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Proposed Regulations Reduce TB Testing Requirements

On July 30th, the Public Health and Health Planning Council (PHHPC) recommended adoption of proposed regulations to provide greater flexibility on tuberculosis testing requirements for health care workers. The regulations would apply to nursing homes, hospitals, hospices, certified home health agencies (CHHAs), licensed home care services agencies (LHCSAs), and assisted living residences (ALRs). Members should note that the regulatory changes do not apply to adult care facilities (ACFs) and assisted living programs (ALPs); however, we are advocating that they be applied to both, since they reflect current standards across provider types and allow more flexibility.

The Department of Health (DOH) first published the proposed regulations in the Jan. 29, 2020 State Register. Adoption was put on hold during the early stages of the COVID-19 pandemic, but the regulations will likely be published very soon in the State Register as adopted by the PHHPC with an immediate effective date and a 90-day grace period for providers to modify their policies.

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 will: (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 published in January 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.

LeadingAge NY will keep members informed on the status of this proposed regulation and its forthcoming guidance.

Contacts: Meg Everett, meverett@leadingageny.org, 518-929-9342 and Dan Heim, dheim@leadingageny.org, 518-461-2934