What does this order mean for hospitals and their clinics?
It means that when one of their patients has COVID-19 symptoms, was exposed to someone with COVID-19, is referred to them for testing by the County Public Health Department, or is an essential worker as defined by California Regulations, the hospital or clinic is required to provide that patient with a COVID-19 test.
Who will hospital and clinics be required to test?
- All of their patients with COVID-19 symptoms;
- All of their patients who have been exposed to a person who tested positive for COVID-19;
- All of their patients who have been referred by the County Public Health Department for COVID-19 testing; and
- Essential workers as defined by the COVID-19 Diagnostic Testing emergency regulations of the California Department of Managed Health Care, 28 C.C.R. § 1300.67.01(b)(5). This includes people who may be at greater risk of COVID-19 exposure, such as: healthcare workers; care providers for the elderly or disabled; people working in shelters, jails, or other settings with large residential populations; first responders; grocery and food service workers; agricultural and food supply workers; public transit workers; childcare, school, and higher education teachers and staff; and all others who are included in the regulation.
What testing guidance is provided for fully vaccinated individuals?
Fully vaccinated individuals experiencing COVID-19 symptoms should still follow standard county guidance for testing and quarantine. They should get tested and quarantine immediately if experiencing COVID-19 symptoms. If they test positive for COVID-19, they must follow standard county guidance for isolation (isolate for 10 days since symptoms first appeared, and 24 hours with no fever and improvements of other symptoms).
Individuals who are not fully vaccinated should continue to follow current County testing and quarantine guidance after exposure to someone diagnosed with COVID-19. Even if the COVID-19 case is fully vaccinated, their close contacts should still follow standard testing and quarantine guidelines.
For fully vaccinated healthcare workers, please see Managing Exposures Among Healthcare Workers for workplace specific guidance based on their vaccination status.
Fully vaccinated inpatients and residents in healthcare settings should continue to follow CDPH quarantine guidance for healthcare settings following an exposure to someone with suspected or confirmed COVID-19; outpatients should be cared for using appropriate Transmission-Based Precautions.
What constitutes “exposure” to a person who tested positive for COVID-19?
A person has been “exposed” to a person who tested positive for COVID-19 if they were within 6 feet of the infected person for at least 15 minutes at any time beginning 2 days before the infected person had symptoms or tested positive. People who have been exposed include people who had 15 minutes of continuous contact with the infected person, as well as people who had repeated short-duration interactions with the infected person. In addition, while face coverings do reduce the likelihood of COVID-19 transmission, they have no impact on the determination of whether someone has been exposed to a person who tested positive for COVID-19.
How should hospitals and clinics confirm that an individual is eligible for COVID-19 Diagnostic Testing?
Hospitals and clinics should rely on information provided by the patient. For example, a Healthcare Facility can ask a patient if they were in close contact with a person with COVID-19 for 15 minutes or more. A Healthcare Facility cannot, however, require proof or verification beyond what is reported to them by the patient. For example, a Healthcare Facility cannot require a patient to provide documentation demonstrating that he or she is an essential worker.
Can I go to an emergency room for a COVID-19 test?
No one should go to an emergency room unless they require emergency care. No one should go to an emergency room solely to obtain a COVID-19 test. If you are experiencing COVID-19 symptoms, you should contact your doctor to seek treatment and obtain a COVID-19 test. And if you are experiencing a medical emergency, you should seek treatment at an emergency room.
Can I get a test at a Kaiser facility if I’m not a Kaiser member?
The order does not require Kaiser to provide testing to non-Kaiser members in its clinics. However, Kaiser will be required to provide COVID-19 testing to anyone receiving care in its facilities (including urgent care clinics or emergency rooms) who has COVID-19 symptoms, was exposed to someone with COVID-19, or is an essential worker.
I go to Palo Alto Medical Foundation for care. Will I be able to get tested if I am an essential worker?
Yes, if you are an essential worker as defined by the COVID-19 Diagnostic Testing emergency regulation of the California Department of Managed Health Care, 28 C.C.R. § 1300.67.01(b)(5) (for example, first responder, grocery store worker, pharmacy clerk, etc.), and you are a patient of Palo Alto Medical Foundation (“PAMF”), PAMF is required to provide you a COVID-19 test if you request one.
