Revisions to QSO 20-38-NH REVISED 09/10/2021

On September 10, 2021 CMS revised QSO-20-38 regarding COVID-19 staff testing which will now be based on the facility's county level of community transmission instead of county test positivity rate (which has been the previously used metric to determine frequency of testing). In addition, the frequency of testing has also been updated. Guidance related to the requirements is summarized below. Noncompliance related to this new requirement will be cited at new tag F886.
MHCA has reached out to leaders of the Maine CDC and DHHS to identify how these changes affect surveillance testing across all Maine provider levels. We urge our members to read this revised memo carefully in order to identify how your current practices will need to be adjusted to comply with these revisions. The revisions identified here apply to all federally licensed nursing homes and ICF-IID providers.  
Key Revisions include:
  • Definition of “Level of community transmission”: refers to facility's county level of COVID-19 transmission. This metric uses two indicators for categorization (1. Total number of new cases per 100,000 persons within the last 7 days and 2. Percentage of positive diagnostic and screening nucleic acid amplification tests (NAAT) during the last 7 days), which can be found on the Centers for Disease Control and Prevention (CDC) COVID-19 Integrated County View site at
  • Testing of Staff and Residents with COVID-19 Symptoms or Signs: Staff with symptoms or signs of COVID-19, vaccinated or not vaccinated, must be tested immediately and are expected to be restricted from the facility pending the results of COVID-19 testing. If COVID-19 is confirmed, staff should follow Centers for Disease Control and Prevention (CDC) guidance “Interim Guidance for Managing Healthcare Personnel with SARSCoV-2 Infection or Exposure to SARS-CoV-2.” Staff who do not test positive for COVID-19 but have symptoms should follow facility policies to determine when they can return to work.
  • Routine testing of unvaccinated staff: should be based on the extent of the virus in the community. Fully vaccinated staff do not have to be routinely tested. Facilities should use their community transmission level as the trigger for staff testing frequency. Reports of COVID-19 level of community transmission are available on the CDC COVID-19 Integrated County View site: Please see the COVID-19 Testing section on the CMS COVID-19 Nursing Home Data webpage: for information on how to obtain current and historic levels of community transmission on the CDC website.
The facility should test all unvaccinated staff at the frequency prescribed in the Routine Testing table based on the level of community transmission reported in the past week. Facilities should monitor their level of community transmission every other week (e.g., first and third Monday of every month) and adjust the frequency of performing staff testing according to the table above.
  • If the level of community transmission increases to a higher level of activity, the facility should begin testing staff at the frequency shown in the table above as soon as the criteria for the higher activity level are met.
  • If the level of community transmission decreases to a lower level of activity, the facility should continue testing staff at the higher frequency level until the level of community transmission has remained at the lower activity level for at least two weeks before reducing testing frequency.
 Staff Contact: