The Wisconsin Department of Health Services is pleased to announce that Wisconsin shelters with shared living environments will be able to order rapid antigen tests for COVID-19 and/or lab-based follow-up PCR tests for free from the state of Wisconsin. This testing support is intended to complement COVID-19 prevention efforts.
All shelters with shared living environments are eligible to receive supplies. Organizations without shared living environments that work with housing insecure populations may be eligible to receive testing supplies. Please contact firstname.lastname@example.org to learn how to apply.
Close contact: being in 6 feet of another person for at least 15 minutes or more.
Asymptomatic: a person who does not report or appear to have any symptoms or signs of illness.
Symptomatic: a person exhibiting symptoms.
Quarantine: is used to keep someone who might have been exposed to the virus away from others.
Isolation: is used to separate people infected with COVID-19 from those who are not infected.
Fully vaccinated: In general, people are considered fully vaccinated: 2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s vaccine.
Molecular test: is a type of highly accurate diagnostic test than can detect if you have an active COVID-19 infection. Samples for diagnostic tests are typically collected with a nasal swab, or saliva collected by spitting into a tube. Samples are usually sent out to a lab for processing.
Antigen test: is a type of diagnostic test than can detect if you have an active COVID-19 infection. Samples for diagnostic tests are typically collected with a nasal swab. Results are available in 15-30 minutes. If individual is symptomatic and tests negative, they will require a follow up molecular test.
Key reasons to test in shelters
- Testing in shelters is recommended by the CDC Testing in Homeless Shelters and Encampment. This includes diagnostic testing for symptomatic individuals and close contacts and/or regular screening testing for asymptomatic individuals such as weekly screenings.
- People living in congregate settings are at a much higher risk for contracting and spreading COVID-19. The housing insecure population is part of this vulnerable group as they often live in close quarters, with rotating staff who have personal lives that create exposure risks in this setting.
- Testing helps reduce community spread and keeps shelters operating safely. Testing individuals who are symptomatic and close contacts helps enable rapid detection of positive cases in shelters to reduce or prevent outbreaks. A routine screening testing program, which regularly tests people without symptoms or known exposures, is a tool to reduce “silent” spread of the virus and can help residents and staff. According to the CDC, at least 50% of infections are likely contracted from someone that is asymptomatic (showing no symptoms) or pre-symptomatic (not currently showing symptoms but may develop them in the future). Testing regularly can prevent an outbreak, keeping residents and staff safe.
Who is able to be tested?
Staff and residents are able to be tested.
When should testing be performed?
There are multiple options to consider when deciding on a testing strategy for residents and staff.
- Provide screening tests upon intake.
- Provide routine screening tests for asymptomatic residents and staff.
- Test symptomatic individuals.
- Test close contacts of someone who has tested positive for COVID-19.
Preparing for COVID-19 testing: step-by-step instructions
1. Determine the right test for your shelter.
Testing supplies are available through the DHS COVID-19 testing supplies website. Shelters have the option to order and use testing supplies that best meet their needs for residents and staff, including rapid point of care tests and highly accurate lab-based tests.
Highly accurate, lab-based molecular tests
Laboratory-based molecular tests are the gold standard test because these tests are the most accurate tests available. The sample must be shipped to a laboratory to be tested for COVID-19 testing. Test results are usually available in 24-48 hours. The laboratory conducts all required certificates and reporting for shelters.
Rapid, point of care tests
Abbott BinaxNOW rapid antigen tests are available for use in shelters and provide results in 15 minutes. They are shipped in boxes of 40 tests. BinaxNOW tests are the most accurate for individuals with symptoms and sometimes require a follow-up test to confirm the test result is accurate. To use BinaxNOW tests, shelters must:
Obtain a Clinical Laboratory Improvement Amendment (CLIA) Certificate of Waiver. The CLIA certificate process is fast and easy.
Report results to state and federal authorities within 24 hours of result.
Facilitate access to confirmatory testing when needed. DHS will provide lab-based molecular testing supplies to shelters for confirmatory testing. More information about confirmatory testing is available.
- Negative BinaxNOW test results occurring in individuals with COVID-19-like symptoms should be confirmed by a lab-based molecular test, because of the risk of false negative results.
- Positive BinaxNOW test results occurring in asymptomatic individuals (for example, tests conducted as part of a routine screening program) should be confirmed by a lab-based molecular test, because of the risk of false positive results.
2. Obtain a CLIA Certificate of Waiver (only for rapid point of care tests).
When ordering rapid antigen tests from DHS, you will need to submit your CLIA Certificate of Waiver number.
To obtain a CLIA Certificate of Waiver, you will need to submit a completed application to email@example.com.
