Kentucky Cabinet Updates COVID-19 Provider Reporting Guidance

On December 11, 2020, the Kentucky Cabinet for Health and Family Services updated guidance requiring all Kentucky healthcare providers to report all positive COVID-19 laboratory tests to the Kentucky Department for Public Health. The updated guidance addresses the requirement for reporting of positive results from at-home testing kits. In these cases, the laboratory performing the test on the specimen collected at home is required to submit the laboratory results. For at-home testing kits that do not require the specimen to be sent to a lab, the provider prescribing the test must complete the laboratory result reporting. Positive tests must be reported on the KDPH COVID-19 Case Report Form within 24 hours of any positive result. 

Antigen Testing

On September 28, 2020, the Kentucky Department of Public Health released guidance to providers regarding interpretation of results from point-of-care antigen tests:

  • A positive result in an individual with symptoms consistent with COVID-19 or with history of specific exposure to COVID-19 provides presumptive laboratory evidence and the individual would be classified as a probable COVID-19 case.
  • A positive result in an individual with no symptoms and no history of specific exposure to COVID-19 is recommended to be immediately followed by a PCR test to verify the positive result.
  • A negative result in an individual with no symptoms and no history of exposure to COVID-19 would be taken at face value and would not require additional follow-up.

A negative result in an individual with symptoms consistent with COVID-19 would be only presumptively negative. This individual would continue as a person under investigation pending verification of that negative antigen test with a negative PCR test.  A negative result in an individual with history of specific exposure to COVID-19 would not eliminate the need for quarantine.

CMS Will Require Positive COVID-19 Test for Inpatient Medicare Reimbursement Add-On

On August 17, 2020, the Centers for Medicare & Medicaid Services (CMS) published new guidance stating that effective September 1, 2020, hospitals will be required to document a positive COVID-19 laboratory test to receive a 20% increase in the MS-DRG weighting factor for their inpatients being treated for COVID-19. Positive tests must be demonstrated using only the results of viral testing consistent with CDC guidelines either performed during the hospital admission or not more than 14 days prior to the hospital admission (certain limited exceptions apply).

HHS Announces Additional CARES Act Funds for Nursing Homes

On August 7, 2020, the Department of Health and Human Services (HHS) announced that nursing homes and long-term care facilities will receive an additional $5 billion in payments from the Provider Relief Fund. $2.5 billion will support increased testing, staffing, Personal Protective Equipment (PPE) needs, and establishment of COVID-19 isolation facilities. The remaining $2.5 billion will be linked to nursing home performance, which will consider the prevalence of COVID-19 in the nursing home’s local geography and the facility’s ability within this framework to control COVID-19 spread and related fatalities among its residents.

FAQs on COVID-19 Testing for Long-Term Care Facilities

On August 5, 2020, the Kentucky Cabinet for Health & Family Services (CHFS) answered Frequently Asked Questions relating to surveillance COVID-19 Testing for long-term care facilities.  These FAQs address common questions about testing of staff and residents, such as who should be tested, how often, should staff be tested if not working, etc.  This follows up the previously issued Provider Guidance: Surveillance COVID-19 Testing for Long-Term Care Facilities which recommends testing each staff member (including agency staff, contracted health professionals and others who regularly enter the facility) at least bi-weekly.

COVID-19 Test Guidance for Healthcare Providers

On August 5, 2020, the Kentucky Cabinet for Health & Family Services (CHFS) issued guidance for healthcare providers, reminding them that they are required by law to report all positive laboratory COVID-19 results, including rapid tests, of Kentucky residents to the local or state health department within 24 hours.

For any positive results, providers must submit a CDC Person Under Investigation (PUI) Form (also called a “COVID-19 Case Report Form”) and Kentucky’s Reportable Disease Form, an EPID 200, to the state or local health department. An updated version of the PUI Form can be found on CDC’s website, and an updated version of the EPID 200 can be found on the Commonwealth’s website.

COVID-19 Test Guidance for Clinical Commercial Laboratories

On August 5, 2020, the Kentucky Cabinet for Health & Family Services (CHFS) issued updated test reporting guidance to clinical laboratories that conduct testing for COVID-19, including rapid testing.  Effective immediately, CHFS now requires that all laboratories and facilities report all test results (all positive and non-positive) electronically through the Kentucky Health Information Exchange (KHIE). Labs not yet submitting results via KHIE must begin transitioning to KHIE reporting.  This guidance provides additional advice to labs on reporting to KHIE, health departments, and providers.

Revised Medicare Billing Guidance Allows for Reimbursement for COVID-19 Counseling During Testing

On July 30, 2020, the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) revised its billing guidance to allow for payment to healthcare professionals who counsel patients, at the time of COVID-19 diagnostic testing, about the importance of self-isolating following testing and prior to the onset of symptoms. Providers should discuss with patients the signs and symptoms of COVID-19, the immediate need for isolation (including before test results are available), and the importance of informing their close contacts to separate from the tested individual. The patient should also be informed that if he or she tests positive, the patient will be contacted by the public health department for contact tracing, and that services may be available to aid the patient’s self-isolation. A counseling check list tool and links to additional information are available here.

Reminder That Physician Orders Aren’t Required for COVID-19 Diagnostic Testing in Kentucky

On July 29, 2020, Governor Beshear reiterated that an order from a licensed clinician is not necessary for laboratory service providers to perform and bill for FDA-approved COVID-19 diagnostic tests. Additionally, pursuant to the Cabinet for Health and Family Services Department for Public Health Order, health insurers may not require a licensed clinician’s order from beneficiaries or laboratories as a precondition of covering a COVID-19 diagnostic test. Governor Beshear’s announcement was in response to reports that some individuals seeking tests are still being asked to provide a doctor’s order.

Nursing Homes Receive Additional Funding and Staff Testing Mandates

The Centers for Medicare & Medicaid Services (CMS) has announced an additional $5 billion of funding from the Provider Relief Fund will go to Medicare-certified long term care facilities to support the enhancement of nursing homes’ response to COVID-19. These funds are meant to assist facilities with enhancing infection control, building up staffing, increasing testing, and providing additional services such as implementing technology to assist residents and families. Nursing homes must participate in the Nursing Home COVID-19 Training on infection control and best practices as a condition to receive the funding. CMS will also begin requiring all nursing homes in states with a 5% positive rate or higher to perform COVID-19 diagnostic testing on all nursing home staff every week. Additional testing devices will be distributed to facilities to support this requirement, beginning with 600 devices shipping this week.