Community Thresholds for Health Care Decision-Making

Community Thresholds for Health Care Decision-Making

COVID-19 activity in the community may affect how facilities and providers make decisions about testing, operations and personal protective equipment (PPE). This page includes guidance and information for health care providers, nursing homes and other long-term care facilities to make decisions based on measures of community-level burden.

Antigen Test Guidance for Health Care Providers

Use the Epidemiology COVID-19 Antigen Test Interpretation flow chart and threshold map below to help you interpret the antigen test.

Testing Guidance for CMS-Certified Nursing Homes

Routine Testing of Staff

Routine staff testing is required for CMS-certified nursing homes. CMS established minimum testing frequencies based on county positivity rate, but these may be supplemented by recommendations from the Department of Health or the Department of Disabilities, Aging and Independent Living.

Minimum Routing Testing Frequency by Community COVID-19 Activity Level
Community COVID-19 Activity County Positivity Rate Minimum testing frequency
Low <5% Once a month
Medium 5% - 10% Once a week
High >10% Twice a week

For more information, see CMS Memo QSO-20-38-NH: Long-Term Care Facility Testing Requirements.

Testing Guidance for Other Long-Term Care Facilities

Long Term Care Guidance for Operations During COVID-19 Health Emergency, from the Department of Disabilities, Aging and Independent Living, in consultation with the Department of Health, identifies phases of operation that are based on the community burden of COVID-19 and cases within a facility. Each phase outlines visitation guidance, congregate activity limits, and testing requirements that apply to all long-term care residential facilities (nursing homes, residential care homes, assisted living residences, and therapeutic community residences).

The phases correspond to county positivity rates. Facilities should monitor their county positivity rate at least every other week. Community incidence should also be considered when making decisions about proactive testing, visitation, and activities within a facility.

Guidance on Personal Protective Equipment

Encounters with asymptomatic or presymptomatic patients with COVID-19 are more likely in the context of moderate (400-799 cases/million) or substantial (800+ cases/million) community transmission. In such instances, the use of universal eye protection reduces the potential for high-risk exposure (and exclusion from work and quarantine recommendations) among providers.

For additional guidance on PPE use beyond those dependent on rates of community burden, read the Health Department’s COVID-19 Personal Protective Equipment (PPE) Guidance.

This is not the travel map.