3. Partner with a clinician.
All COVID-19 testing sponsored by this program needs to occur under the authority of a clinician with prescribing authority (MD, DO, PA, or NP). If you do not have a local clinician who manages your shelter's health services, you can complete the attestation form and submit to WICovidTest@Wisconsin.gov. This will allow you to conduct testing under the statewide standing order for COVID-19 tests prescribed by the Wisconsin DHS Chief Medical Officer.
4. Submit a request for testing supplies.
- To receive rapid point of care tests, complete all fields under BinaxNOW Testing Supplies.
- To receive lab-based molecular tests, in the PCR Testing Supplies field, type “Exact” for the Clinical Laboratory, click “Add Item,” and select “Collection Supplies and Laboratory Services.” Complete fields in form.
- To order both rapid point of care and lab-based molecular tests, complete both PCR Testing Supplies and BinaxNOW Testing Supplies fields.
5. Complete training.
Any staff who will administer COVID-19 testing at your shelter must complete training to assure they are using the tests safely and effectively.
Performing and Reporting the BinaxNOW test (Rapid Antigen) in Shelters
BinaxNOW antigen testing does not allow for a self collection option.
- How to do a nasal swab video
- How to use BinaxNOW test video
- How to interpret BinaxNOW test video
- BinaxNOW package insert
- Reporting antigen results to public health
Performing and Reporting PCR test in Shelters
6. Set up an account with the Wisconsin State Lab of Hygiene to report results.
COVID-19 is a Category I reportable condition in Wisconsin. As such, test results must be reported to the State of Wisconsin and to federal authorities (HHS). To report results, set up an account.
If you have questions about ordering testing supplies or shelter testing in general, please email firstname.lastname@example.org.
Frequently asked questions by category
- What support is the Department of Health Services providing shelters to conduct COVID-19 testing? The Department of Health Services is offering free Abbott BinaxNOW point-of-care tests with optional confirmatory PCR supplies and comprehensive testing services through approved vendors. Tests may be used for staff and residents who are symptomatic and close contacts, to conduct surveillance testing, or to test residents who have appointments outside of the facility.
- Is it mandatory for shelters to test residents and staff? No. Providing testing in shelters is voluntary, but having routine testing is one way to prevent the spread of COVID-19.
- How do I order Abbott BinaxNOW tests under this program? Free Abbott BinaxNOW tests may be ordered through the Wisconsin COVID-19 Collection Supply Request website. Shelters conducting testing must provide a valid CLIA Certificate of Waiver number during the ordering process.
- Is biohazard waste disposal provided by the state? No. Biohazard waste disposal is not covered. Shelters are responsible for safely disposing of waste. Options include the use of biohazard bags for used Abbott BinaxNOW cards, hard-sided biohazard containers for used swabs, and/or the use of a medical biohazard disposal service. For additional information, see CDC Waste Management Guidelines for SARS-CoV-2 Point-of-Care Testing.
CLIA Certificate of Waiver
- When does a shelter need a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver? For a shelter to conduct point of care tests (like the COVID-19 Abbott BinaxNOW tests or diabetic glucose checks), the shelter must apply for and receive a CLIA Certificate of Waiver. Shelters may not conduct testing until the certificate of waiver has been approved. A shelter does not need a certificate of waiver if they collaborate with another entity willing to conduct testing at the shelter under that entity’s CLIA Certificate of Waiver or if the shelter is not conducting point of care tests.
All testing would occur under the external entity’s CLIA certificate. The shelter should verify that the external entity conducting the test has a valid CLIA Certificate of Waiver. To find out if an entity has a valid CLIA Certificate of Waiver, request the CLIA number from the testing partner and verify it by checking the CDC CLIA Laboratory Search website or emailing DHSDQACLIA@wi.gov. All entities ordering BinaxNOW supplies from DHS are required to provide their CLIA number when placing their orders.
- What responsibilities must a shelter fulfill as an organization with a CLIA waiver? Any organization with a CLIA Certificate of Waiver is responsible for the safety and effectiveness of services they provide. For shelters conducting COVID-19 point of care testing, this includes staff training, effective infection control practices, and reporting infectious disease test results to the state of Wisconsin and to the federal authorities (HHS). Guidance about how to set up an account and report COVID-19 point of care test results is available from the Wisconsin State Laboratory of Hygiene. If a shelter coordinates with a testing partner, or is providing lab-based molecular tests (not point of care tests), then the laboratory will assume the responsibility for the safety and effectiveness of testing – including responsibility for reporting test results on the shelter’s behalf.
