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Adopted Regulations Reduce TB Testing Requirements

Effective Dec. 16th, final regulations have been adopted by the Department of Health (DOH) to provide greater flexibility on tuberculosis testing requirements for health care workers. The notice of adoption was published in the Dec. 16th issue of the New York State Register. The regulations apply to nursing homes, hospitals, hospices, certified home health agencies (CHHAs), licensed home care services agencies (LHCSAs), and assisted living residences (ALRs). Although these regulatory changes do not apply to adult care facilities (ACFs) and assisted living programs (ALPs) at this time, LeadingAge NY has been advocating for their inclusion, and DOH has advised that future regulatory changes will extend this flexibility to these providers.

The rule requires an “initial individual tuberculosis (TB) risk assessment, symptom evaluation, and TB test” prior to employment. Under the existing requirements, all employees with negative findings must be tested every year thereafter unless or until there are positive findings. The new regulations: (1) exempt workers from testing who do not provide direct care if they are in a non-patient care building/site; and (2) require a risk assessment and symptom evaluation along with the test at the time of hiring, but only annual assessments (defined to include education, risk assessment, and follow-up tests as indicated) thereafter.

The regulatory impact statement justified the change by noting that:

“Over the past two decades, with improved infection control, diagnostic testing and treatment of persons with tuberculosis (TB) disease, incidence has decreased. Evaluation of persons at risk for TB to detect and treat latent infection, including contacts with infectious TB, is also ongoing in all settings including health care facilities...In NYS, providing universal annual tuberculosis education and individual risk assessment, followed up as needed with appropriate testing, clinical evaluation, and encouragement of optimal treatment, is expected to benefit health care personnel, minimize risk of transmission from health care personnel to others, and refocus occupational health and infection control efforts. Thus, the requirement to be tested 'no less than every year' for negative findings is no longer necessary and is being eliminated from these regulations.”

Positive findings will still require appropriate clinical follow-up, and the medical staff must “…develop and implement policies regarding positive [outcomes] findings, including procedures for facilitating and documenting treatment for latent TB infection where indicated.”

Even with the change to annual assessments, impacted providers can still consider using serial TB screening of certain groups who might be at increased occupational risk for TB exposure (e.g., pulmonologists or respiratory therapists) or in certain settings if transmission has occurred in the past (e.g., emergency departments). Policies would also require clear procedures for offering and documenting treatment of TB infection.

DOH’s Division of Epidemiology has issued guidance to providers on these regulations. The regulations are currently effective but provide for a 90-day grace period for providers to modify their policies. Full implementation is expected to occur over a one-year period as successive groups of persons are screened according to the revised protocols. Questions about TB testing can be directed to DOH’s Bureau of Tuberculosis Control at tbcontrol@health.ny.gov.

Contacts: Meg Everett, meverett@leadingageny.org, 518-929-9342 and Dan Heim, dheim@leadingageny.org, 518-867-8866