DHHS Issues Guidance to Nursing Facilities for COVID-19 Testing

The Maine Department of Health and Human Services (DHHS) issued guidance to nursing facilities to assist them in meeting new federal requirements for routine COVID-19 testing, which is supported by the federal government's release of more than $10 million in funding and its distribution of point-of-care testing devices to Maine's nursing facilities. DHHS also announced that it is helping nursing facilities address staffing challenges by launching a new online tool to connect them with qualified job applicants.

The U.S. Centers for Medicare and Medicaid Services (CMS) released new rules last week that require nursing facilities to test all staff for COVID-19 at set frequencies based on the prevalence of the virus in the facility's county. CMS requires that residents continue to be tested based on a physician's order, in concert with the Maine Center for Disease Control and Prevention (CDC) as the result of a COVID-positive staff or resident, or if they show symptoms.

Maine CDC already offers universal testing of nursing facility residents and staff in the event of a single confirmed case and has worked with several facilities to support their choice to proactively test staff and residents. Now, all nursing facilities must develop plans for proactive surveillance testing that meet the new federal criteria. The plans are due to Maine DHHS by September 15.

Maine DHHS will review the plans, which will inform the State's ongoing review of restrictions on visitation at nursing facilities that are designed to ensure health and safety while recognizing need for residents to maintain critical connections with loved ones.

"Today's guidance along with the new federal support will add to our progress in limiting the impact of COVID-19 on Maine's nursing facilities," said DHHS Commissioner Jeanne Lambrew. "It will also bring us one step closer to allowing family and friends to visit their loved ones in nursing facilities, which has been limited by the threat of COVID-19."

Under last week's federal guidance, CMS has established federal regulatory authority to take enforcement action against nursing homes that fail to appropriately test their staff and residents.

CMS announced that nursing facilities will receive additional Federal funding to support their COVID-19 response, including testing. Maine nursing facilities received $10.4 million to support additional staff and increased testing in the first round of a $5 billion allocation to nursing facilities from the U.S. Department of Health and Human Services. This funding could support nursing facilities' use of commercial laboratories for surveillance COVID-19 testing or the costs of transporting samples to the Maine CDC Health and Environmental Testing Laboratory (HETL).

Maine DHHS issued guidance to nursing facilities Wednesday outlining their options for surveillance testing of staff to meet the new federal requirements. Nursing facilities may:

1. Send samples to HETL for testing. Facilities that choose this option must enroll in the State's Electronic Testing Order and Reporting (eTOR) portal and coordinate the timing of such testing with HETL to avoid unnecessary delays in processing of samples. Facilities' clinical staff would swab other staff members or supervise staff who self-swab.
2. Send samples to a private commercial lab for testing. Facility clinical staff or a contractor would collect samples from staff.
3. If they employ fewer than 75 staff, arrange for staff testing through one of the DHHS-contracted Swab and Send sites, provided the facility coordinates scheduling of this testing with DHHS. This option is currently available only to facilities under this staffing level to ensure that the Swab and Send locations retain sufficient capacity to serve the public.
4. Use Federally provided Point of Care (POC) antigen testing devices to conduct staff testing consistent with the Federal testing frequency guidelines. The federal government has informed DHHS that approximately 90 nursing facilities in the state will receive POC testing devices. This option does not exempt nursing facilities from continuing to conduct staff and visitor screening consistent with U.S. CDC guidelines. Additionally, follow up PCR testing may be necessary in some circumstances. Facilities that choose this option are responsible for conducting all testing, securing all testing supplies and reporting test results to the Maine CDC.

Regardless of which option a facility chooses, Maine CDC will continue to offer universal testing of nursing facility staff and residents through HETL in the event of a single confirmed case of COVID-19.

To help nursing facilities address staffing challenges, which predate the COVID-19 pandemic but may intensify with the implementation of surveillance testing, DHHS is launching Connect to Care, a new portal where facilities can connect with qualified job applicants. DHHS is testing the portal with a small number of nursing facilities with plans to make it available to all nursing facilities shortly. Connect to Care is offered at no charge in partnership with ADvancing States, a national organization of state aging and disability agencies. DHHS expects to expand the portal to additional long-term care settings in the near future.

According to CMS data, Maine's rates of COVID-19 infections and deaths in nursing facilities is among the lowest in the nation. This follows numerous actions taken by DHHS to support the state's nursing homes, including issuing an emergency rule in April to further protect the health and safety of staff and residents against the spread of COVID-19 and being among the first states in the nation to conduct universal testing at nursing facilities when an outbreak of COVID-19 was confirmed. The State provides an emergency cache of PPE to facilities with outbreaks and provides same-day support and guidance.

On March 26, DHHS announced that MaineCare will pay nursing facilities for extra costs associated with COVID-19, including staffing above and beyond customary levels to maintain proper ratios and to monitor residents and screen visitors, supplies and PPE, such as face masks and gowns, beyond the amounts typically purchased. This financial support for long-term care facilities and congregate living facilities is coupled with DHHS' proactive public health measures to support them.