CMS Administrator Chiquita Brooks-LaSure
Long-term care and other healthcare facilities that participate in the Medicare and Medicaid programs must develop COVID-19 vaccination policies for their workers by Dec. 5, and all eligible workers must be fully vaccinated by Jan. 4, under an emergency regulation issued this morning by the federal Centers for Medicare & Medicaid Services.
The emergency regulation is expected to be published in the Federal Register tomorrow but is available as a PDF now.
The CMS announcement comes on the same day that the Labor Department issued an emergency temporary standard requiring private businesses with 100 or more employees to develop, implement and enforce a mandatory COVID-19 vaccination policy, unless they adopt a policy requiring employees to choose to either be vaccinated or undergo regular COVID-19 testing and wear a face covering at work. That standard takes effect immediately upon publication in the Federal Register, which also is expected tomorrow.
Under the emergency regulation issued by CMS today, a first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine will be required of workers before they provide any care, treatment or other services, CMS said.
“Ensuring patient safety and protection from COVID-19 has been the focus of our efforts in combating the pandemic and the constantly evolving challenges we’re seeing,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Today’s action addresses the risk of unvaccinated healthcare staff to patient safety and provides stability and uniformity across the nation’s health care system to strengthen the health of people and the providers who care for them.”
The new national requirement will cover more than 17 million healthcare workers and protect residents and patients at almost 76,000 providers, according to the agency. Providers and suppliers that do not meet the requirements will be cited by a surveyor as being non-compliant and will have an opportunity to return to compliance before additional actions occur, the agency said.
Forty-eight percent of assisted living communities are Medicaid-certified, according to the American Health Care Association / National Center for Assisted Living. In answers to frequently asked questions posted by CMS, however, the agency notes that the regulation will not apply to assisted living communities or group homes, nor will it apply to providers of home- and community-based services, because CMS does not have authority over them. The emergency regulation, however, notes that home health agency and hospice workers covered by the regulation often provide services in assisted living communities, and that assisted living residents are at risk of infection because workers in assisted living communities often work in more than one long-term care or healthcare setting where they can be exposed to the coronavirus.
In a tight labor market, workers also might be attracted to settings where peers are vaccinated, CMS said. Many senior living companies have implemented their own COVID-19 vaccination mandates.
Assisted living communities and other settings not affected by the emergency regulation “may provide alternative places of employment for some of the staff currently working for providers and suppliers subject to this [interim final rule] who refuse vaccinations,” CMS notes in the emergency regulation. “On the other hand, staff shortages might be offset by persons returning to the labor market who were unwilling to work at locations where some other employees are unvaccinated and hence provide some risk, to those who have completed the primary vaccination series for COVID-19.”
Consistency across settings
The emergency regulation is designed to create a consistent standard within Medicare and Medicaid while giving residents and patients assurance of the vaccination status of those delivering care, the agency said.
Exemptions based on recognized medical conditions or religious beliefs, observances or practices will be available. Under the emergency regulation, facilities also must develop a process or plan for permitting exemptions in alignment with federal law.
In addition to nursing homes and other long-term care facilities, the regulation applies to home health agencies, hospices, Programs of All-Inclusive Care for the Elderly (PACE), intermediate care facilities for individuals with intellectual disabilities, ambulatory surgical centers, hospitals, psychiatric residential treatment facilities, comprehensive outpatient rehabilitation facilities, critical access hospitals, clinics (rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services), community mental health centers, home infusion therapy suppliers, rural health clinics/federally qualified health centers, and end-stage renal disease facilities.
Vaccination rates increase
CMS said that since announcing a vaccination requirement for nursing homes in August, vaccination rates have increased by approximately nine percentage points, from 62 to 71%. “This increase is encouraging, and this regulation will help to ensure even greater improvement in the vaccination rate among healthcare workers,” the agency said today.
The Biden administration announced in September that it would be expanding the requirement to other Medicare and Medicaid-certified healthcare settings as a condition for participating in the Medicare and Medicaid programs. The emergency regulation issued today accomplishes that expansion.
Organizations that have vaccination requirements have seen their vaccination rates increase by more than 20 percentage points and have routinely seen their share of fully vaccinated workers rise above 90%, according to a recent White House report sharing an analysis of healthcare systems, educational institutions, public-sector agencies and private businesses.
“Unvaccinated staff pose both a direct and indirect threat to the very patients that they serve,” CMS said today, adding that the new requirement “presents an opportunity to continue driving down COVID-19 infections, stabilize the nation’s healthcare system, and ensure safety for anyone seeking care.”
The agency has posted answers to frequently asked questions about the emergency regulation online.