Weekly Health Care Policy Update – June 18, 2021

June 25, 2021

In this update: 

  • Biden Administration Announces Updates on COVID-19 Response 
    • J&J Vaccine Expiration Extended
    • OSHA Requires Employers to Provide PTO for COVID-19 Vaccination
    • HRSA Sends Funds to RHCs
    • Administration Invests $3 Billion in COVID-19 Antivirals
  • CDC and FDA Officials Discuss Myocarditis After COVID-19 Vaccination
  • OMB Issues Biden Administration’s Spring 2021 Unified Agenda
  • HHS Revises PRF Reporting Requirements, Extending Deadlines
  • ONC Announces Release of Draft Technical Specifications for Patient Addresses
  • ONC Establishes Public Health Informatics & Technology Workforce Development Program
  • CMS Releases Data on Reduced Cost-Sharing for New ACA Customers
  • HRSA Issues FY 2022 FQHC Service Area Competition
  • MACPAC Releases June 2021 Report to Congress
  • HHS Rescinds Rule for FQHCs to Pass on 340B Discounts for Insulin and EpiPens
  • CMS Publishes User Guide for ACOs Reporting via the APM Performance Pathway  
  • NIH Releases Plan on Cultural Racism
  • Supreme Court Rejects ACA Challenge in California v. Texas
  • Novavax Vaccine Highly Effective in Late-Stage Trial
  • U.S. News Releases Children’s Hospitals Rankings
  • JAMA Publishes Research Letter on Low Hospital Price Transparency Compliance
  • Congressional Hearings
  • NYS Provides Update on Adult BH HCBS Transition to CORE Services
  • New York State Legislature Passes Additional Health Care Bills Prior to End of Session
  • NYS Launches COVID-19 Pandemic Small Business Recovery Grant Program
  • DOH Updates COVID-19 Testing Guidance for Nursing Homes and Adult Care Facilities

Administration Updates

Biden Administration Announces Updates on COVID-19 Response
This week, the Biden Administration announced new updates on the COVID-19 response: 

  • J&J Vaccine Expiration Extended: On June 9th, Johnson & Johnson announced that the Food & Drug Administration (FDA) authorized an extension of the expiration date on millions of doses of its COVID-19 vaccine by six weeks. The FDA concluded that doses are safe and effective for at least four and a half months at normal refrigeration levels, despite originally authorizing the vaccine for up to three months in February. The FDA has been regularly reviewing expiration dates for all three approved vaccines since shots were first produced. Vaccines from Pfizer-BioNTech and Moderna have a six-month shelf life.
  • OSHA Requires Employers to Provide PTO for COVID-19 Vaccination: On June 10th, the Department of Labor’s Occupational Safety and Health Administration (OSHA) issued an Emergency Temporary Standard requiring health providers to pay employees for the time it takes them to get vaccinated and recover from any side effects. The Standard existed previously only as “guidance,” and applies to hospitals, nursing homes, home health workers, and ambulatory care facilities. OSHA also required that health providers install physical barriers where social distancing isn’t possible indoors within 30 days, maintain logs for employees with COVID-19 (contracted inside or outside of work), and report COVID-19-related employee hospitalizations to OSHA within 24 hours. As of early March, only slightly more than half of frontline health care workers had received a vaccine dose, including only a quarter of home health workers.
  • HRSA Sends Funds to RHCs: On June 11th, the Department of Health and Human Services (HHS) announced that the Health Resources and Services Administration (HRSA) has distributed a total of $424.7 million to over 4,200 Rural Health Clinics (RHCs) for COVID-19 testing and mitigation. An additional $35.5 million will be distributed later in the summer. HRSA is funding RHCs based on the number of certified clinic sites they operate, providing $100,000 per clinic site. RHCs will use the funds to “maintain and increase COVID-19 testing, expand access to testing for rural residents, and broaden efforts to mitigate the spread of the virus in ways tailored to their local communities.”
  • Administration Invests $3 Billion in COVID-19 Antivirals: On June 17th, HHS announced the Antiviral Program for Pandemics, an initiative that will invest $3 billion from the American Rescue Plan (ARP) to support research to accelerate the development of antivirals that prevent serious COVID-19 illness and death. This funding will enable the National Institutes of Health (NIH) to help advance antiviral candidates to Phase 2 trials through funding for research and lab support, preclinical and clinical evaluation, and development and manufacturing. It also allocates $1.2 billion for collaborative drug discovery groups.

