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COVID-19 Guidance for NEMT Drivers Transporting Nursing Facility Residents - IHCA

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COVID-19 Guidance for NEMT Drivers Transporting Nursing Facility Residents

Posted Dec 1, 20206 min Read

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On November 30, 2020, the Indiana Department of Health (IDH) issued COVID-19 guidance for non-emergency medical transportation (NEMT) drivers transporting nursing facility residents.  This guidance goes into effect on December 14, 2020, and can be found in full here.  Under the guidance, NEMT drivers must be tested by nursing facilities once a week using a rapid, point-of-care (POC) test, if available.  Alternatively, the driver can choose to be tested at a local health department or OptumServe site.

IHCA/INCAL has repeatedly voiced concern that this policy places additional burden on facilities and is not in keeping with CMS’s testing mandate.  IDH has indicated that they have sought CMS’s guidance on this policy and will change the policy if CMS requires change.  If changes are made to the guidance, we will update you immediately.

Further highlights of the guidance are as follows:

  • PPE/Environmental Cleaning:  NEMT drivers must wear a mask that meets CDC requirements at all times, in addition to any other appropriate PPE, and must disinfect the vehicle after reach resident transport per CDC instructions.  Importantly, it is the responsibility of Southeastrans to ensure that drivers have appropriate PPE.
  • Return to Work:  NEMT drivers must adhere to the CDC’s Return to Work Criteria (i.e., must quarantine for at least 14 days if the driver was exposed or for a minimum of 10 days if the driver tested positive).
  • COVID-Positive Driver:  If a NEMT driver tests positive, Southeastrans must notify every facility that the driver transported residents from within two (2) days of the positive test or within two (2) days of the symptom onset.  This notification by Southeastrans must take place within four (4) hours of learning of the positive test or symptom onset of the NEMT driver.
  • COVID-Positive Resident:  Nursing facilities are required to report a resident’s COVID-19 status to the NEMT driver prior to the run.
  • Testing of NEMT Drivers:  NEMT drivers that transport nursing facility residents are required to undergo weekly COVID-19 testing, unless a driver had and recovered from COVID-19 within the past 90 days or has received a complete series of an FDA-approved COVID-19 vaccine.  The guidance states NEMT drivers must be tested by the nursing facility using a POC test, if available.  Alternatively, the driver can choose to be tested at a local health department or OptumServe site.  Test results are valid for the day of testing and for the next six (6) calendar days.  If the nursing facility cannot provide the test at the time of pickup, the trip should still occur.  If a driver tests positive using the POC test, the driver should inform Southeastrans immediately, and Southeastrans will work to satisfy the trip with another driver that has already been tested that week.
  • Reporting Test Results:  The guidance states that it is the responsibility of Southeastrans to report the test results of the NEMT drivers to IDH using a RedCap Survey.  However, if a nursing facility conducts a POC test for a NEMT driver using its CLIA Waiver, the nursing facility should report the results of the test to NHSN (if the nursing facility has SAMS Level 3 Access) or the RedCap Survey for POC Test Results (if the nursing facility does not yet have SAMS Level 3 Access), based on the utilization of the facility’s CLIA Waiver for the test.  IHCA/INCAL has expressed concerns regarding this duplication to IDH.
  • Testing of Residents:  Nursing facility residents to be transported by NEMT must also be tested prior to the run, unless the resident had and recovered from COVID-19 within the past 90 days or has received a complete series of an FDA-approved COVID-19 vaccine.  The test results would be valid for the day of testing and for the next six (6) calendar days.  If the resident’s test is positive, transportation should occur by BLS ambulance and not the NEMT driver.

IDH has answered the following questions via email, though we are uncertain at this time on whether IDH will issue a Q&A relative to the policy document.

Q:  SET drivers are known to be on tight schedules and only wait short periods for residents to be delivered to the vehicle.  How will a facility hold the driver onsite while a POC test, if available, is run?

A:  Point of care tests take 15 minutes to perform. Facilities can do the test and the drive can wait until the results.

Q:  Assuming the SET driver stays at the facility until test results are available, if the driver is positive will SET send another driver to make the appointment or will all need to be rescheduled, including the medical appointment?

A:  SET would work to satisfy the trip with another driver that has already been tested.

Q:  SET drivers serve multiple facilities in an area.  How will a driver show proof of testing if they do not get that at an Optum site?  Are they to be tested at each facility they serve?

A:  Drivers will provide a weekly attestation form. Nursing homes that perform the test will sign the form if the driver is negative. Drivers who are positive will report to SET for appropriate guidance on isolation. Drivers will not be tested at each facility.

Q:  Who will the state provide Binax Cards to for testing – the facility or driver?

A:  Facilities already receive Binax cards to help facilitate testing of their staff and those who care for their residents.

Q:  If residents are to be tested prior to transport, does this policy require a dialysis resident to be tested three times per week for the three transports they take to their three dialysis appointments?

A:  The resident would only require one test per week.

Q:  If a facility is in outbreak testing, how recent does the test prior to transport have to be such that a test administered during outbreak testing counts under this policy?  Under outbreak testing all residents, and staff, are tested every 3-7 days until no new positives are found.

A:  If the resident was tested as part of an outbreak that would count towards this requirement.

If a driver is wearing a mask inappropriately, or there are infection control, safety, or professional issues to report, please contact Southeastrans Inc. at 1-888-833-4154.  Please contact Elizabeth Eichhorn with any questions at Eeichhorn@ihca.org.