FAQs: Tuberculosis Program in Assisted Living

Posted on March 10, 2022 by Kari Everson

During the Coaching Room on March 1, members asked questions about tuberculosis (TB) programs in assisted living. As a result of the questions from the Coaching Room, we've taken the two most asked questions and responded.

FAQ: Can I accept a chest X-Ray, TST, or IGRA result if it’s less than 12 months old?

According to the Minnesota TB Manual, a documented single negative TB blood test known as an Interferon-Gamma Release Assay (IGRA) completed 90-days before hiring is acceptable. Assisted living settings cannot accept a negative IGRA outside of that timeframe.

A documented two-step Mantoux series completed 90-days before hiring can be accepted. Assisted living settings cannot accept a negative two-step Mantoux test outside of that timeframe. However, there may be another option for those staff who have at least one documented negative Mantoux test in the past year. The CDC guidance describes the purpose of the 1st step to boost the immune system reaction, which makes the 2nd test result more reliable. This reaction lasts for 12 months. Therefore, if the employee has a documented negative Mantoux within 12 months, the assisted living only needs to do a single Mantoux test to get a new, complete test result.

Example #1: First Step Mantoux Test: Nov. 2, 2021 – negative; Second Step Mantoux Test: Nov. 18, 2021 – negative. Hire date at the assisted living: March 8, 2022. The assisted living would not be able to accept this two-step Mantoux test; however, they would be able to accept the Mantoux test from Nov. 18, 2021, and give a second TST now to comply with the requirement. The two-step test is not within 90-days of hire, but the second step is within 12 months of the hire date.

Example #2: First Step Mantoux Test: Dec. 21, 2021 – negative; Second Step Mantoux Test: Jan. 6, 2022 – negative. Hire date at the assisted living: March 1, 2022. The assisted living would accept this Mantoux testing sequence as both steps are within 90-days of hire.

A negative chest x-ray must go with a positive TB test. Its purpose is to rule out active TB disease when someone has a positive TB test. To accept a chest x-ray, the assisted living must also have the corresponding positive TB test to go along with it. In addition, the chest x-ray must be dated either 90 days before the positive test date or taken any time after the positive test date. The chest x-ray for assisted living organizations may be 20 years old as long as it meets the criteria. The most common issue with new hires is that the staff will have a copy of the old chest x-ray but no longer have the old positive TB test or a provider letter of treatment. Staff may use a provider letter of treatment in place of the old positive test. When a new hire cannot provide these documents, the assisted living will need to complete a new Mantoux test. If that test is positive, follow up with the chest x-ray, and make sure to instruct the staff member to keep both documents. The Minnesota TB Manual provides this information on page 13.

FAQ: Do organizations need to complete annual TB screening and testing for their employees?

Assisted living organizations are no longer required to complete annual TB screening or annual TB testing of their employees.

Staff still require screening and testing upon hire and proof of at least one negative Mantoux or a negative IGRA before working with residents, but the CDC and MDH removed the annual screening and testing requirements in 2019.

LeadingAge Minnesota updated the TB policy and procedure in our assisted living manual to clarify questions.

You can find the references for assisted living TB requirements in Minnesota Statute 144G.41, Subd. 2 (10) and 144G.42 Subd. 9 and Subd. 9a.

If you have any questions about TB requirements for assisted living organizations, please contact Kari Everson.