CDC and FDA Officials Discuss Myocarditis After COVID-19 Vaccination
On June 9th, federal health officials presented surveillance data to the FDA’s Vaccines and Related Biological Products Advisory Committee on the risk of myocarditis (inflammation of the heart) for adolescents and young adults after their second shot of an mRNA COVID-19 vaccine. Officials are still unsure if there is a link between vaccination and myocarditis, but did report seeing rare but higher-than-expected cases of both myocarditis and pericarditis after vaccination, particularly in men. The Defense Department and Israeli health officials have also noted a potential connection. Overall, among 16- to 17-year olds, there have been 79 cases of myocarditis or pericarditis reported, compared to an expected 2 to 19 cases at baseline; among 18- to 24-year olds, there have been 196 cases reported, compared to an expected 8 to 83 cases at baseline, though not all of these cases have been confirmed. Additional data will be presented on June 18th. 

Regulatory Updates

OMB Issues Biden Administration’s Spring 2021 Unified Agenda
On June 11th, the Office of Management and Budget (OMB) published the Biden administration’s Spring 2021 Unified Agenda. A unified agenda is generally released in the spring and fall, communicating an administration’s short- and long-term regulatory priorities.
Other than regular annual updates to payment systems and benefit and payment parameters, some key new policies included in the Agenda are: 

  • A proposed rule to implement a new mandatory Medicare model to test ways to reduce Medicare expenditures while preserving or enhancing the quality of care;
  • A Request for Information (RFI) on all aspects of the transplant system, and a rule to change standards used to evaluate and recertify transplant centers and organ procurement organizations;
  • A rule to revise the infection control requirements that long-term care facilities must meet to participate in the Medicare and Medicaid programs;
  • A proposed rule to streamline eligibility and enrollment processes for all Medicaid and CHIP populations; and
  • A proposed rule to extend prohibitions on states modifying Medicaid managed care risk mitigation arrangements to prospective periods.

The Agenda also includes repeals of or modifications to various Trump-era policies: 

  • A plan to issue a second Notice of Proposed Rulemaking (NPRM) on the SUNSET Rule to create procedures for periodic review of HHS regulations;
  • A plan to issue a second NPRM on the Trump Administration’s rule to establish a Medicare coverage pathway for faster access to medical devices designated as breakthrough by the FDA; and
  • A proposed rule to repeal Section 1332 State Innovation Waiver guidance codification, extend open enrollment, and expand Navigator duties.

Some notable agenda items previously known due to statutory requirements include: 

  • A final rule on civil monetary penalties for misconduct related to HHS grants, contracts, and information blocking, as provided for in the 21st Century Cures Act;
  • The two-part proposed rule on surprise billing to implement the No Surprises Act; and
  • Modifications to the confidentiality of substance use disorder patient records, as included in the CARES Act.

HHS Revises PRF Reporting Requirements, Extending Deadlines
On June 11th, HHS released a revised Notice of Reporting Requirements for providers receiving funds through the Provider Relief Fund (PRF) created by the CARES Act. Under the revised requirements, providers who received funds later will have an extended timeline to spend PRF money or return unused amounts to the federal government. Previously, all funds had to be used by June 30th. Now, the deadline will be based on when the provider received the funds, giving providers at least one year from the date of receipt to use them. Specifically, deadlines will be staggered in four periods: 

  • Providers receiving funds between April 20, 2020 and June 30, 2020 must spend funds by June 30, 2021;
  • Providers receiving funds between July 1, 2020 and December 31, 2020 must spend funds by December 31, 2021;
  • Providers receiving funds between January 1, 2021 and June 30, 2021 must spend funds by June 30, 2022;
  • Providers receiving funds between July 1, 2021 and December 31, 2021 must spend funds by December 31, 2022;

In addition, providers now have 90 days after the deadlines to meet all reporting requirements instead of the original 30 days. The Reporting Portal will open on July 1st for initial submissions.
 
ONC Announces Release of Draft Technical Specifications for Patient Addresses
On June 16th, the HHS Office of the National Coordinator for Health Information Technology (ONC) announced the release of the first version “Project US@” draft technical specifications. Project US@ is an industry-wide initiative to develop a single standard for representing patient addresses, intended to improve patient matching across different records systems. Project US@ has been developed in collaboration with standards development organizations, including Health Level 7 (HL7), the National Council for Prescription Drug Programs (NCPDP), X12, and others.
 
