in Kansas or at the local level for this situation. We are working on getting an answer.   

Q3: Are there any special procedures or permissions we need to get to do testing of staff who are under 18?
A: COVID-19 testing of staff is federally mandated and should therefore be a condition of employment. Follow the same procedures you do for any other testing of minors conducted as a condition of employment.

Q4: How do we handle testing of temporary agency staff?
A: QSO-28-38-NH references testing requirements for contractors, however there is no specific written guidance for agency staff or contractors on the mechanics of conducting the mandatory surveillance testing. The only details we can find are from the September 8th CMS webinar on testing. The following was stated in response to a caller question: "One caller asked for specifics on the testing of contractors or consultants, staff that are not frequent workers or those who do not have a set weekly schedule in the nursing home. It was stated throughout each answer, that yes, these individuals need to be tested. The nursing home may place the individual into the organization testing plan frequency, however, if the individual was tested in another outside nursing home the day or two before, that test result can be documented. The key to this type of contractor or consultant category for testing is their contact with residents, staff and entry into the nursing home. An organization can place the individual into the testing plan the next time they are expected to come into the facility. That gives a bit of room for the nursing home when planning for consultants and contractors." 

Q5: What do I do if we get a positive antigen test (BD Veritor of Quidel) result?
A: In this instance KDHE says that a PCR swab should be obtained and submitted to your lab WITHIN 48 hours of the positive antigen test.  If it comes back negative, the person should be considered negative.  If a PCR swab is completed and submitted AFTER 48 hours of the positive antigen test, and it comes back negative, then the person should be considered positive.  It really behooves the facility to get that follow-up  PCR test in within 48 hours of a positive antigen result.

Q6: I hear that KDHE is doing weekly Zoom COVID-19 updates, including an opportunity for Q&A. How do I sign up?
A: You can register here. The meeting is every Thursday at 10 a.m. LeadingAge Kansas encourages members to register and tune in when they can.


Testing Equipment, Supplies & Costs

Q1: Will we be getting sent more testing kits to use with the testing machines we were sent? 
A: Facilities will not be sent another round of kits for their antigen testing machines from the government. They will have to purchase more kits on their own using the money distributed at the end of August from the federal government. CMS did announce in their call this week that they will be sending out Abbott BinaxNow cards to nursing homes in red counties to help supplement their testing needs. These are new antigen testing cards that accept nasal swabs but do not require a machine. CMS stated that they cost $5-$6 each and will eventually be available to purchase on the open market as a cheaper and faster way to get COVID-19 results. 

Q2: Is there a phone number or website to order additional testing kits for our antigen testing machine?
A: Ordering information is available on the websites for both BD Veritor and the Quidel Sofia 2

Q3: We are not able to get a lab that can guarantee turnaround of test results in 48 hours. And I don’t have a machine, yet.  What do we do?
A: CMS guidance in QSO-28-38-NH states: If the 48-hour turn-around 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 contact with the local and state health departments. In a subsequent stakeholder call with LeadingAge national staff, CMS stated that if the facility should prioritize testing if they are not able to meet the entirety of the testing mandate.  In reference to priority testing, QSO=28-38-NH states: When prioritizing individuals to be tested, facilities should prioritize individuals with signs and symptoms of COVID-19 first, then perform testing triggered by an outbreak. 

Q4: How do we pay for all of this new testing we are supposed to be doing?
A: Beginning August 27th CMS distributed $2.5 billion to nursing homes specifically to be used toward staff surveillance testing.  

Q5: What is the difference between molecular, antigen and antibody tests for COVID-19?
A: Here’s a nice recap. (note: Saliva test are molecular tests. BD Veritor Sophia Quidel and Abbott BinaxNow tests are antigen tests.)

Q6: I still haven’t received an antigen testing machine. What should I do?
A: Email [email protected] to let them know and attach a copy of your CLIA waiver.  CC your email to [email protected], [email protected] and [email protected].  


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