HHSC COVID-19 Testing FAQs & Reference Documents

Last Updated: May 29, 2020

Delegation Order for COVID-19 Testing

HHSC Nursing Home Data Upload Template

HHSC Instruction Sheet for Data Upload Template

HHSC May 15th FAQ #1 

HHSC May 21st FAQ #2

HHSC May 29th Response to THCA Webinar Questions

 

HHSC COVID-19 FAQs

Below are answers to some frequently asked questions related to this effort.  To search for a specific topic, click on the magnifying glass on the right side of the screen.

Frequently Asked Questions

FAQ #1 (May 15)

1. When will the testing initiative begin?


Testing has already begun. Facilities that have not had all residents and staff tested since April 15 will be contacted to schedule testing.




2. How long will this process take?


The goal is to complete the process within two weeks. We will work to complete the testing as quickly as possible and will continue deploying teams until all facilities have been tested.




3. What is the plan for how this testing will be done?


In order to conduct testing for the 1,224 licensed nursing facilities in Texas, it will take a lot of partners working together. Depending on where you are in the state the team that conducts the testing for your facility may be from the/an:

  • Local Health Department or DSHS Public Health Region
  • Regulated fire department for your area
  • Emergency Medical Task Force team at the direction of the state
  • Texas Military Department Mobile Testing Teams at the direction of the state




4. Who is paying for this?


The costs associated with this testing will be covered using available funding sources. More information will be coming about how to seek reimbursement for those expenditures.




5. Who is considered staff?


Staff refers to all paid and unpaid persons serving in facilities who have the potential for direct or indirect exposure to residents or infectious materials. Staff includes, but are not limited to, EMS personnel, nurses, certified nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the health care setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel).




6. What is the local health departments responsibility in this undertaking?


The role of the LHD varies depending on jurisdiction. The LHD can be the lead for testing for nursing facilities in their area if desired. Conversely, the LHD does not need to play a role in nursing facility testing. In either case, LHDs should coordinate with the DSHS public health region, and TDEM or local fire agencies through their emergency management coordinator. LHDs may speak directly with an HHSC Long Term Care Region Director.




7. Are other long-term care facilities included in this initiative?


This current testing initiative is focused on staff and residents in licensed nursing facilities. However, other long-term care facilities with outbreaks should continue to report those outbreaks to the Long-Term Care Regulatory region and will be supported through the Rapid Assessment Quick Response Force (RA-QRF) process, which can include testing support.




8. How can a nursing facility prepare for this initiative?


The testing team assigned to your facility will contact you to schedule your testing. When the testing team calls, you should be prepared to provide the patient census and number of staff.

Facilities that are scheduled for testing will be given at least 24-hours of notice prior to the specimen collection process taking place. Facilities should work with the testing team on the time the testing will take place and are encouraged to schedule the specimen collection over a shift change to maximize the number of people already scheduled to be on-site.

Administrators should make arrangements for off-duty staff to be present at the facility during the specimen collection.

Nursing facilities may choose to conduct testing independent of the state process. If your facility has tested 100 percent of residents and staff since April 15, inform the testing team when you are contacted to schedule testing. You will be required to provide documentation to the team calling to schedule testing and to HHSC Long-Term Care Regulatory showing when all residents and staff were tested.

Depending on where your facility is located in the state, you may be contacted to schedule testing by the:

  • local fire department
  • Local Health Department or DSHS Public Health Region
  • Emergency Medical Task Force
  • Texas Military Department Mobile Testing Teams




9. How do I sign up to get my facility tested?


There is no need for facilities to sign-up or for jurisdictions to submit a State of Texas Assistance Request (STAR) on behalf of facilities. All licensed nursing facilities that have not had all staff and residents tested since April 15 will be included in this initiative.




10. Will there be multiple rounds of testing done or just this one?


We will evaluate the need for further testing.




11. How do I contact the team who will be conducting testing for my facility?


The testing team assigned to your facility will contact you directly to schedule the testing.




12. What can we expect when the testing team arrives?


The testing team will bring their own PPE and the test kits. The team will self-screen prior to entering the facility.




13. Is contracted agency staff working in the facility required to be tested?


Yes.




14. Will facilities that have already tested residents and staff be included in this initiative?


If testing occurred before April 15, or if all residents and staff were not tested, testing will occur. If you receive a call from a testing team you should provide them with information about previous testing. If you have completed testing of all residents and staff since April 15, you will need to provide documentation of that testing to the testing team and your Long- Term Care Regulatory region.