I go to a Stanford clinic for my care. Will they test me if I have no symptoms but work as a grocery store clerk?
Yes. Because you are considered an essential worker under the COVID-19 Diagnostic Testing emergency regulation of the California Department of Managed Health Care, 28 C.C.R. § 1300.67.01(b)(5), Stanford is required to provide you a COVID-19 test if you request one.
How can I find a testing site if I don’t have a healthcare provider?
There are many places in the County where people without insurance can get a free COVID-19 test. Information on these testing sites is available at www.sccfreetest.org.
I’m having symptoms of COVID-19. Where should I go?
Contact your primary care provider to arrange for testing and directions on what to do. If you need emergency care, go to the nearest hospital emergency room.
Will I still have to make an appointment to be tested?
Contact your primary care provider to arrange for testing. Generally, you should not be required to schedule an appointment with your doctor prior to being tested for COVID-19 if you do not have COVID-19 symptoms.
How long do I have to wait to get tested?
If you have COVID-19 symptoms, were exposed to someone who tested positive for COVID-19, or have been referred by the County Health Department to your healthcare provider for COVID-19 testing, you must be provided a test at the time you present for care if you do so in person or not later than the end of the following calendar day if you sought care remotely (e.g., through a call center or patient portal). If you are an essential worker, your healthcare provider must provide you with a COVID-19 test within 3 business days of your request for one.
How frequently can I get tested?
Healthcare providers must provide COVID-19 testing to any patient with COVID-19 symptoms, who was exposed to a person who tested positive for COVID-19, or who has been referred by the County Public Health Department to their healthcare provider for COVID-19 testing regardless of the last time the patient was tested. Healthcare providers may, however, ask patients who are essential workers who do not fall into any of the other categories of eligibility for testing to wait up to 14 calendar days since their last COVID-19 test.
Note: The May 18, 2021 Public Health Order now requires businesses and schools to conduct weekly PCR testing for COVID-19, or daily antigen testing with COVID PCR confirmation of any positives, for unvaccinated employees and volunteers.
Are healthcare providers required to provide COVID-19 Diagnostic Testing to otherwise eligible patients who received positive COVID-19 Diagnostic Tests within the past 90 days?
Yes. The Order requires Healthcare Facilities to offer COVID-19 Diagnostic Testing to all patients who are eligible under the Order within the frequency and time requirements of the Order. Healthcare Facilities can require patients who are essential workers who do not fall into any of the other categories of eligibility for testing to wait up to 14 calendar days since their last COVID-19 test, but may not otherwise limit patients’ access to testing based on the date of their last test.
However, the CDC recommends against retesting within 90 days of an initial positive COVID-19 Diagnostic Test in the absence of new symptom(s) consistent with COVID-19. The CDC also recommends against retesting until a patient receives a negative COVID-19 test in order for that patient to stop isolating or quarantining. Similarly, the Santa Clara County Public Health Department discourages employers and schools from requesting proof of a negative COVID-19 Diagnostic Test before allowing individuals who previously tested positive for the virus to return to work or school after their applicable isolation period. Accordingly, a healthcare provider may suggest that a patient need not be retested within 90 days of an initial positive test unless it is clinically indicated because, for example, the patient is experiencing new symptoms consistent with COVID-19 or was exposed to a confirmed case of COVID-19.
How long do I need to wait to get my test results?
Healthcare providers are required to provide the results of any COVID-19 tests within 3 calendar days from the date they provide the test. If healthcare providers are not able to meet this time requirement, they must provide notice to the County explaining the delay and what they’re doing to solve it.
Will all hospitals provide COVID-19 testing?
Yes. The Order requires hospitals and their clinics to provide COVID-19 testing to any patient who has COVID-19 symptoms, was exposed to a person who tested positive for COVID-19, has been referred by the County Public Health Department for COVID-19 testing, or is an essential worker. However, no one should go to a hospital to be tested for COVID-19 unless they need emergency care.
Does this Order require large healthcare systems to test me for COVID-19 antibodies?
