Vaccine Mandate Clarifications for Nursing Homes

Vaccine Mandate Clarifications for Nursing Homes

LeadingAge National met with CMS on Tuesday, Jan 18th, and received clarifications from the Division of Nursing Homes on a few outstanding vaccine mandate questions, as below.

Please recall that the vaccine mandate interim final rule is now in effect for providers in all states EXCEPT Texas. There are 2 separate sets of compliance dates for this rule. Providers who were covered in the injunction that was overturned this past Friday must meet phase 1 requirements by February 14 and phase 2 by March 15. Previous compliance dates remain in effect for those states (including WA) not covered by the previous injunction (phase 1 January 27 and phase 2 February 28). Even though Washington has the state mandate for vaccination, this rule remains important for WA SNFs – since you will be surveyed based on these requirements. 

  • 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 immune-compromised; 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 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 immune-compromised.
  • 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

 

Questions?

Contact:

Laura Hofmann, MSN, RN – Director of Clinical and Nursing Facility Regulatory Services

c: 425-231-4804

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January 20, 2022