The Centers for Medicare and Medicaid Services (CMS) released new nursing home guidance on staff and resident testing that will impact hospice contractors.

New guidance from the CMS, released on Thursday March 10^th, will mean more testing requirements not only for hospice contractors who are not “up-to-date” on their vaccinations but also for all nursing home staff, hospice contractors, and residents when COVID-19 infections are identified.

The guidance clearly defines “Facility Staff” to includes contractors who provide care and services to residents on behalf of the nursing home which would include hospice providers serving residents.

The key change replaces the term “vaccinated” with “up-to-date with all recommended COVID-19 vaccine doses.” This is consistent with Center for Disease Control’s (CDC) definition of “up-to-date” meaning a person has received all recommended doses in their primary series COVID-19 vaccine, and a booster dose(s) when eligible.

For hospice contractors providing services in nursing homes who are not “up-to-date” on vaccinations, nursing homes will be required to implement routine testing based on the COVID-19 level of community transmission. If a hospice contractor receives testing from outside the nursing home (i.e. their employer or on their own.), the nursing home is still required to obtain documentation that the testing was completed in the timeframes as defined by the community transmission levels below.

+Staff who are up-to-date do not need to be routinely tested.

*This frequency presumes availability of Point of Care testing on-site at the nursing home or where off-site testing turnaround time is <48 hours

The new guidance further changes testing requirements for nursing home staff, hospice contractors, and residents regardless of vaccination status. Nursing homes will prioritize testing for individuals who are in the nursing home on a weekly basis and have contact with residents or staff. CMS identified four triggers that will require additional testing measures regardless of vaccination status.

1. Symptomatic individual identified: staff, hospice contractors, and residents, regardless of vaccination status, must be tested immediately and restricted from nursing home access pending test results.
2. Newly identified COVID-19 positive staff or residents in a nursing home that can identify close contacts: requires testing for all staff, hospice contractors, and residents, regardless of vaccination status, that had a higher risk of exposure with the COVID-19 positive individual.
3. Newly identified COVID-19 positive staff or resident in a nursing home that is unable to identify close contacts: requires testing of all staff, hospice contractors, and residents, regardless of vaccination status, nursing home-wide or at a group level where the new case occurred (e.g., unit, floor, or other specific area(s) of the nursing home).
4. Routine Testing: As stated above, for any hospice contractors who are not up-to-date, testing is required based on the COVID-19 Community Transmission Levels

Hospices providing care to residents in nursing homes should maintain close contact with nursing home administration to ensure they understand current testing expectations and are aware of any additional testing requirements due to COVID-19 staff or resident infections.