October 27, 2021
DAL NH 21-23 Updated Nursing
Home Testing Requirements
Dear Nursing Home Operators and Administrators:
The purpose of this Dear Administrator Letter (DAL) is to confirm that nursing homes licensed in
NYS should follow the requirements for routine testing of nursing home personnel as well as
testing of symptomatic or exposed staff and residents, and staff and residents during an
outbreak situation as outlined in the most recent CMS QSO 20-38 Revised September 10,
2021. This letter also details the operator’s responsibility for ensuring ongoing testing for
purposes of routine surveillance of COVID-19 transmission.
Routine COVID-19 Testing of Nursing Home Personnel
As of September 27, 2021, all NYS nursing home staff, including employees, contract staff,
medical staff, operators, and administrators, must be vaccinated. Operators and administrators
of all nursing homes are required
1
to test or arrange for the routine testing of COVID-19 of all
personnel who are not yet fully vaccinated
2
, as defined by the Centers for Disease Control and
Prevention, and those who have a qualified medical exemption or other accommodation.
Frequency of COVID-19 testing for unvaccinated nursing home personnel should follow CMS
guidelines. That information, including routine testing intervals can be found here: QSO-20-38-
NH REVISED (PDF).
Providers are advised that until further notice, any positive test result must continue to be
reported to the Department by 1:00 p.m. of the day following receipt of such test results, in
accordance with existing reporting protocols and mechanisms, and including but limited to data
entry to the Electronic Clinical Laboratory Reporting System (ECLRS).
Distribution of Testing Supplies from New York State
To facilitate surveillance testing of unvaccinated medically or other exempt nursing home staff in
New York State, the Department will continue to distribute Abbott BinaxNow COVID-19 antigen
tests directly to nursing homes, based on availability to support the CMS required second
weekly staff test for those with community transmission warranting such frequency
1
Pursuant to Public Health Law Sections 225, 2800, 2803, 3612, and 4010, as well as Title 10 (Health) of the Official
Compilation of Codes, Rules and Regulations of the State of New York as amended in Section 415.19 of Part 415
effective September 27, 2021.
2
For additional information, including the definition of fully vaccinated, please refer to the NYSDOH document titled
Frequently Asked Questions (FAQs) Regarding the August 26, 2021 – Prevention of COVID-19 Transmission
by Covered Entities Emergency Regulation
(surveillance testing). This distribution is not intended to support the provider’s responsibility to
conduct outbreak testing or be the source of tests for the first weekly test. Until further notice,
tests will continue to be allocated on a monthly basis, with the next delivery occurring in
November. For additional information on SARS-CoV-2 Point of Care (POC) Antigen Tests
please refer to the updated CDC recommendations located at
https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antigen-tests-guidelines.html specific
to testing in a congregate living setting.
As previously referenced, nursing homes conducting facility-wide testing in response to an
outbreak are responsible for the procurement and payment of all test supplies necessary
to complete outbreak testing.
Please be advised that regardless of the frequency of testing, the facility should continue to
screen all staff, residents (daily) and all persons entering the facility, such as vendors,
volunteers, and visitors, for signs and symptoms of COVID-19. When prioritizing individuals to
be tested, facilities should prioritize individuals with signs and symptoms of COVID-19 first,
regardless whether such symptomatic staff are vaccinated against COVID-19, then perform
testing triggered by an outbreak as specified below.
Testing of Staff and Residents with COVID-19 Signs or Symptoms
Staff with signs or symptoms of COVID-19, whether fully vaccinated or not, must receive a
COVID-19 test immediately, along with any other medically-appropriate testing (e.g. viral
respiratory pathogens), and are expected to be restricted from the facility pending the results of
COVID-19 testing. If COVID-19 is confirmed, facilities and staff must follow CDC return to work
requirements for facility staff working in nursing homes. Staff who do not test positive for
COVID-19 but have symptoms should follow facility policies to determine
when they can return to work.
Residents who have signs or symptoms of COVID-19, whether fully vaccinated or not, must be
tested immediately. While test results are pending, residents with signs or symptoms should be
placed on transmission-based precautions (TBP) in accordance with CDC guidance. Once test
results are obtained, the facility must take the appropriate actions based on the results.
Testing of Staff and Residents with a Higher-Risk Exposure and Residents who Had a
Close Contact When the Facility is Not Experiencing an Outbreak
CMS QSO 20-38 provides testing guidance for those personnel or residents who have been
identified as having a close contact with a COVID-19 positive individual when the facility is not
experiencing an outbreak. Examples may include exposures from a visitor, while on a leave
of absence, or during care of a resident on the COVID-19 unit.
In these instances, facilities should refer to CDC’s “Interim Infection Prevention and Control
Recommendations to Prevent SARSCoV-2 Spread in Nursing Homes” and “Interim Guidance
for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2.”
Testing of Staff and Residents in Response to an Outbreak
An outbreak is defined as a new COVID-19 infection in any healthcare personnel (HCP) or
any nursing home-onset COVID-19 infection in a resident. In an outbreak investigation,
rapid identification and isolation of new cases is critical in stopping further viral transmission. A
resident who is admitted to the facility with COVID-19 does not constitute a facility outbreak.
Upon identification of a single new case of COVID-19 infection in any HCP or residents, testing
should begin immediately. CMS QSO 20-38 advises that outbreak testing can be conducted
either via contact tracing or broad-based (facility-wide testing).
For additional information related to contact tracing and broad-based testing, refer to CDC
guidance “Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2
Spread in Nursing Homes.”
Thank you for your ongoing commitment and efforts to protect the health and safety of your
residents and staff. If you have further questions regarding this DAL, please contact the Division
of Nursing Homes /IID Surveillance Bureau of Quality Assurance and Surveillance at
covidnursinghomeinfo@health.ny.gov.
Sincerely,
Sheila McGarvey, RN BSN,
Director Division of Nursing Homes and
ICF/IID Surveillance
cc: J. Treacy
A. Herbst
M. Hennessey
V. Deetz
M. Vogel
E. Lutterloh
M. Quinn
J. Sheltry
