More governors are requiring COVID-19 testing for nursing facility residents and staff. But questions remain about availability, cost and protocol, according to industry advocates.

The states’ actions follow last week’s White House recommendation that all nursing facility staff and residents be tested by the end of May. The recommendation is intended to help identify and isolate individuals who have the virus but are asymptomatic, thereby preventing further transmission. But even more needs to be done to protect residents and staff, according to the American Health Care Association / National Center for Assisted Living.

One challenge is the uneven availability of the tests themselves, which varies state by state. Moreover, one-time testing isn’t enough, said David Gifford, M.D., the organization’s senior vice president of quality and regulatory affairs. To effectively prevent transmission, testing would need to be ongoing, he told Scripps National News. A tested individual’s condition may change with subsequent exposure. In addition, test results are not 100% accurate, and do not always identify an infection due to the virus’s incubation period. 

Doubts also persist about what should be done when results are determined, and who should cover testing costs. Not all labs bill Medicare, so some facilities have had to pay upfront, Gifford told Kaiser Health News. Tests can cost $115 to $500, and Medicare Part B will only reimburse approximately $100 for polymerase chain reaction tests (which the organization recommends) and $35 for other tests, AHCA/NCAL reports.

Some providers are finding the testing expectations unrealistic. New York long-term care providers, for one, are calling on “full assistance” from state government to increase testing availability and alleviate cost concerns.

AHCA/NCAL has created testing guidance that covers which tests to use, and what to do once results are determined. The Centers for Disease Control and Prevention has also released testing recommendations for nursing homes. However, “the availability of the tests may make it difficult to meet these guidelines,” the organization said.

Test mandates have been announced in Maryland, Michigan, New Hampshire, North Dakota, New York, Rhode Island, South Carolina, Tennessee, Virginia and West Virginia, according to AHCA/NCAL.