- How does a shelter apply for a CLIA Certificate of Waiver? To apply to receive a CLIA Certificate of Waiver, the shelter must fill out the Center for Medicare and Medicaid Services (CMS) application form CMS-116 CLIA Application and submit it to the State of Wisconsin CLIA Section at DHSDQACLIA@wi.gov. Once approved, CMS will assign a CLIA number and send a letter or email of confirmation to the shelter. For more information on CLIA certification, reference the CMS Laboratory Quick Start Guide.
- How long does it take to process the CLIA Certificate of Waiver? Once a shelter submits an accurate and complete application, CMS usually processes the Certificate of Waiver in one week or less. Once approved, the shelter will be assigned a Federal CLIA number and may begin testing. Provide the CLIA number to DHS when ordering testing supplies.
- Is there a fee associated with applying for a CLIA Certificate of Waiver? Yes. An entity is required to pay $180.00 to CMS before the CLIA Certificate of Waiver is approved. CMS will send an invoice to the shelter and you may submit payment to CMS directly or pay online at Pay.Gov.
- Does the CLIA Certificate of Waiver expire? The CLIA Certificate of Waiver is good for two years. CMS will send a renewal invoice 6 months prior to the expiration date of the certificate.
- The CLIA application asks to identify the "director" of the laboratory. Can this be anyone in the shelter? The shelter may list any employee as the director on the CLIA application. It is recommended that the director is an individual who is or who will become knowledgeable about the requirements of maintaining the CLIA Certificate of Waiver and the shelter’s testing operations, including testing and safety protocols, staff training, and reporting of test results.
- What other information will the application request? The application requires the shelter to provide their tax ID number. The application also requires the shelter estimate the number of tests they plan to conduct. This can be a general estimate based on the number of staff and residents.
- How can a shelter verify whether they already hold a CLIA certificate? To verify whether an entity has a valid CLIA Certificate of Waiver, check the CDC CLIA Laboratory Search website or email DHSDQACLIA@wi.gov.
- Who do I contact if I have additional questions about the CLIA Certificate of Waiver process? For any questions about the CLIA Certificate of Waiver and process, email the State of Wisconsin Department of Health Services, Division of Quality Assurance at DHSDQACLIA@wi.gov.
- Who at the shelter is allowed to collect the specimen for a COVID-19 test? Does it have to be a nurse? Any staff member who is properly trained is allowed to collect the specimen and test the specimen to obtain a result. Training may be accessed through many venues, including from a trained clinician (a health care provider) or through the test manufacturer’s materials. If you need assistance finding these vendor materials, email WICovidTest@Wisconsin.gov
- Does a shelter need to have access to lab-based molecular tests? All shelters conducting point of care testing under Dr. Westergaard's statewide standing order (including Abbott BinaxNOW tests) must assure compliance with the DHS and CDC recommendation for providing follow-up testing to confirm some antigen results. Lab-based molecular tests are recommended for this follow-up testing. Shelters can order and provide these follow-up, confirmatory tests for residents and staff, or refer staff to follow-up:
- at a free community testing side that conducts molecular testing
- using a free at-home saliva collection kit
- at the individual’s health care provider or a free or low cost health clinic for those who do not have a health care home (verify if they are conducting COVID-19 molecular testing prior to referral).
- Should shelters require a negative test result for residents to return to the general population and staff to return to work? No. It is not recommended to require a negative test before returning. There have been reports that an individual can continue to test positive long after they are considered to be contagious.
- If staff or resident test positive, how long should they isolate and quarantine? A person who tests positive should observe a 10-day isolation period from the date their symptoms begin. Additionally, they need to be fever-free for 24-hours and have improved symptoms before they end their isolation period. An asymptomatic person should observe a 10-day isolation period starting on the date the positive specimen was collected. Learn about isolation and quarantine. For additional guidance on this topic, contact your local health department who may offer specific guidance for the shelters.
- When should an individual be referred for follow-up lab-based molecular testing? Follow-up confirmatory molecular testing is recommended for individuals who are symptomatic and test negative using the Abbott BinaxNOW, and for people who are asymptomatic and test positive using the Abbott BinaxNOW. Confirmatory testing should be conducted as soon as possible and within 48 hours. For a simple guide on when to retest, see COVID-19 Antigen Testing: When is it best to retest? Additional guidance for the use of antigen testing is located in the COVID-19 Health Alert #17: Important Considerations for Use of COVID-19 Antigen Tests.
Does a shelter providing testing need an order signed by a medical provider? Yes, COVID-19 testing needs to occur under the authority of a medical provider. A shelter may obtain a written order through a clinician with prescribing authority (MD, DO, PA, or NP), or opt to use a standing order issued by Dr. Ryan Westergaard, Chief Medical Officer for the Wisconsin Department of Health Services. If a shelter chooses to use Dr. Westergaard’s standing order, they must sign an attestation form agreeing to follow the requirements of the order.