15. How will facilities be prioritized for testing?


We will continue to prioritize facilities with known positive cases for testing. Prioritization for other facilities will be done in partnership with the testing teams for that area, which may include local and/or DSHS Regional public health, local fire departments, Emergency Medical Task Force, and/or Texas Military Department Mobile Testing Teams.




16. What type of testing is being done?


The tests will use nasopharyngeal swabs to collect specimens for Polymerase Chain Reaction (PCR) testing.




17. Who will be the ordering physician for these tests?


The ordering physician for all the tests will be John Hellerstedt, MD., Commissioner of State Health Services. Test results will be sent directly to the nursing facility.




18. How will test results be reported to a facility?


The testing team will complete paperwork for the facility to accompany the specimens collected. The paperwork will include information about who at the facility should receive the results once the laboratory testing is complete.




19. How long will it take to get test results?


Specimens must be sent to a laboratory. Results are typically available between one and seven days after testing.




20. Can I use the laboratory my facility has an existing relationship with to test these specimens?


Yes. This is not only allowed but preferred. There will be more information coming about how these costs will be billed or reimbursed.




21. What happens if a nursing home staff member tests positive during mass testing?


Health care personnel that test positive for COVID-19 should be excluded from work until they meet all Return to Work Criteria. Facilities should refer to the COVID-19 Response for Nursing Facilities plan.




22. Can administrative or support staff (laundry, office, dietary, etc.) who have no direct contact with patients and are wearing PPE when doing their jobs, and have no symptoms, continue to work uninterrupted if they test positive during mandated testing?


No. Even persons not directly involved in patient care but who could be exposed to infectious agents that can be transmitted in the facility (including administrative and support staff) should follow the guidance for returning to work provided in the abovementioned Return to Work Criteria.




23. If a staff member works at multiple facilities do they have to have multiple tests?


No. Each person only needs one test. However, that staff member will need to provide documentation of the testing to all facilities where they work.




24. Who will be performing the collection of the specimens?


Specimen collection will be performed by the local fire department, local or DSHS Regional public health department, Emergency Medical Task Force, or Texas Military Department Mobile Testing Teams.




25. Can a nursing facility conduct their own testing and be reimbursed by the state?


Yes. Nursing facilities may, in consultation with their assigned testing team, conduct their own testing and may use a private laboratory. The testing must be PCR testing. The nursing facility must provide the results to the testing team assigned to the facility and to the Long-Term Care Regulatory region. More information about how to seek reimbursement will be forthcoming.




26. Will the nursing facility be expected to provide PPE or test kits for the testing team?


No. The testing team will bring their own PPE and the supplies needed for testing. The team will ask you for a patient census and the number of staff when they contact you to schedule testing so they can bring the appropriate amount of supplies.




27. What if a nursing home resident or staff member declines a COVID- 19 test?


Residents and staff do have the right to refuse testing. Residents who refuse testing should be treated as though they are positive and isolated and monitored for 14 days. However, they should not be “co-horted” with residents with confirmed positive cases. Staff who refuse testing should stop working and self-quarantine at home and self-monitor for 14 days unless they provide proof of a negative PCR test.




28. What if a resident is unable to consent to testing?


If a resident is unable to consent, their legally authorized representative should be contacted to provide consent. Facilities should obtain that consent prior to the testing team arriving.




29. What if a staff member cannot be present when testing takes place at the facility?


All staff members must have a test as part of this initiative. If a staff member misses the testing at the facility, they should have their test conducted at another location prior to returning to work. Staff can visit https://www.dshs.state.tx.us/coronavirus/testing.aspx for more information about how to obtain a test. If a staff member has had a negative PCR test completed since April 15 they do not need to be retested but must provide documentation of the test result.




30. Who should facilities report positive tests to?


Per QSO-20-29-NH facilities should report positive results to the CDC, residents and their representatives. Facilities must also comply with requirements to report to their local health department, DSHS, and HHSC.




31. If someone in the facility should test positive for COVID-19, how long should they isolate and avoid contact with others?


A person who tests positive for COVID-19 should isolate until all of the following criteria are met:

  1. At least 3 days (72 hours) have passed since the resolution of fever without the use of fever-reducing medications -AND-
  2. At least 10 days have passed since symptoms first appeared -AND-
  3. Overall symptoms have improved.
  4. Please see updated CDC Return to Work Criteria.




32. If residents or staff have confirmed antibody testing, should they be retested?


Yes. The reliability of antibody tests is unknown at this time, and those results will not be used to exclude anyone from this testing.




