High-volume labs that test for COVID-19 at nursing homes are going to reap double the amount of pay under a new policy announced Wednesday by the Centers for Medicare & Medicaid Services. 

Medicare will pay $100 for COVID-19 clinical diagnostic lab tests using high throughput technology as of Tuesday (April 14) until the current national emergency is over. 

The policy rewards systems that use highly sophisticated equipment operated by specially trained technicians to process 200 or more specimens per day, officials said. 

Local Medicare Administrative Contractors will remain responsible for developing the payment amount in their respective jurisdictions for other COVID-19 laboratory tests. MACs currently pay approximately $51 for those. As with other laboratory tests, there is generally no beneficiary cost-sharing under original Medicare.

“This is an absolute game-changer for nursing homes, where risk of Coronavirus infection is high among our most vulnerable,” Centers for Medicare & Medicaid Services Administrator Seema Verma said Wednesday in a statement. “CMS has made a critical move to ensure adequate reimbursement for advanced technology that can process a large volume of COVID-19 tests rapidly and accurately.”

She added at a press briefing that the enhanced payment should bring previously idle players into the picture.

“What we’ve seen is that there are a lot of labs that are not performing these tests,” she explained. “We recognize that there may have been some issues with reimbursement. There’s a lot that’s involved in running these high throughput tests, and that’s why we’re increasing the reimbursement. So that should increase testing capacity across the country. There’s a lot of unused capacity.”
CMS has asked local and state officials to use the high-volume labs to expand testing at the community level. This fits hand-in-glove with other flexibilities federal officials have recently allowed nursing homes, Verma said.

“For nursing homes, now they they not only have the increased reimbursement for performing the tests, but they’re also able to get reimbursement to go into the nursing homes and collect the samples, so we think both of those changes together will enhance testing in the nursing homes, and that’s really important,” she noted.

Better identification of COVID-19-positive patients will lead to better isolation practices, which will lead to decreasing the virus’ spread, she said.

“The testing piece really goes hand-in-hand with our recommendations around isolation and our recommendations and flexibility that we’ve been giving to nursing homes, even outside their facility,” Verma said.

More needed for workers?

The American Health Care Association/National Center for Assisted Living on Wednesday called CMS’s increased lab testing reimbursements “encouraging for our residents who are especially vulnerable.”

“We also need priority testing for our staff members, who want to get out of isolation and back to work, so they can serve their residents,” they told McKnight’s in a statement. “We’re already facing a workforce shortage crisis due to this pandemic, so priority testing for our healthcare workers is crucial.”

Current Centers for Disease Control and Prevention guidance says that nursing home residents are Priority 2 for testing, and nursing home staff without symptoms are Priority 3. 

“With limited tests available, most labs, states and hospitals are only focusing on Priority 1. While healthcare workers with symptoms are Priority 1, many are only applying that to hospital workers and not to nursing home or assisted living staff,” the AHCA/NCAL statement said. “We also are hearing that when we do get tests that it is taking three to seven days on average (sometimes as long as 10 days) to get the results back.”

Last week during a CNN interview, AHCA President and CEO Mark Parkinson said nursing homes felt like they had been “forgotten” in the nation’s response on COVID-19. In addition to a desperate need for more personal protective equipment, he said more and better testing capabilities were needed.

More information on Wednesday’s payment announcement can be found here.