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State Is Accepting Comments on Proposed Changes to TB Testing for ACF Personnel

LeadingAge NY is alerting members that proposed regulations modifying the tuberculosis (TB) testing requirements for adult care facility (ACF) personnel were posted in the State Register on June 2nd. The public can comment on the regulations; comments can be sent to Katherine Ceroalo, Department of Health (DOH), Bureau of Program Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, 518-473-7488, regsqna@health.ny.gov, and are due by Aug. 1, 2021.

This change has already been implemented for assisted living residences (ALRs) and other providers. When the change occurred, LeadingAge NY reached out to DOH to encourage them to adopt the same for ACFs, given that the modification implements current clinical best practice. We are pleased to see that they have included ACFs; however, we are reviewing the text of the proposed regulations to determine the impact on our members.

As outlined in the Dear Administrator Letter (DAL), the regulations would modify TB testing requirements for ACF personnel by removing the requirement for ACF staff to be tested for TB at least every two years and instead require annual assessments for TB testing, which focus on evaluating individual risk and encouraging treatment for persons with untreated latent TB infection. The individual must have an initial baseline test prior to employment, after which an annual assessment would be required, while serial testing would cease. The text of the proposed regulations can be viewed here.

In reading the text of the proposed regulations, it points to “medical staff” to develop and implement policies regarding positive findings, including procedures for facilitating and documenting treatment for latent TB infection where indicated. It also states that the annual TB assessments shall include education, individual risk assessment, and follow-up tests as indicated. Given that ACFs do not have medical staff, we will raise this issue in public comment.

Ultimately, we hope that this will become an easier process to implement, but we welcome your questions and concerns. Members may provide public comment directly and/or provide comments to us to include in any comment.

Given that this process has been applied to other settings, the Department has provided various guidance and questions and answers on the change that may be instructive to you in contemplating what the new process might look like in the ACF setting.

Members should also be aware of Centers for Disease Control and Prevention (CDC) guidance that the State has adopted regarding the timing of tuberculin skin tests (TST) and COVID-19 vaccinations. This is critical to consider, as it can delay the onboarding of new staff:

Deferring the second step of a TST test may be necessary when prospective employees are in the middle of a COVID vaccine series.

For prospective employees who require baseline TB testing at onboarding at the same time they are to receive a COVID-19 mRNA vaccine, the CDC recommends the following sequence:

  • Perform TB symptom screening on all personnel;
  • If using IGRA, draw blood prior to COVID-19 mRNA vaccination;
  • If using TST, place prior to COVID-19 mRNA vaccination;
  • If COVID-19 mRNA vaccination has already occurred, defer TST or IGRA testing until 4 weeks after completion of 2-dose COVID-19 mRNA vaccination.

We welcome member questions and comments on the proposed regulations and any associated issues.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828