33. If nursing facilities have additional questions, who do we contact?


Regional Long-Term Care Regulatory Directors are serving as the point of contact for the groups scheduling and conducting testing. If you have questions about this process contact your LTCR region.




34. Who does a facility call if they are facing COVID-19-related infection control challenges?


Facilities with ongoing COVID-19-related infection control challenges should immediately call the LTCR Associate Commissioner, the LTCR Director of Survey Operations, the local health department or DSHS for assistance.




35. What should a facility do if the local health department or someone else tells the facility to send all staff who test positive home?


If staff are ill or if the local health department, DSHS or TDEM recommends that all or part of the NF staff immediately leave the NF and self-isolate at home, immediately notify the HHSC LTCR Associate Commissioner or the LTCR Director of Survey Operations.





FAQ #2 (May 21)

1. Will NFs have to provide testing kits? If not, how will fire departments and other testing teams get kits and PPE?


If NFs are conducting their own testing, they should work with their laboratory to obtain testing kits. If they cannot obtain kits, they can work with their local emergency manager and health department to submit a State of Texas Assistance Request (STAR) for test kits.

Fire departments supporting the statewide COVID-19 testing mission should coordinate with their TDEM assistant chief to be integrated into their regional nursing facility testing effort. COVID-19 testing supplies, including kits and PPE, will be provided to these fire departments by the Regional Coordination Teams.




2. What is the Regional Coordination Team?


Eight Regional Coordination Teams (RCTs) have been deployed across the state to support this testing initiative. The RCT consists of a Texas Intrastate Fire Mutual Aid System (TIFMAS) liaison, Texas A&M Engineering Extension Service (TEEX) Incident Support Team, Emergency Medical Task Force (EMTF) Medical Incident Support Team, HHSC Long Term Care Regulatory Regional Director or designee, and the DSHS Public Health Preparedness Manager or designee. The RCTs will assist with situational awareness; information management and sharing; distribution of supplies, including test kits and PPE; and routing of specimens to laboratories.




3. How will specimens be transported to the lab?


If a NF is obtaining testing through their laboratory, they also should arrange for specimen transport to the lab.

For facilities not using labs with which they have relationships, the testing team will return the specimens to the RCT that provided the kits and PPE. The team at the RCT site will arrange for the specimens to be delivered to the appropriate laboratory for processing.




4. How can a facility be held responsible for the testing of staff that do not work for the facility but do come on-site, such as EMS personnel, phlebotomists, and others?


If an individual routinely enters the facility to provide critical services, they should be tested, either when the facility is being tested or otherwise. EMS personnel would not need to be tested, for example, and nor would a phlebotomist who visits a facility only once. However, a phlebotomist who visits weekly would need to be tested when the rest of the facility is tested or would need to provide proof of individual testing and results.

Additionally, it is important to note that anyone who enters the facility and has not been tested should be in full PPE and screened for symptoms, including a fever. (EMS and other personnel conducting a testing self-screen are the exception to this).




5. Are NFs required to notify residents and family of the planned testing? Will NFs be responsible for obtaining consent forms from all residents and staff to test?


For residents, HHSC asks facilities to follow their normal documentation processes for informing residents and/or their legally authorized representative of the planned testing and for obtaining consent.

For staff members, facilities should follow the same process they would if they offered flu shots to staff, etc. For staff members under the age of 18, please see question #6.




6. Do staff members who are minors need to obtain parental/guardian consent for testing?


Minors can provide their own consent to certain types of medical treatment in seven general circumstances under the Texas Family Code. Specifically, Family Code § 32.003(3) provides that a minor can consent “to the diagnosis and treatment of an infectious, contagious, or communicable disease that is required by law or a rule to be reported by the licensed physician or dentist to a local health officer or the Texas Department of Health, including all diseases within the scope of Section 81.041, Health and Safety Code.”

Since COVID-19 diagnosis is a communicable disease, parental consent is not required. However, HHSC recommends obtaining consent of the parent/guardian where feasible.




7. Has TDEM contacted local hospital administrators where a local hospital district also administers the NF to ask the district to conduct the testing for that facility?


All nursing facilities, including those administered by a local hospital district, are encouraged to conduct testing within their facility if they have the resources to do so. For those facilities that are unable to so, a testing team will be deployed to assist.




8. Some communities offer multiple levels of care on the same campus, including facility types like independent living that are not regulated by HHSC. Will all residents of these multi-level facilities be required to be tested?


