Mandatory Testing for Intermediate Care Facility for the Developmentally Disabled Staff

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NO.:RULE TITLE:

59AER20-7Mandatory Testing for Intermediate Care Facility for the Developmentally Disabled Staff

SPECIFIC REASONS FOR FINDING AN IMMEDIATE DANGER TO THE PUBLIC HEALTH, SAFETY OR WELFARE: The Novel Coronavirus Disease 2019 (COVID-19) is a severe respiratory illness that can spread among humans through respiratory transmission. According to the Centers for Disease Control and Prevention (CDC), people at risk for serious illness from COVID-19 include older adults and people with serious chronic medical conditions. The CDC has also recognized special circumstances and risk for congregate settings, such as intermediate care facilities for the developmentally disabled (“intermediate care facilities”). In late 2019, a new and significant outbreak of COVID-19 emerged in China and the World Health Organization declared COVID-19 a Public Health Emergency of International Concern. The CDC also confirmed community spread of COVID-19 in the United States and has issued extensive written guidance to help control the spread of COVID-19. According to the CDC, at the time of this filing, the United States has over 4,600,000 total cases and over 154,000 total deaths.

On March 1, 2020, Governor Ron DeSantis declared a Public Health Emergency exists in the State of Florida as a result of COVID-19 pursuant to Executive Order number 20-51. On March 7, 2020, the State Surgeon General and State Health Officer declared a Public Health Emergency in the State of Florida as a result of COVID-19. On March 9, 2020, Florida Governor Ron DeSantis declared a state of emergency in Florida. As of the date of this filing, all counties in Florida have positive cases for COVID-19. There have been over 487,000 confirmed cases in Florida as a result of COVID-19 and over 7,000 deaths.

In guidance issued by the CDC titled Key Strategies to Prepare for COVID-19 in Long-Term Care Facilities (LTCFs), including intermediate care facilities, the CDC directed that “[g]iven the high risk of spread once COVID-19 enters a LTCF, facilities must act immediately to protect residents, families, and staff from serious illness, complications, and death.” In order to carry out this guidance, the CDC further instructs facilities to, among other things, 1.) Keep COVID-19 from entering the facility and 2.) Identify the infection early. While much of the CDC guidance focuses on nursing homes and assisted living facilities, the CDC has pointed out in guidance that these precautions, including testing, should be applied to all long-term care facilities, including intermediate care facilities.

Medical research shows the highly contagious COVID-19 virus can manifest as asymptomatic in positive individuals and the live, contagious coronavirus can shed at high concentrations before symptomatic development resulting in spread of the infection. Due to the congregate nature of intermediate care facilities, the increased risk of transmission of COVID-19 is high. The highly transmissible nature of COVID-19 combined with the congregate nature of the intermediate care facility settings and the close and personal contact that facility staff have with the patients puts both residents and staff at a high risk of infection. Combining the high risk of long-term care facility settings with the risk posed by positive, asymptomatic staff creates a potential for sudden outbreaks in these facilities.

The Department of Health and its agents, including the Agency for Health Care Administration, are working daily to respond to positive cases to avoid outbreaks at long-term care facilities, including intermediate care facilities. These agencies have been responding to significant viral outbreaks at intermediate care facilities across the state affecting both staff and residents. A single positive staff member in a facility can cause an outbreak resulting in the hospitalization and death of many vulnerable residents. If the staff member works at multiple facilities, this can result in facility-to-facility spread. Early identification of positive cases in long-term care facilities, including intermediate care facilities, allows the state to implement immediate action to control outbreaks and avoid the loss of life.

Therefore, this emergency rule establishes a requirement that intermediate care facilities must not admit any staff who have not been tested for COVID-19 beginning on August 24, 2020. Thereafter, intermediate care facilities must also require all facility staff be tested for COVID-19 every two (2) weeks with testing resources provided by the state. Prompt implementation of this rule is necessary to ensure the health, safety and welfare of residents and staff in Florida’s intermediate care facilities.

REASON FOR CONCLUDING THAT THE PROCEDURE IS FAIR UNDER THE CIRCUMSTANCES: The procedure used to adopt this emergency rule is fair as the State of Florida is under a declaration of emergency due to the outbreak of COVID-19. This emergency rule is necessary and fair to ensure the health, safety, and welfare of the facility residents, and provides at least the procedural protection given by other statutes, the State Constitution, or the United States Constitution; and takes only that action necessary to protect the public interest under the emergency procedure.

SUMMARY: This Emergency Rule establishes a requirement that intermediate care facilities must not admit any staff who have not been tested for COVID-19, must require all facility staff be tested for COVID-19 every two (2) weeks, and requires staff to report the results of those tests to the facility.

THE PERSON TO BE CONTACTED REGARDING THE EMERGENCY RULE IS: Kimberly Stewart, Agency for Health Care Administration, Division of Health Quality Assurance, Bureau of Health Facility Regulation, 2727 Mahan Drive, MS# 28A, Tallahassee, FL 32308; Phone: [phone]; Email: [e-mail].

 

THE FULL TEXT OF THE EMERGENCY RULE IS:

 

59AER20-7 Mandatory Testing for Intermediate Care Facility for the Developmentally Disabled Staff.

(1) APPLICABILITY.  The requirements of this emergency rule apply to all intermediate care facilities for the developmentally disabled licensed under Chapter 400, F.S., Part VIII.

(2) DEFINITIONS.

“Staff” means all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances (e.g., blood, tissue, and specific body fluids); contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air. Staff may include, but are not limited to, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff not employed by the health care facility, and persons (e.g., clerical, dietary, environmental services, laundry, security, maintenance, engineering and facilities management, administrative, billing, and volunteer personnel) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted among from staff and patients. This definition is consistent with the Centers for Disease Control and Prevention definition of Healthcare personnel as defined in Appendix 2. Terminology.

(3) MANDATORY STAFF TESTING FOR COVID-19.

(a) Beginning August 24, 2020, intermediate care facilities for the developmentally disabled shall not admit into the facility any staff who has not been tested for COVID-19.

(b) Intermediate care facilities for the developmentally disabled shall require all staff be tested every two (2) weeks thereafter with testing resources provided by the state.

(4) EXEMPTION FROM TESTING.

Staff who have already been infected and recovered from COVID-19 do not need to be tested if they can provide medical documentation to the facility.

(5) DOCUMENTATION.

(a) If testing is conducted off-site, then staff must provide proof of testing to the facility. 

(b) Intermediate care facilities for the developmentally disabled shall document all staff testing, including the name of the individual, time, and date of the test.

(c) Intermediate care facilities for the developmentally disabled shall require all tested staff to notify the facility of the test results the same day the results are received. Written documentation of test results must be provided to the facility upon receipt by the staff.

(d) Intermediate care facilities for the developmentally disabled shall keep copies of all staff testing documentation on site.

(6) REVOCATION OF LICENSE, FINES OR SANCTIONS. For a violation of any part of this rule, the Agency may seek any remedy authorized by Chapter 400, Part VIII, or Chapter 408, Part II, F.S., including but not limited to, license revocation, license suspension, and the imposition of administrative fines.

Rulemaking authority, 400.967, 400.969, 408.819, 408.821 FS, Law Implemented 400.967, 400.969, 408.819, 408.821, FS. New 8/3/202.

 

THIS RULE TAKES EFFECT UPON BEING FILED WITH THE DEPARTMENT OF STATE UNLESS A LATER TIME AND DATE IS SPECIFIED IN THE RULE.