HL7, NCDPD, and X12 will accept public comments on the draft from July 1st through July 31st. More information, including guidance on commenting, will be posted shortly. A final version will be published later in 2021.
 
The HHS press release is available here.
 
ONC Establishes Public Health Informatics & Technology Workforce Development Program
On June 17th, ONC announced the establishment of the Public Health Informatics & Technology (PHIT) Workforce Development Program. This program, which is funded with $80 million through the ARP, is intended to train more than 4,000 individuals in public health informatics and technology programs. Funding will be awarded to consortiums of colleges and universities to develop curricula, recruit and train participants, and assist them in securing internships and career placements for careers in public health. ONC particularly encourages participation by minority-serving institutions, such as historically black colleges and universities (HBCUs).
 
ONC will host an information session about this funding opportunity on June 23rd at 2pm. The full announcement is available here.
 
CMS Releases Data on Reduced Cost-Sharing for New ACA Customers
On June 14th, the Centers for Medicare and Medicaid Services (CMS) released datashowing that, since April 1st, 43% of new individual insurance purchasers on Healthcare.gov Marketplaces, established by the Affordable Care Act (ACA), since April 1stselected a plan whose premiums cost $10 or less per month. Of returning customers, 30% chose a plan with premiums of $10 or less per month. Overall, 1.2 million consumers have newly enrolled in Marketplace plans since February 15th, during a COVID-19-related Special Enrollment Period (SEP). The reduced cost-sharing requirements are the result of the ARP, which expanded advance payments of premium tax credits (APTC).
 
Overall, the average monthly premium for consumers who are new to the marketplace was $87 per month in April and May, a 26% drop from before the implementation of the ARP. The median deductible for consumers new to the marketplace also fell by 83%, from $450 prior to April 1 to $75 after April 1. For the first time, this SEP enrollment report also includes comprehensive demographic data on gender, race, and ethnicity, showing a higher proportion of Black and Hispanic enrollment than in prior years. The current SEP will close on August 15th.
 
HRSA Issues FY 2022 FQHC Service Area Competition
On June 14th, HRSA posted an additional Service Area Competition (SAC) opportunity for fiscal year (FY) 2022. Through the SAC, organizations may apply to participate in the federally-qualified health center (FQHC) program in an existing service area. FQHCs are typically approved for a three-year period and, if they seek to renew, must reapply to the SAC. For this opportunity, there are additional SACs open in Manhattan, the Bronx, and several other areas of New York.
 
Applications are due August 13th. More information is available here. HRSA posted a previous opportunity (here) in May that included two SACs open in Manhattan and several others in other areas of New York. Applications for that competition are due July 12th.
 
MACPAC Releases June 2021 Report to Congress
On June 15th, the Medicaid and Chip Payment and Access Commission (MACPAC) released its June 2021 report to Congress. The report made recommendations relating to high-cost specialty drugs, access to mental health services under Medicare, access to behavioral health services for children and adults, and included a congressionally mandated report on non-emergency medical transportation. MACPAC made the following specific recommendations: 

  • High-cost specialty drugs: Congress should increase the minimum rebate percentage and the inflationary rebate on drugs that receive FDA approval through the accelerated approval pathway. After traditional approval, both the minimum rebate percentage and the inflationary rebate would revert to the typical amount.
  • Access to mental health services for adults: CMS and the Substance Abuse and Mental Health Services Administration (SAMHSA) should issue subregulatory guidance to address how Medicaid and CHIP can be used to fund a crisis continuum for beneficiaries experiencing behavioral health crises, and provide education and technical assistance on the implementation of a behavioral health crisis continuum that responds to people in real time, including the use of federal funds to improve crisis service access.
  • Access to behavioral health services for children and adolescents: CMS and SAMHSA should issue subregulatory guidance to address the design and implementation of benefits for children and adolescents with significant mental health conditions covered by Medicaid and CHIP, including new guidance on the use of home and community-based services (HCBS), and provide education and technical assistance on improving access to HCBS, including the use of federal funds to improve access to these services.

HHS Rescinds Rule for FQHCs to Pass on 340B Discounts for Insulin and EpiPens
On June 15th, HHS issued a notice in the Federal Register that it intends to rescind a rule, published in December 2020 by the Trump Administration, which would have required federally qualified health centers (FQHCs) to pass 340B discounts for insulin and injectable epinephrine (EpiPens) on to patients. The Administration previously argued that the rule would reduce out-of-pocket costs for patients, but HHS now states that the infrastructure required by health centers to determine a patient’s eligibility to receive the drugs at the lower price would put undue administrative costs and burdens on the facilities. The previous rule never went into effect.
 