This current testing initiative is focused on nursing facilities. If some staff members move between varying levels of care within a multi- level facility, the facility is advised to test residents in the other levels, but it will not be carried out as part of this testing initiative.

If you do operate a multi-level facility and do not test all areas, it is recommended that staff not move between levels of care to avoid potentially spreading the virus.




9. When the testing is done, are residents automatically considered presumptive positive pending outcome of the test, which would mean increasing the level of PPE worn by staff until test results are received?


All staff in the NF should be wearing the appropriate level of PPE to safely interact with the residents under their care. The PPE required to care for symptomatic residents differs from that needed for those who are asymptomatic with no known exposure.

HHSC is offering weekly webinars on “Infection Control Basics – Personal Protective Equipment (PPE).” This webinar is being offered on May 22 and May 29. Register here to participate. For additional training dates or information on proper use of PPE, please contact the

Policy, Rules and Training section of Long-term Care Regulation at mailto:PolicyRulesTraining@hhsc.state.tx.us.




10. How is the testing being handled in facilities that have been working with local authorities, HHSC, and others on outbreaks?


If testing has occurred since April 15 as part of an outbreak investigation and response, facilities will not be required to re-test as part of this initiative.




11. Will Rapid Assessment-Quick Response Force (RA-QRF) deployments still occur? How do those differ from this testing initiative?


RA-QRF teams are deployed to facilities with positive cases and significant needs as identified by an HHSC surveyor. RA-QRF missions can include testing, infection control assessments, building and site assessments, and disinfecting services. If an RA-QRF team has tested a facility prior to this statewide initiative, residents and staff will not need to be tested again.




12. Do NFs have to complete the 14-page infection control checklist?


No. The infection control checklist in the RA-QRF plan was developed for health-care associated infection (HAI) epidemiologists conducting infection control surveys. If you were provided the checklist, you are not required to fill it out, but it can serve as a resource for NFs reviewing their infection control practices. The form also does not need to be submitted to HHSC or any other agency, nor does it need to be completed for a facility to receiving testing.




13. What should Local Health Departments (LHD) do if they are contacted by a fire department to conduct testing in NFs?


If the LHD has access to a lab within their jurisdiction and can support the testing efforts, that LHD could coordinate testing with the fire department.

If the LHD does not have access to a lab within its jurisdiction, it should refer the fire department to the TDEM Assistant Chief to be integrated into the regional nursing home testing effort.




14. How do testing teams report on completed missions?


Testing teams should report their completed missions to the RCT for their area.




15. How does a fire department get trained to conduct COVID-19 testing?


Testing teams should contact the RCT for information about training.




16. What does it mean that a testing team is required to “self- screen” prior to entering a facility?


All testing teams are screening their members for COVID-19 symptoms, including taking their temperature and their exposure history, prior to team members entering the facility to conduct testing. As such, the facility does not need to re-screen the teams upon entry.




17. When staff in a NF refuse to test and go home to self-quarantine for 14 days, can they return to work and the NF be considered as meeting the state mandate of 100 percent staff testing?


Yes. People have the right to refuse testing, and some have medical conditions that make it impossible (or nearly impossible) to collect a specimen. As such, the 14-day isolation rule protects others in cases where testing is not possible or is refused.




18. Previous guidance is that staff who refuse testing should stop working, self-quarantine at home, and self-monitor for 14 days unless they provide proof of a negative PCR test. Creating confusion is additional guidance that says "all staff members must have a test as part of this initiative," implying that a staff member "must" test before returning to work. Can you clarify?


Yes. People have the right to refuse testing, and some have medical conditions that make it impossible (or nearly impossible) to collect a specimen. As such, the 14-day isolation rule protects others in cases where testing is not possible or is refused.




19. A provider had a positive test in early May that resulted in the LHD conducting facility-wide testing. The facility was later notified that 11 to 15 of the tests were lost. It still has not received results from any of the tests but is asking what to do about residents and staff whose tests were lost. Does the facility need to retest these individuals even if it has passed the 14 days taken for precautionary purposes?


In this situation, additional tests would not be necessary if residents and staff has been tested within the past 30 days and it had been at least 14 days since the last known positive case of COVID-19.





THCA FAQ (May 29)

1. What is the process when an employee or resident does not consent to testing?


Per the NF Testing FAQs, Residents and staff do have the right to refuse testing. Residents who refuse testing should be treated as though they are positive and isolated and monitored for 14 days. However, they should not be “cohorted” with residents with confirmed positive cases. Staff who refuse testing should stop working and self-quarantine at home and self-monitor for 14 days unless they provide proof of a negative PCR test.




