On November 5, 2021, the Facilities for Medicare and Medicaid Providers (CMS) printed rules that set up the primary ever federal vaccination necessities for well being care supplier workers. Drawing on its authority to determine affected person well being and security requirements, CMS is requiring well being care suppliers that take part within the Medicare and/or Medicaid packages to make sure that their workers are absolutely vaccinated in opposition to COVID-19. The brand new rule applies to workers who present any care, remedy, or different providers for suppliers or sufferers, together with contractors and volunteers.
CMS says it’s now requiring well being care workers to be vaccinated as a result of its earlier efforts to easily encourage vaccination have been “inadequate” to guard affected person well being and security. CMS cites information displaying that COVID-19 instances in nursing houses surged with the rise of the Delta variant. The nursing dwelling workers vaccination fee is almost 73 % nationally as of October 2021, with substantial variation by area. CMS concluded that normal federal necessities throughout supplier sorts are wanted as a result of the present “patchwork” of state and employer necessities has not been sufficient to deliver the pandemic beneath management in well being care settings. CMS notes that the vaccines are secure and extremely efficient at stopping extreme sickness and dying, and unvaccinated workers can pressure the well being care system by transmitting COVID-19 to sufferers and having to overlook work if they’re recovering from COVID-19 or quarantining after publicity.
The new rule applies to Medicare and Medicaid suppliers which can be instantly regulated by CMS and due to this fact doesn’t attain all Medicaid suppliers, similar to sure dwelling and community-based providers (HCBS) suppliers. The rule applies to nursing houses, hospitals, outpatient rehab amenities, federally certified well being facilities, rural well being facilities, and residential well being companies, amongst different supplier sorts. Residents and workers of different HCBS suppliers, similar to group houses, assisted dwelling amenities, and day habilitation packages, face elevated danger of significant sickness or dying from COVID-19, much like nursing houses. However, as a result of states (and never CMS) license and regulate these suppliers, CMS has not required them to adjust to the brand new rule. States or particular person suppliers may undertake workers vaccination mandates, and suppliers could also be topic to different guidelines such because the Occupational Security and Well being Administration requirement for giant employers (which has been placed on maintain by the courts) or state or native necessities.
The brand new rule raises many essential points to observe:
- Will suppliers have sufficient lead time to implement the brand new rule? Employees should have obtained their first vaccine dose by December 6, 2021, and should be absolutely vaccinated by January 4, 2022, or have been granted an exemption (primarily based on incapacity or honest non secular perception) or non permanent delay (primarily based on CDC medical pointers). Choices about whether or not to grant exemptions shall be made by suppliers. The rule doesn’t require workers to obtain booster pictures, although suppliers should monitor workers who’ve obtained a CDC-recommended booster. Suppliers additionally should implement “further precautions” to mitigate COVID-19 transmission and undertake contingency plans to handle workers who should not absolutely vaccinated.
- How will the brand new rule have an effect on well being care staffing ranges? An October 2021 KFF monitoring ballot discovered that 1 in 5 adults proceed to say that they positively won’t get the COVID-19 vaccine or will achieve this provided that required. When requested what they might do if their employer required the COVID-19 vaccine with out an choice for normal testing, 72% of unvaccinated staff (9% of all adults) say they would go away their jobs. The identical ballot discovered that simply 5% of unvaccinated adults mentioned they’ve left a job as a result of an employer required them to get vaccinated. CMS acknowledges that some workers might go away their jobs as a result of they don’t need to obtain the vaccine. It stays to be seen whether or not the brand new rule will exacerbate present staffing shortages or whether or not these results might fluctuate by area. CMS cites examples of vaccine mandates adopted by well being programs in Texas and Detroit and a long-term care mother or father company with 250 amenities in addition to the New York state well being care employee mandate, all of which resulted in excessive charges of compliance and few worker resignations.
- Will efforts to observe and implement the brand new rule be ample? CMS says that supplier compliance with the brand new rule shall be a part of the present oversight course of via which state or federal inspectors evaluation all Medicare and Medicaid program necessities. CMS envisions that inspectors will evaluation facility insurance policies and data and conduct workers interviews to confirm vaccination standing. CMS will present steering about oversight in addition to penalties for noncompliance, which may embody civil financial penalties, denial of cost for brand new long-term care facility admissions, or termination of Medicare and/or Medicaid program participation.
- How lengthy will the brand new rule be in place? CMS will decide whether or not to make the brand new rule everlasting primarily based on public feedback (due January 4, 2022) and the long run course of the pandemic. The brand new rule shouldn’t be tied to the length of the COVID-19 public well being emergency (PHE), and CMS expects that it’ll “stay related for a while past” the PHE finish. Medicare interim closing guidelines expire after three years except they’re finalized. Within the close to time period, the brand new rule already has been challenged in a lawsuit filed by 10 state attorneys normal in Missouri federal district court docket, which may delay or stop implementation of the rule.