CMS Publishes User Guide for ACOs Reporting via the APM Performance Pathway 
On June 15th, CMS posted a user guide outlining quality reporting and scoring policies for organizations reporting via the Alternative Payment Model (APM) Performance Pathway (APP) in the Medicare Shared Savings Program for Accountable Care Organizations (ACOs). The APP is required for all shared savings program ACOs, but optional for MIPS APM participants. 

  • ACOs will only need to report one set of quality measures via the APP to satisfy the quality reporting requirements under both the Sharing Savings Program and MIPS.
  • Each ACO’s MIPS quality performance category score will be calculated using the ACO’s performance on the measures reported under the APP, any applicable MIPS bonus points, and quality improvement points.
  • For the purpose of the Shared Savings Program, the MIPS quality performance category scores will be used to determine shared savings and shared losses, meeting the reporting requirements for both programs.
  • Starting with performance year 2021, ACOs are required to report quality data via the APP on behalf of their participants. If an ACO reports via the APP, then the ACO participants are not required to report quality separately to MIPS.

NIH Releases Plan on Cultural Racism
On June 9th, the NIH released a plan to eliminate gaps in grant awards between white and minority scientists, as well as to increase funding for research on health disparities. The NIH is the largest funder of biomedical research in the United States, distributing more than $40 billion per year, but fewer than 2% of NIH senior investigators are Black. In the report, NIH leaders pledge to spend $60 million on projects to reduce health disparities and $30 million to study and address the impact of structural racism and discrimination on minority health. 

Grant Updates

HHS Announces Funding for Telehealth in Pediatric Mental Health Care
On May 20th, HRSA announced the availability of $14.2 million from the ARP to integrate tele-mental health services into pediatric primary care. This funding will be used to expand the Pediatric Mental Health Care Access (PMHCA) Program to new states and tribal areas across the nation. Today, 21 PMHCA state and regional networks provide teleconsults, training, technical assistance, and care coordination for pediatric primary care providers. HRSA expects to make 32 awards, with an award ceiling of $445,000.
 
Applications are due July 6th. More information is available here.
 
HRSA Issues FY 2022 FQHC Service Area Competition
On May 13th, HRSA posted the Service Area Competition (SAC) opportunity for fiscal year (FY) 2022. Through the SAC, organizations may apply to participate in the federally-qualified health center (FQHC) program in an existing service area. FQHCs are typically approved for a three-year period and, if they seek to renew, must reapply to the SAC. This year, there are two SACs open in Manhattan and several others in other areas of New York.
 
Applications are due July 12th. More information is available here.
 
Office of Minority Health Announces Diabetes Control Funding Opportunity
On May 12th, the Office of Minority Health at HHS announced a funding opportunity to identify family-centered factors that promote self-management and prevention of Type 2 diabetes. The program targets racial and ethnic minority families with a family member age 12 and older who has Type 2 diabetes. A total of $1.5 million is available, and HHS expects to make four awards, each with a ceiling of $500,000. Non-profit organizations as well as state, county, city, and tribal governments, are eligible to submit applications.
 
Applications are due July 13th. More information is available here.

Other Updates

Supreme Court Rejects ACA Challenge in California v. Texas
On June 17th, the Supreme Court released its ruling in California v. Texas, the latest case to challenge the constitutionality of the ACA. In a 7-2 opinion, the Court reversed the Fifth Circuit’s ruling, which would have overturned the ACA on the grounds that the individual mandate had been repealed by the 2017 Tax Cuts and Jobs Act, which set the mandate penalty to $0, and that it was inseverable from the rest of the law. The Court ruled that none of the challengers, which included 18 states controlled by Republicans, had standing to sue as they had not shown an injury traceable to the allegedly unlawful conduct.

The full text of the ruling is available here.

Novavax Vaccine Highly Effective in Late-Stage Trial
On June 14th, Novavax announced results of its Phase 3 COVID-19 vaccine trial. Its recombinant protein vaccine was 90% protective against symptomatic infection, roughly the same efficacy as the mRNA vaccines produced by Pfizer-BioNTech and Moderna. Novavax expects to apply for FDA approval in the third quarter of 2021 and expects to be able to produce 150 million doses per month by the end of the year. The vaccine was 93% protective against variants of concern, including the Alpha variant. None of the trial participants were infected with the Delta variant, so data on efficacy against Delta is unknown. The vaccine was also 91% protective in high-risk individuals (those over 65, those with conditions increasing their risk of serious infection, and those with frequent exposure). If approved, the vaccine would be Novavax’s first licensed product.  

