COVID-19 UPDATE #57
July 20, 2020
UPDATE ON CMS DISTRIBUTION OF TESTING INSTRUMENTS
Last week we reported that the Centers for Medicare and Medicaid Services (CMS) had authorized the distribution of rapid point-of-care diagnostic test instruments and test kits to all nursing homes in the country.

In that communication we noted that Washington labs do not operate under CLIA Certificates of Waiver and instead are licensed as state “Medical Test Sites.” Washington is only one of two states that are exempt from CLIA. We inquired with DOH and CMS about Washington’s nursing home located Medical Test Site’s eligibility to receive the distribution of rapid point-of-care diagnostic test instruments and test kits. After some investigation, DOH and CMS report that Washington’s regulatory framework will allow distribution of these test instruments and test kits from CMS to skilled nursing facility located Medical Test Sites. DOH also reports that at the start of the COVID-19 crisis, it sought authority from the FDA, and received, the ability to authorize labs in our state to perform COVID tests.

Based upon information provided by DOH, Washington State requires Medical Test Sites performing tests that are waived by the FDA to report to DOH that they are adding tests to their sites. Here is the form they can use to do that. You can send the form to the address on the top left of the form or email to lqa@doh.wa.gov .

CMS will be distributing the Quidel Sofia and Sofia 2 Instruments and BD Veritor Plus Systems. Both use antigen tests that can quickly detect fragments of proteins found on or within the virus by testing samples collected from the nasal cavity using swabs, providing results in minutes. Antigen tests will play a critical role in the fight against COVID-19 and will be essential to reach the nation’s goal of testing millions of Americans each day. The two antigen detection tests are: (1) the Sofia SARS Antigen FIA manufactured by Quidel Corporation (Quidel) and (2) the Veritor System for Rapid Detection of SARS-CoV-2 manufactured by Becton, Dickenson and Company. It should be noted that these test may be slightly more likely to have a false negative result than molecular PCR COVID tests. For more information click here .

WHCA encourages SNFs to complete the DOH form so that the SARS COVID 19 test is included in the DOH list of waived test. The SNF could be determined to be out of compliance with state testing guidelines absent making this change. WHCA has been provided a list of 204 SNFs with Medical Test Sites. Based upon information provided to us, there are six SNFs that do not house a Medical Test Site. WHCA will be checking with those six SNFs to confirm their status. 
 
The distribution of the testing instruments will occur over the course of the next six to eight weeks. Based upon our experiences over the last five months, we expect the distribution to be haphazard, with many fits and starts. We will continue to monitor the distribution process and, as always, keep you informed.
ASSISTED LIVING COVID-19 TESTING COMING SOON
DSHS issued a Dear Provider letter on July 17, 2020, informing assisted living facilities of upcoming resident and staff one-time COVID-19 testing efforts. While details are not yet available, the letter does indicate that testing will likely be completed by the end of August. Someone from the Department of Health will be contacting your facility to learn of the number of tests you’ll need in order to test all residents, staff, and available agency staff. We have requested a webinar to orient assisted living providers to the testing guidelines and processes. We will keep members updated as more information becomes available.
WA-PALTC TO HOST WEBINAR ON COVID ANTIGEN TESTING FOR ALL
On Wednesday, July 22, 2020, you are invited to join Washington Society for Post-Acute and Long-Term Care Medicine (WA-PALTC) for a webinar COVID Antigen Testing for All: How will we utilize the results to make our patients and staff safer? The Centers for Medicare and Medicaid Services (CMS) has committed to sending point-of-care COVID antigen testing out to all nursing homes. During this webinar, Sabine von Preyss-Friedman, MD, FACP, CMD, will moderate a discussion to address the following questions:
  • What experience do we have with COVID antigen testing?
  • How will we utilize the results?
  • What are the limitations?

The webinar will begin at 6 PM PST. You may register here if you wish to participate.
DSHS RELEASES THREE DEAR PROVIDER LETTERS TO SKILLED NURSING FACILITIES ON JULY 17
HHS FUNDING APPLICATION DEADLINE EXTENDED TO AUGUST 3
The deadline for eligible assisted living Medicaid providers to apply for CARES Act relief funds was  EXTENDED to August 3.  Argentum is providing some materials to help you apply for these funds should you choose to do so. While HHS has not provided any written confirmation that accepting Medicaid funds will not disqualify the provider from receipt of future CARES Act provider relief funds, we were told verbally by HHS that everyone who is eligible should be encouraged to apply.

Argentum has shared a memo from their law firm , Foley Hoag, describing the relief funds and application process in more detail. Argentum is also sharing a cheat sheet and an example provided by the Chief Financial Officer at Affinity Living Group, who has gone through the process. Please be aware that the application is a two-step process. Step one is to submit Tax Identification Numbers for validation--it will take approximately 24 hours before HHS validates the number; then, the second part of the application can be completed. Many thanks to Argentum for sharing this information.
CDC UPDATES RECOMMENDATIONS FOR TRANSMISSIONS-BASED PRECAUTIONS
The Centers for Disease Control and Prevention (CDC) has updated its recommendations for isolation following COVID-19. The new guidance focuses on the patient's symptoms rather than test results. Below are links to the decision memo, which summarizes the key findings and provides links to referenced studies. Also included are interim guidance pages for discontinuation of transmission-based precautions and the criteria for return to work for healthcare providers.
ADDITIONAL RESOURCES
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.