This has updated diagnostic and response testing guidance for COVID-19, superseding PIN 21-32.1-ASC and superseding in part PINs 20-38-ASC and 20-23-ASC. This relates to employees who fully recovered form COVID-19 and continue to test positive 90 days after infection and to testing of new or returning employees. It has guidance on routine diagnostic screening testing for employees and on diagnostic and response testing for residents and employees

Diagnostic Screening Testing of Asymptomatic Staff in Facilities Without COVID-19

Required of all staff (paid and unpaid) who are

1) unvaccinated with an exemption to the vaccination requirement in PIN 22-05.1-ASC or

2) vaccinated with an exemption to the booster requirement; or are

3) booster-eligible and within the 15 day grace period for a booster or deferral deadline are required to undergo screening testing at least once weekly with either PCR testing or antigen testing. These staff are not exempt from the testing requirement even if they have a medical contraindication to vaccination, and must observe all infection control requirements, including vaccination.

Staff who have recovered from a diagnosis of COVID-19 in the last 90 days, and remained asymptomatic, do not need to submit to testing until after 90 days has expired but must self-monitor for symptoms and continue to follow all infection control requirements, including masking.

Diagnostic screening testing is not currently required for asymptomatic facility staff who are either fully vaccinated and have received a booster dose or not yet booster-eligible.

Maintain records of the staff’s testing results and maintain signed vaccine declination forms of unvaccinated staff with a written health care provider’s statement where applicable.

Diagnostic Testing of Symptomatic Staff and Residents

Perform a diagnostic COVID-19 test for the following individuals:

Staff and residents with signs and symptoms consistent with COVID-19 regardless of their vaccination status. Testing should occur immediately at onset of symptoms.

If an antigen test is used for a symptomatic individual and the test result is negative, a PCR test should be performed and the person should be isolated pending results of the PCR test. The individual should be tested for other viral respiratory pathogens as well, such as influenza in consultation with the resident’s healthcare provider.

Facilities should not delay testing of symptomatic individuals by waiting until their scheduled diagnostic screening test or response-driven test. If the diagnostic COVID-19 test confirms a positive test result among a resident or staff member, then facilities should begin response testing.

Diagnostic Testing of Exposed Asymptomatic Staff and Residents

Individuals who had a close contact with a COVID-19 positive person while infectious:

• Staff who are boosted, or fully vaccinated but not yet booster-eligible. Test not earlier than 2 days after the exposure and, if negative, again 5–7 days after the exposure.

• Staff who are unvaccinated with an exemption to the vaccination or booster requirement should be quarantined. Test not earlier than 2 days after the exposure and, if negative, test again 48 hours prior to return to work following a 7-day quarantine.

• Staff who are booster-eligible and have not yet received a booster dose within the 15 day grace period for the booster or deferral deadline should be quarantined. Test not earlier than 2 days after the exposure and, if negative, test again 48 hours prior to return to work following a 7-day quarantine.

• Residents who completed the primary vaccination series and booster dose if booster eligible are not required to be quarantined. Test not earlier than 2 days after the exposure and, if negative, again 5–7 days after the exposure.

• Residents who are unvaccinated or are booster eligible and have not yet received a booster dose should be quarantined. Test not earlier than 2 days after the exposure) and within 48 hours before the time of planned discontinuation of quarantine.

Staff should quarantine at home and be excluded from work. Residents should be quarantined.

Testing of New or Returning Facility Staff

New staff and staff returning from a leave of absence who are unvaccinated with an exemption to the vaccination requirement, vaccinated with an exemption to the booster requirement, or booster-eligible and have not yet received a booster dose within the 15 day grace period for a booster or deferral deadline should be tested prior to working and must be tested at least once weekly after their start date.

New staff and staff returning from a leave of absence who are fully vaccinated and received a booster dose; are fully vaccinated and not yet eligible for a booster dose; or are fully vaccinated and have a deferral for the booster dose do not need to be tested prior to working in the facility, unless they show signs and symptoms consistent with COVID-19 or they had had a close contact with a COVID-19 positive person.

Response Testing in Facilities With COVID-19

There may be circumstances where, as part of response testing, a facility may only need to test residents and staff who had close contacts. Contact tracing can be done with assistance from the local health department (LHD) in order to reduce the need to test all residents and staff after a positive individual is identified.

In facilities where 90% or more of residents and 90% or more of staff are fully vaccinated, and the LHD determines that contact tracing is possible, contact tracing should be performed to identify any staff who have had a higher-risk exposure or residents who may have had close contact with the individual with COVID-19 infection:

• All staff who have had a higher-risk exposure and residents who have had close contacts, regardless of vaccination status, should be tested not earlier than 2 days after the exposure and, if negative, again 5–7 days after the exposure.

• Unvaccinated residents, or residents who have completed their primary series and are booster eligible but not yet boosted, who had close contact with someone with COVID-19 infection should be placed in quarantine for 10 days after their exposure, even if viral testing is negative. Duration of quarantine can be reduced to 7 days if testing is performed 5-7 days after their exposure and the resident tests negative.

• Residents who completed their primary series and received a booster dose if booster eligible should wear a well-fitting face mask but do not need to be quarantined, restricted to their room, or cared for by staff using the full PPE recommended for the care of a resident with COVID-19, following an exposure.

Testing should be performed at least every 3-7 days with PCR testing or a minimum of twice weekly with antigen testing for staff and residents identified as close contacts. Retesting should continue until no new cases are identified in sequential rounds of testing covering a 14-day period.

If testing of close contacts reveals additional staff or residents with COVID-19 infection, contact tracing should be continued to identify residents with close contact or staff with higher-risk exposures to the newly identified individual(s) with COVID-19 infection. A facility-wide or group-level approach should be performed if all potential contacts cannot be identified or managed with contact tracing or if contact tracing fails to halt transmission.

In facilities where less than 90% of residents and less than 90% of staff are fully vaccinated, or the LHD determines that contact tracing is not possible, facilities must:

• Perform retesting at least every 3-7 days with PCR testing or a minimum of twice weekly with antigen testing of all residents (excluding independent Continuing Care Retirement Community residents, unless they have been in communal settings with other residents) and staff, regardless of vaccination status. If PCR testing is chosen, the licensee should contract with a laboratory that has a turnaround of 24-48 hours for test results. Retesting should continue to be performed until no new cases are identified in sequential rounds of testing covering a 14-day period. The facility may then resume their regular diagnostic screening testing schedule.

Health Insurance Coverage Reminders

As provided by federal law, health plans and issuers must cover the cost of COVID-19 diagnostic tests without imposing any cost-sharing requirements, prior authorization, or other medical management when the purpose of the testing is for individualized diagnosis or treatment of COVID-19. Further, health plans and issuers cannot require the presence of symptoms or a recent known or suspected exposure, or otherwise impose medical screening criteria on coverage of tests. If you are having trouble accessing a COVID-19 test through your health plan or if you have any questions, please contact the CDMHC Help Center at 1-888-466-2219 or visit www.HealthHelp.ca.gov.

Supplemental Guidance

CDSS also issued a six summary tables with different testing scenarios to manage staff and resident testing.

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