Agency for Health Care Administration Hospital Emergency Rule 59AER20-1 Questions & Answers

BY AHCA

Last updated: 6/1/2020

To prevent the spread of COVID-19 at long-term care and residential facilities, the Agency for Health
Care Administration issued Emergency Rule 59AER20-1. This rule requires COVID-19 testing by
hospitals of all patients, regardless of symptoms, prior to discharge to long-term care facilities.

Hospitals are prohibited from discharging any patient who tests positive for COVID-19 to a longterm
care facility until the resident has two consecutive negative test results separated by 24 hours
unless the receiving facility has a dedicated COVID-19 wing, unit or building with dedicated staff to
exclusively care for COVID-19 patients. Long-term care and residential facilities listed in the
emergency rule include nursing homes, assisted living facilities, intermediate care facilities for the
developmentally disabled and group home facilities.
To see the emergency rule, please visit the Agency’s Hospital and Outpatient Services Unit webpage
or https://ahca.myflorida.com/docs/Emergency_Rule_59AER20-1.pdf .

1. Qualifying Hospital Visit

Q 1.a. Is testing required for patients receiving services in outpatient diagnostic care departments
of the hospital?

Answer: No, the requirement only applies for patients admitted to the hospital.

Q 1.b. Is testing required for patients seen only in the Emergency Department and not admitted to
the hospital?

Answer: If the long-term care resident is sent to the ER for a situation unrelated to COVID-19 and
the resident is not admitted to the hospital, they may be discharged/returned to the long-term care
facility without testing. However, if the hospital has the ability to perform a rapid test they should
do so.

Q 1.c. Is testing required for patients placed in observation?
Answer: Yes. Patients in observation should be tested within 48 hours prior to returning to a
longterm care facility.

Q 1.d. Does the emergency rule apply to a patient discharged from a mental health facility? If the
person was never positive, are 2 negatives still required?

Answer: The emergency rule only applies to any patient discharged to a long-term care facility from
a hospital licensed under chapter 395, F.S, (general acute care hospital, long-term care hospital,
psychiatric hospital, comprehensive medical rehabilitation hospital, etc.). It does not apply to
patient’s discharged from a residential mental health facility licensed under Chapter 394, F.S.

2. Discharges Requiring Tests

Q 2.a. Does the requirement to test prior to discharge apply to hospice inpatient facilities or other
settings?

Answer: The requirement to test only applies to patients discharged to nursing homes, assisted
living facilities, intermediate care facilities for the developmentally disabled and group home
facilities licensed by the Agency for Persons with Disabilities. However, hospitals are encouraged to
test prior to transfers to another health care facility.

Q 2.b. If a hospital discharges to a hospital-based skilled nursing unit operating under the same
hospital’s license (Chapter 395, F.S.), is testing required?

Answer: The emergency rule does not apply to patients transferred within a hospital (i.e. patients
transferred from an acute care unit to a hospital-based skilled nursing unit or comprehensive
medical rehabilitation unit operated under the hospital’s license). It would apply if the patient is
then transferred from the hospital-based skilled nursing unit or hospital comprehensive medical
rehabilitation unit to a long-term care facility.

Q 2.c. Does the testing requirement also apply to patients discharged from a general acute hospital
to a long-term acute care hospital or comprehensive medical rehabilitation hospital?

Answer: The emergency rule does not require testing of patients transferred from hospital to
another hospital, such as a patient transferred from an acute care hospital to a comprehensive
medical rehabilitation hospital. However, hospitals are encouraged to test prior to transfers to
another health care facility.

Q 2.e. If the patient comes from a long-term care facility and is returning to that same facility, does
the hospital need to test them prior to return or is this only for patients discharging to that level of
care for the first time?

Answer: The testing requirement applies to both residents being returned to a long-term care
facility as well as patients being transferred to a long-term care facility for the first time.

3. Testing

Q 3.a. When should the test be performed? If the hospital is testing all patients upon admission (or
those with suspected COVID) and they test negative, does the hospital have to test them again
before discharge? If so, what is the recommended timeframe to test before discharge? What do we
do about the delays in getting the test results back?

Answer: This testing requirement is expected to be a part of the discharge planning process, not
admission. If the patient has never tested positive they should be tested within 48 hours prior to
discharge. If a patient has tested positive, the individual must have 2 negative test results separated
by 24 hours prior to discharge unless the receiving long-term care facility has
a dedicated wing, unit or building with dedicated staff to accept COVID-19 positive residents. If the
hospital has the ability to perform a rapid test they should do so.

Q 3.b. Does the requirement to test twice apply only to positive cases? In the case where the
patient has tested negative and has not previously had symptoms do we still test twice?
Answer: A patient is only required to be tested twice prior to discharge if they have previously
tested positive.

Q 3.c. If the testing isn’t readily available in the hospital (with a quick turnaround time), can these
tests be sent to the state lab?

Answer: If you have a hospitalized patient who needs to be tested for COVID-19 for either
diagnostic purposes or for medical clearance prior to transfer to another facility, testing remains
available from the Florida Department of Health (DOH), Bureau of Public Health Laboratories. DOH’s
current turnaround time is 24 to 48 hours. Hospitals should contact their County Health
Department to coordinate submitting tests to the Bureau of Public Health Laboratories.

Q 3.d. (New 6/1/20) If the hospital is unable to obtain a test result within a 48-hour period, can a
patient who has never tested positive and is not a PUI be discharged to a long-term care facility
from the hospital if the hospital has initiated the COVID-19 test but is still awaiting the final result?
Answer: As long as there are no symptoms or reason to suspect the patient may be positive, they
may be admitted to the long-term care facility into a single-person room or in a separate
observation area so the resident can be monitored for evidence of COVID-19. Consistent with CDC
guidance to nursing homes for admission of a resident with an unknown COVID-19 status, facility
staff should wear an N95 or higher-level respirator (or facemask if a respirator is not available), eye
protection (i.e., goggles or a disposable face shield that covers the front and sides of the face),
gloves, and gown when caring for the resident while awaiting test results. The resident may be
transferred out of the observation area to the main facility upon receipt of a negative test result if
they remain afebrile and without symptoms.

4. COVID Discharge

Q 4.a. The emergency rule states that a hospital can discharge a patient to a long-term care facility
if they have a dedicated wing, unit, or building and dedicated staff to accept COVID patients. How
can hospitals obtain a list of these facilities?

Answer: The Agency is working with the Department of Health to identify facilities with COVID
Designated areas and will share this information with hospitals.