With Rising Positivity Rates, Nursing Homes May Need to Increase Staff Testing

COVID-19 positivity rates are rising across New York State and nationwide. Nursing homes should remain aware of community rates not only to inform general infection prevention measures, but also to ensure compliance with Centers for Medicare and Medicaid Services (CMS) guidance on testing and visitation. Under CMS testing guidance, nursing homes are required to test unvaccinated staff weekly if their county positivity rate is 5 percent or higher. If rates rise above 10 percent, nursing homes must test unvaccinated staff twice weekly.

Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency. However, if rates rise to 5 percent or more, triggering weekly testing, and then drop, they must remain below 5 percent for at least two weeks in order to permit a resumption of monthly testing.

According to CMS Frequently Asked Questions (FAQs) on testing, facilities may use either the CMS- or the State-published positivity rates as the basis for their staff testing. Facilities should document the source, date, and rate used to trigger staff testing. Facilities should also continue to use the same source for determining testing (i.e., do not switch sources from week to week). The CMS FAQs instruct facilities using the CMS data to rely on the color-coded positivity classification. Green represents counties with test percent positivity of less than 5.0 percent or with less than 20 tests in the past 14 days. Yellow represents test percent positivity of 5.0 percent to 10.0 percent, or with less than 500 tests and less than 2,000 tests/100K and greater than 10 percent positivity over 14 days. Red represents greater than 10.0 percent and not meeting the criteria for “Green” or “Yellow.”

In the most recent 14-day positivity data, all New York counties remain under 5 percent. However, daily positivity rates published by the State show some counties over 5 percent, suggesting that next week's 14-day rates may exceed the 5 percent threshold. LeadingAge NY publishes the updated State and CMS positivity rates with the CMS color codes each week. This week's update is available here.

Positivity rates may also influence visitation. Under Department of Health (DOH) and CMS guidance, indoor visitation must be suspended for unvaccinated residents if the nursing home’s county positivity rate is greater than 10 percent AND less than 70 percent of residents in the facility are fully vaccinated. In addition, facilities should consider county positivity rates in determining whether to quarantine new admissions and residents who leave the facility for extended periods.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383