U.S. News Releases Children’s Hospitals Rankings
On June 15th, U.S. News and World Reportreleased its best children’s hospitals rankingsfor 2021-22. U.S. News surveyed 193 freestanding children’s hospitals and large pediatric departments. Boston Children’s Hospital took the top spot, followed by Children’s Hospital of Philadelphia, and Texas Children’s Hospital. As with other U.S. News rankings, the children’s hospital rankings are based on a range of survey and outcomes data. This year, the weighting of the data was as follows: outcomes (33%), a survey of practitioners (15%), and measures of patient safety, excellence, and family centeredness (52%) based on hospital-reported survey data.

JAMA Publishes Research Letter on Low Hospital Price Transparency Compliance
On June 14th, JAMApublished a Research Letter indicating that a majority of hospitals are still not in compliance with price transparency rules that went into effect on January 1, 2021. In an analysis of 100 randomly-sampled hospitals, 83% were noncompliant with at least one of the rule’s requirements, and a little over half had a price estimator tool. Performance was slightly better, however, among a sample of 100 of the top-earning hospitals of 2017. Only 75% were noncompliant with at least one requirement, and 86% offered a price estimator tool.

Congressional Hearings

Tuesday, June 22nd: 

  • At 10am, the Senate Committee on Health, Education, Labor, and Pensions (HELP) will hold a hearing entitled “Vaccines: America’s Shot at Ending the COVID-19 Pandemic.” More information is available here. 

Wednesday, June 23rd: 

  • At 2pm, the House Committee on Small Business will hold a hearing entitled “Prioritizing Small Undeserved [sic] and Rural Businesses in the SBIR (Small Business Innovation Research)/STTR (Small Business Technology Transfer) Programs”. More information is available here.

New York State Updates

NYS Provides Update on Adult BH HCBS Transition to CORE Services
On June 15th, the New York State (NYS) Department of Health (DOH), in partnership with the Office of Mental Health (OMH) and Office of Addiction Services and Supports (OASAS), announced that it will modify the planned transition of the current adult behavioral health (BH) Home and Community Based Services (HCBS) to a new service array called Community Oriented Recovery and Empowerment (CORE) services. DOH announced in April that the transition to CORE, previously scheduled to start June 1st, would be delayed due to the provision of the ARP which provides states with a one-year increase to their Federal Medical Assistance Percentage (FMAP) for HCBS of 10 percentage points. The State was concerned that the transition might make these services ineligible for additional funding.
 
However, following discussions with CMS to clarify requirements, DOH intends to continue pursuing the transition of the following adult BH HCBS to CORE services: 

  • Community Psychiatric Support and Treatment (CPST)
  • Psychosocial Rehabilitation (PSR)
  • Empowerment Services – Peer Support
  • Family Support and Training (FST)

As previously planned, the PSR under CORE will be broadened to support individuals with employment and educational goals. The remaining services, which were initially intended to be consolidated under the CORE services or removed, will remain a part of the Health and Recovery Plan (HARP) and HIV Special Needs Plan (SNP) benefit package under adult behavioral health HCBS and will continue to be offered by designated providers. These services include: 

  • Habilitation
  • Education Support Services
  • Prevocational Services
  • Transitional Employment
  • Intensive and Ongoing Supported Employment
  • Non-medical Transportation

DOH has highlighted the following key points for providers: 

  • Health Home Care Management Agencies and Recovery Coordination Agencies will continue to complete the NYS Eligibility Assessment (EA) and follow existing policy to make referrals to the remaining BH HCBS.
  • Eligibility for CORE services will be based on the recommendation of a Licensed Practitioner of the Healing Arts. The NYS EA will not be required for referral to CORE.

DOH will provide an implementation timeframe for CORE services as soon as possible. Final CMS approval is still required for the transition. Questions may be submitted to Adult-BH-HCBS@omh.ny.gov or PICM@oasas.ny.gov.
 
New York State Legislature Passes Additional Health Care Bills Prior to End of Session
Prior to the close of the annual session, the New York State Legislature passed the below health care-related bills. These bills will now be delivered to the Governor to be signed or vetoed. 

