On the weekly CMS Nursing Home call, it was confirmed HHS will send the first round of shipments of the antigen testing machines out this week. They are sending testing instruments and tests to 600 nursing homes (initially, HHS had anticipated sending 2,000 in the first round). They anticipate sending out instruments and tests over the next 14 weeks with a goal of reaching all nursing homes with a CLIA certificate of waiver. We know that Medicare certified nursing homes in WA State have CLIA waivers and are on the list to receive the Sophia and Sophia 2 diagnostic test equipment.

WA DOH shared If nursing homes have a medical testing CLIA license, they can fill out a test menu change form to add SARS CO-V COVID-19 testing to their existing license:  https://www.doh.wa.gov/Portals/1/Documents/Pubs/505088.pdf

Nursing homes in the first group are prioritized according to the following criteria:

• Active CLIA certificate of waiver
• 3 or more new cases reported in the past 7 days or 1 new case reported in the past 7 days after having no cases
• Inadequate access to testing reported in the past 7 days
• 1 new death reported among residents in the past 7 days
• 1 new confirmed or suspected case reported among staff in the past 7 days

Nursing homes will be divided into 5 groups to determine how many testing instruments/tests they will receive. CMS did not provide info into how the facilities were classified (did they use census or license? What are the thresholds for each classification? etc.):

• Small facilities: 1 instrument and 150 tests
• Small – medium facilities: 1 instrument and 240 – 250 tests
• Medium – large facilities: 1 instrument and 325 – 330 tests
• Large facilities: 1 instrument and 600 tests
• Major outliers: 2 instruments and 900 tests

We continue to have several questions around the roll out of the new antigen test machines, including access and cost to purchase supplies, reliability, and sensitivity of test results (these machines were not tested on asymptomatic people).  We have been told that a positive test can be relied on to be positive, but a negative test, particularly if the individual is symptomatic or exposed, needs to be followed up with a PCR test to verify antigen test results.  Given that staff working in long term care settings have a higher probability of exposure to COVID or may not wear a mask when in public, frequent repeat PCR tests may be necessary.  This, of course, adds to both costs of supplies and staff time to administer antigen and PCR tests.  As we learn more information, it may be appropriate to use the antigen test for certain limited groups and the PCR test on others.  

We are also waiting for more information on the new testing plan announced this week in which CMS will begin requiring, rather than simply recommending, testing of all nursing home staff on a weekly basis for those nursing homes in states with 5% or greater positivity rates (meaning that 5% or more of the tests administered in the state have come back positive for COVID-19). At this time, Washington state exceeds this 5% threshold and has a positivity rate of 5.8 %. We have not seen a QSO memo with any of this information, however, we will be sure to pass this information on when we receive it.

Questions?

Contact:

Laura Hofmann, MSN, RN – Director of Clinical and Nursing Facility Regulatory Services
c: 425-231-4804