No. This Order only requires diagnostic testing for COVID-19 to determine whether certain categories of patients currently have COVID-19. It does not apply to antibody testing.
What should I do if I qualify for a COVID-19 test under this Order but my healthcare provider refuses to provide me with the test?
If you believe that a large healthcare system is not complying with the terms of the Order, you should first file a complaint or raise a concern with the designated management or patient care contact at your healthcare provider. As a reminder, this Order only applies to hospitals, and clinics associated with healthcare systems that also own or operate a hospital.
If your healthcare provider does not provide an adequate response, please submit a complaint at www.scccovidconcerns.org.
Can my healthcare provider require me to make an appointment with my doctor before providing me with a COVID-19 Diagnostic Test?
Generally, no. Healthcare Facilities may not require patients who have been exposed to a confirmed case of COVID-19, have been referred by the County Public Health Department to their provider for COVID-19 Diagnostic Testing, or are essential workers, to meet with a healthcare provider in order to access COVID-19 Diagnostic Testing. Further, Healthcare Facilities must provide all categories of eligible patients with COVID-19 Diagnostic Testing within the time requirements of the Order.
However, Healthcare Facilities may require that patients with COVID-19 symptoms be seen by a healthcare provider (e.g., where a patient has shortness of breath that may require a medical evaluation), but they must provide symptomatic patients with COVID-19 Diagnostic Testing within the time requirements of the Order.
If I was exposed to a confirmed case of COVID-19, when must my healthcare provider provide me with a COVID-19 Diagnostic Test?
If you were exposed to a confirmed case of COVID-19, your healthcare provider must offer to provide a COVID-19 Diagnostic Test either when you present for care if you seek testing in person, or by the end of the following calendar day if you seek testing via phone or electronic message.
However, the Santa Clara County Public Health Department recommends that asymptomatic close contacts be tested seven days after their last exposure to a confirmed case of COVID-19, because that is when most people who are infected would test positive, and your provider may suggest you wait until seven days after exposure to be tested. If you are tested earlier, you should be retested toward the end of the quarantine period. And all persons exposed to a confirmed case of COVID-19 must quarantine for 14 days following the exposure, regardless of whether they test negative for COVID-19.
I’m a healthcare provider. I have a patient with symptoms of COVID-19, but I believe those symptoms are or may be attributable to something other than COVID-19. Do I have to provide my patient with a COVID-19 Diagnostic Test?
Yes. The Order requires Healthcare Facilities to provide COVID-19 Diagnostic Testing to all Patients with at least one symptom of COVID-19 who present for care. This is true regardless of whether the Patient requested to be tested. Even if the healthcare provider believes the symptoms are likely attributable to an alternative diagnoses, the Healthcare Facility must provide the Patient a COVID-19 Diagnostic Test within the time requirements of the Order.
I’m a healthcare provider treating a patient for something other than COVID-19. During the course of providing care to this patient, I learn that the patient is eligible for a COVID-19 Diagnostic Test under the Order. Do I have to provide my patient with a COVID-19 Diagnostic Test?
Healthcare Facilities must provide all eligible Patients with COVID-19 Diagnostic Testing within the time requirements of the Order even if a Patient sought care for a reason other than COVID-19. For example, a healthcare provider treating a Patient for a broken wrist learns during the course of treatment that the patient has COVID-19 symptoms. The Healthcare Facility must provide that Patient with a COVID-19 test at that time. As another example, a healthcare provider treating a Patient for a skin condition learns during the course of treatment that the patient is an Essential Worker. The Healthcare Facility must provide that Patient with a COVID-19 test within three business days if requested by the Patient.
Where are Healthcare Facilities required to post the Patient Testing Notice?
The Order requires Healthcare Facilities to conspicuously post the Patient Testing Notice “in patient waiting areas and exam or treatment rooms.” This means that hospitals and clinics must post the Patient Testing Notice in all patient waiting areas and all rooms in which patients are examined and evaluated, including all exam or treatment rooms in any outpatient clinic, urgent care facility, emergency department, or other similar facility. “Treatment room” does not include inpatient hospital rooms.