2. Are tests kits left at the nursing facility for employees that are not present on testing day? If not, do these employees go to a free testing site?


All staff members must have a test as part of this initiative. If a staff member misses the testing at the facility, they should have their test conducted at another location prior to returning to work. Staff can visit the DSHS webpage for more information about how to obtain a test. If a staff member has had a negative PCR test completed since April 15 they do not need to be retested but must provide documentation of the test result.




3. Are new hires allowed to go through orientation and start working if they have proof of testing and are awaiting results?


Yes - If a new hire is available to be tested with the rest of the staff and residents of a facility, it is fine to include them. Otherwise, as this is a one-time testing initiative, it is not required that new hires be tested as a condition of employment.




4. Is there a grace period to extend the deadline if there are delays in coordinating testing with the local Fire Departments, National Guard, etc?


While the initial goal of the testing initiative was to complete testing within two weeks, there is no deadline.




5. It there a tracking system for employees that refuse to test & apply for a job at another SNF?


HHSC LTCR does not have a tracking system for this.




6. If a new employee is hired after testing is completed, does the new employee have to be tested before they are allowed to work?


If a new hire is available to be tested with the rest of the staff and residents of a facility, it is fine to include them. Otherwise, as this is a one-time testing initiative, it is not required that new hires be tested as a condition of employment.




7. Is there specific guidance regarding testing of providers and physicians that regularly provide services in a nursing facility?


If an individual routinely enters the facility to provide critical services, they should be tested, either when the facility is being tested or otherwise. EMS personnel would not need to be tested, for example, and nor would a phlebotomist who visits a facility only once. However, a phlebotomist who visits weekly would need to be tested when the rest of the facility is tested or would need to provide proof of individual testing and results. Additionally, it is important to note that anyone who enters the facility and has not been tested should be in full PPE and screened for symptoms, including a fever. (EMS and other personnel conducting a testing self-screen are the exception to this).




8. If a resident or staff refuses to be tested, does the 14-day quarantine begin on the date the facility is notified of the refusal or on the testing date?


The 14-day period of isolation and monitoring would begin on the date of the refusal to test.




9. Since nursing facilities will have a baseline of COVID residents, will hospitals be mandated to test patients before they are sent to the nursing facility?


At this time, hospitals are not required to test all patients being discharged from a hospital and admitted into a NF. As a reminder, all new admissions and readmissions into a NF should be isolated and monitored for 14 days.




10. Can COVID positive staff members care for COVID positive residents?


COVID-19 positive staff should not work at all until they meet the DSHS criteria to return to work. If a NF is faced with a staffing shortage, they should immediately notify the HHSC Associate Commissioner of Long-term Care Regulation or the LTCR Director of Survey Operations.




11. If a nursing facility does their own tests, are they required to use a specific lab?


No.




12. Is there specific verbiage regarding continued isolation of dialysis residents?


DSHS guidance is that these residents should not be put in quarantine. Relevant infection prevention recommendations are found in the CDC’s Nursing Home Infection Prevention Assessment Tool for COVID-19. It provides a clear description of this situation and provides some recommendations on prevention measures to take.

Residents, who must regularly leave the facility for medically necessary purposes, should wear a facemask (surgical facemask) whenever they leave their room, including for procedures outside of the facility. In addition, they should continue to practice social distancing.

In other words, if a resident (hemodialysis patient) has a chronic condition which requires regular reoccurring visits to a treatment center, then the resident should be wearing a facemask every time they leave their room. Additionally, the CDC guidance is for staff to wear all recommended PPE (gown, gloves, eye protection, N95 respirator (or facemask if not available)) for the care of these residents, regardless of presence of symptoms (if PPE supply allows).

Refer to strategies for optimizing PPE when shortages exist.




13. Can a CNA cut residents’ hair if they have a license?


If the CNA is already an employee of the facility and is reporting to the facility regularly as a CNA, yes, they can also cut a resident’s hair if they are licensed to do so. A hairdresser/barber/beautician/etc. who comes to the facility only to cut hair, is not an essential visitor providing critical assistance and is restricted from entering the facility.




14. When can family do their loved one’s laundry?


At this time, it is still not recommended. NFs are required to have policies and procedures in place for staff to handle, store, process, and transport all linens and laundry in accordance with national standards to produce hygienically clean laundry and prevent the spread of infection to the extent possible. There is not currently a timeline for when this recommendation will change, but we are actively working on updating recommendations for NFs.