Maryland plans to stop paying for coronavirus testing for nursing home staff after Aug. 15

The Maryland health department plans to stop paying for the weekly coronavirus tests it requires from all nursing home staff members after Aug. 15, and has ordered the state’s nursing home facilities instead to use emergency federal CARES Act funds they have received to continue testing staff.

But the facilities are already paying significantly more than usual for personal protective equipment, “hero pay” and other staffing costs, and they are concerned they cannot afford to pay for mandatory staff testing, the state’s three leading industry groups told Gov. Larry Hogan in a letter last week.

Nursing homes account for 60% of Maryland’s coronavirus deaths, with more than 2,000 residents and staff dying from COVID-19, according to the state. Officials began requiring testing of all nursing homes staff in June, following outbreaks at many facilities. The state will continue to pay for universal testing of nursing home residents.

But depending on the size of the nursing home, testing all staff costs about $15,000 to $75,000 per week, “an unsustainable cost [that] will put at risk the quality care provided to Marylanders most in need,” wrote the Health Facilities Association of Maryland, the LifeSpan Network and LeadingAge Maryland.

“Maryland continues to experience surges of cases in some communities, and as such, outbreaks in skilled nursing and rehabilitation centers are subject to rise again after several weeks of declining cases,” they wrote in a July 22 letter to the Republican governor.

“Now is not the time for the State to stop coordinating and underwriting testing in centers.”

The nursing home industry groups also asked the state to continue processing the test kits at its state labs, which produce results quicker than some commercial labs.

“It is not possible to prevent the spread of COVID-19 in our sector if skilled nursing and rehabilitation centers and assisted living campuses have to wait over a week for test results,” they wrote.

Spokespeople for the Maryland Department of Health did not immediately respond to questions Wednesday.

The state will work with facilities that cannot afford the testing, Mike Ricci, a spokesman for Hogan, told The Washington Post. “We expect the vast majority of facilities to have plans in place, but there’s a range of options depending on the situation,” he said.

Maryland has agreed to continue paying for the tests through Aug. 15 -- an extension of a previous Aug. 1 deadline -- “in light of the continuing dangers of COVID-19 to our state,” Maryland Health Secretary Robert Neall told the three industry groups in a letter dated Friday.

“However, your member facilities must step up and do their part,” he wrote.

All nursing home facilities must ensure they are in full compliance with staff testing requirements, the health secretary said. Some have not supplied complete staff rosters and collected and returned specimens from their staff to the designated state lab in a complete and timely manner, he wrote.

Nursing homes must establish COVID-19 testing arrangements with laboratories by Aug. 14, Neall wrote, “and provide your plans for continued weekly testing of staff to MDH for review and approval.”

Nursing home revenues from Medicaid and Medicare have “dramatically decreased” because of government-imposed limitations on admissions and elective surgeries, said Joe DeMattos, president of the Health Facilities Association of Maryland, which represents 150 nursing homes in the state.

“Maryland is one of the states that has not increased Medicaid rates,” DeMattos said in a statement. “Although we are glad for the stopgap federal Cares Act funding that most nursing homes in Maryland received, that is simply not enough to pay for weekly universal testing and other extraordinary costs.”

Allison Ciborowski, president and CEO at LeadingAge, said most nursing homes are in compliance with state regulations, but discrepancies are bound to occur while testing 30,000 to 40,000 residents and staff each week. Her group represents 30 nursing homes and another 110 affordable senior housing complexes across the state.

“This is an incredibly complex process that is not perfect,” Ciborowski said. “There have been many hiccups along the way.”

More than 200 of the state’s nursing homes received a collective $75 million in CARES Act relief funds out of the $175 billion earmarked for hospitals and other health care providers to help them combat the coronavirus and cover surging labor and equipment costs.

They will also receive some of the $5 billion in funding announced by the U.S. Department of Health and Human Services last week, Neall wrote to the industry groups Friday.

“We fully expect that your member facilities will make use of those funds to protect your residents from COVID-19 by continuing weekly mandated testing of all staff, and residents, where appropriate and required,” Neall wrote.

The amount awarded to individual nursing homes nationally ranged from $65,000 to $3.2 million, with the average facility receiving about $315,000, Ciborowski said.

If nursing homes do not receive additional funding for tests, they could be forced to pass on the costs of testing to residents or their families, although the financial challenges faced by each facility will be different based on their size and other factors.

“It will affect the bottom line of these organizations, what they’re able to provide in the future and what that costs,” Ciborowski said. “There’s just a lot of different trickle-down effects of all of this.”

Nursing home caregivers already are doing one of the riskiest jobs in the country by providing for COVID-19 patients and other residents, she said, and they deserve to have their coronavirus tests paid for and coordinated by the state.

”We need to be celebrating and applauding the work the nursing homes are doing and not demonizing or faulting them for being on the front lines of this situation,” Ciborowski said. “We are hopeful the administration will continue to engage with us and help find solutions.”

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