  • Assembly Bill A5339/Senate Bill S5560-A would modify the funding system for the Early Intervention (EI) program to set up a statewide pool that would allocate EI funding to the State and municipalities. This money, amounting to $40 million per year initially, will be funded through the Health Care Reform Act (HCRA) Covered Lives Assessment.
  • Assembly Bill A5713/Senate Bill S6375 directs the Commissioner of Health to conduct a study of the delivery of ambulatory care and other medical care in response to the COVID-19 pandemic and make recommendations to improve the delivery, quality, accessibility, and cost of ambulatory health care services across the state.
  • Assembly Bill A6166-1/Senate Bill S6571 requires reporting of alcohol overdose data in addition to opioid overdose requirements.
  • Assembly Bill A1396/Senate Bill S3762 requires licensure of pharmacy benefit managers.
  • Assembly Bill A7598/Senate Bill S6603 requires Medicaid managed care plans to reimburse retail pharmacies at parity with fee-for-service rates, allows retail pharmacies the opportunity to participate in another provider’s network under Medicaid, and prohibits pharmacy benefit managers from limiting an individual’s option to receive medications from non-mail order pharmacies. 
  • Assembly Bill A5854-A/Senate Bill S3566 ensures that consumers are not forced into mandatory mail order and can receive every covered medication from a local network participating pharmacy.
  • Assembly Bill A6476-A/Senate Bill S4807-A permanently expands the immunizations that licensed pharmacists are authorized to administer.
  • Assembly Bill A3516/Senate Bill S7075 requires insurance plans to provide consumers or subscribers with an explanation of pharmaceutical benefits. 
  • Assembly Bill A2030/Senate Bill S649-A removes prior authorization for medication assisted treatment for Medicaid beneficiaries with substance use disorders.
  • Assembly Bill A4668/Senate Bill S4111 prohibits insurance plans from changing their prescription drug formularies during an enrollment year and requires advance notice to policyholders of the intent to remove a prescription drug from a formulary or alter patient cost-sharing in the upcoming plan year.

NYS Launches COVID-19 Pandemic Small Business Recovery Grant Program
On June 10th, Empire State Development (ESD) began accepting applicants for the COVID-19 Pandemic Small Business Recovery Grant Program. This program, created in this year’s NYS Enacted Budget, included $800 million for flexible grant assistance to currently-viable small businesses, microbusinesses, and for-profit independent arts and cultural organizations across the state who have experienced economic hardship due to the COVID-19 pandemic. Only for-profit organizations with between $25,000 and $500,000 in gross receipts are eligible to apply; not-for-profits are ineligible. The award amount will be based on annual gross receipts for 2019, as follows: 

  • Annual gross receipts of $25,000 – $49,999.99: Award of $5,000
  • Annual gross receipts of $50,000 – $99,999.99: Award of $10,000
  • Annual gross receipts of $100,000 – $500,000: Award of 10% of gross receipts

Grants must be used for COVID-19-related losses or expenses that occurred between March 1, 2020 and April 1, 2021, such as payroll, insurance, commercial rent or mortgage payments, and costs of personal protective equipment, among others. Grant funding may not be used to repay or pay down any portion of a loan obtained through a federal COVID-19 relief package or any other NYS business assistance programs.
 
Additional details on the grant program, and the application materials, are available here.
 
DOH Updates COVID-19 Testing Guidance for Nursing Homes and Adult Care Facilities
On June 10th, DOH released updated guidance for nursing homes and adult care facilities (ACFs) regarding routine COVID-19 testing of nursing home personnel and ACF staff. Effective immediately, fully vaccinated personnel are no longer required to undergo routine COVID-19 testing. However, such facilities must test or arrange for the routine testing of COVID-19 for all personnel who have not been fully vaccinated, including employees, contract staff, medical staff, operators, and administrators. Unvaccinated nursing home staff must be tested twice per week and unvaccinated ACF staff must be tested once per week. Any positive test result must continue to be reported to DOH by 1pm of the day following receipt of such test results.
 
Additionally, facilities should continue to screen all staff, residents, and individuals entering the facility for signs and symptoms of COVID-19. The updated documents also include guidance for prioritizing testing of staff and residents with COVID-19 signs or symptoms, following an exposure, and in response to an outbreak.
 
The nursing home guidance is available here and the ACF guidance is available here.