01/20/2022

Vaccine mandate clarifications for nursing homes

Following the Supreme Court decision last week, the Centers for Medicare & Medicaid Services (CMS) issued QSO-22-09-ALL, spelling out timelines for compliance with the vaccine mandate for healthcare providers in 24 states, including Ohio. On Tuesday, LeadingAge met with the CMS and received clarifications from the Division of Nursing Homes on a few outstanding vaccine mandate questions, as below. Ohio providers must meet phase 1 requirements by February 14 and phase 2 by March 15. 

Per CMS:

• Tracking vaccination status of non-employee staff: CMS requires a process for tracking vaccination status of all staff, including non-employee contract staff. Two major considerations will be 1) Do you have a process? and 2) Does your process work? CMS has confirmed that this may mean you do not maintain copies of vaccination cards for contract staff on site, provided you have other ways of ensuring that these staff are vaccinated and that the required documentation can be provided upon request. One example of this might be an agreement with the contracting organization to provide only vaccinated staff, a list of staff and vaccination status, and an agreement to provide proof of vaccination in a timely manner upon request.
  
  
• Additional precautions for unvaccinated (including exempt) staff: Unvaccinated staff, including those who have requested and/or been approved for exemption, are required to follow additional precautions to mitigate transmission of COVID-19. CMS outlines several precautions in guidance, including reassignment of staff to telework, non-patient care roles, or caring only for those who are not unvaccinated or immunocompromised; practicing physical distancing and using an N95 or other approved respirator for source control at all times; and submitting to at least weekly testing. While other interventions may also be appropriate, CMS advises that these are not pick-list options and providers should attempt to layer strategies as appropriate. One example may be requiring all unvaccinated staff to physical distance, wear N95s, and submit to weekly testing while reassigning staff along the lines of the Centers for Disease Control and Prevention (CDC) staffing capacity (outlined here) where contingency capacity allows for reassignment to non-patient care while crisis capacity allows for care of residents who are not unvaccinated or immunocompromised.
  
  
• At-home testing for staff: Despite developments from the Administration to expand access to at-home testing, CMS has confirmed that at-home testing is not appropriate for meeting requirements for routine testing of unvaccinated staff. Routine testing of unvaccinated staff should take place on site where healthcare personnel can observe testing, confirm the integrity of test results, and document results. An emergency contingency may include performing this observation over a virtual real-time video call; however, in-person, on-site testing is preferred.