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CMS is expected to release guidance on its new vaccine mandates for nursing homes and hospitals receiving federal funds.


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The Centers for Medicare & Medicaid Services (CMS) revealed last week that it was in the rulemaking stage of a collaboration with the Occupational Safety and Health Administration (OSHA) on the establishment of a federal vaccine mandate.

Last Monday, Dr. Lee Fleisher, CMS’ chief medical officer and director of the Center for Clinical Standards and Quality (CCSQ), confirmed that the agency is slated to release its guidelines in late October. Fleisher did so while appearing at the National Association for the Support of Long-Term Care’s (NASL) annual meeting.

This means that Medicare-certified home health providers should expect CMS to release guidance any day now.


“CMS will soon issue the emergency regulation requiring staff vaccinations within the nation’s more than 15,000 Medicare and Medicaid-participating nursing homes and Medicare and Medicaid-certified health care providers that are regulated under CMS regulations, but we cannot comment on the specifics of the pending regulations as we are in the active rulemaking process,” a CMS spokesperson told Home Health Care News in an email. “There will be a 60-day comment period that will begin when the regulation is published in the Federal Register for the public to share their feedback with CMS.”

The journey to a federal vaccine mandate officially began last month after President Joe Biden announced a six-pronged approach to his administration’s COVID-19 strategy, with plans explicitly mentioning home health providers. The approach also pushed for American workers to get vaccinated and called for increased COVID-19 testing.

At the time, CMS confirmed that vaccinations would be a condition for participating in the Medicare and Medicaid programs.


“The staff vaccination requirement would only apply to Medicare and Medicaid-certified provider and supplier types that are regulated under the Conditions of Participation,” the agency said. “If an entity is not regulated under the CoPs, then this requirement would not apply.”

For now, providers can only speculate on the potential details of the mandate and if any exceptions will be taken into consideration. When one comes out, CMS will need to keep several considerations in mind, according to National Association for Home Care & Hospice (NAHC) President William A. Dombi.

“First, any mandate must provide sufficient time for reasonable compliance,” Dombi told HHCN in an email. “That matters primarily because there is a high risk of interruption of patient services resulting from lost clinical staff. The vaccine mandates in health care settings that already have occurred have demonstrated that some staff leave their jobs. In home care and hospice, there is a current staff shortage such that even the loss of one staff member can cause difficulties in continuing to serve existing patients as well as taking on new patients.”

Secondly, a CMS mandate must provide for exceptions with clear standards for applying those exceptions, he noted.

Additionally, “to the extent possible,” a CMS vaccine mandate should be evenly applied across the health care sector, NAHC’s leader advised. On top of that, CMS should also consider the costs of a vaccine mandate, especially on newer home health and home care agencies.

“A vaccine mandate presents a variety of new costs for home care companies,” Dombi said. “Appropriate compensation for such costs is a reasonable expectation as these costs are not built into today’s payment rates.”

On the state level, New York rolled out its own vaccine mandate back in August. The regulation mandates the vaccination of home health and personal care workers in the state, with the requirement that the first dose be administered by Oct. 7.

Since then, the rate for New York home-based care workers checked in at about 86% partially vaccinated and 71% fully vaccinated. About 34,000 caregivers have not begun the process at all, according to reports from The New York Times.

The state has received pushback from organizations such as the Home Care Association of New York State (HCA-NYS).

“We have been saying to our governor and our state health department, from the beginning, if you’re going to apply the mandate … you need to do it in a way that doesn’t cause a dislocation of care service for patients and a loss of workforce,” Al Cardillo, president of HCA-NYS, previously told HHCN.

Another East Coast state, Massachusetts, announced plans to require vaccinations for all staff at rest homes, assisted living residences, hospice programs, as well as home-based care workers.

Along these lines, individual home-based care providers have also taken a leap and implemented vaccine mandates within their organizations.

In August, Empath Health announced a policy that requires its staff, volunteers and vendors to be fully vaccinated against COVID-19 by Nov. 1.

“This was not a decision that was made lightly or quickly,” Dr. Neville Sarkari, chief medical officer at Tidewell Hospice, previously told HHCN. “We spent a great deal of time debating this internally. The vaccines are effective and safe, so we felt it was the right thing to do to protect our patients and our colleagues.”

Tidewell Hospice is one of Empath Health’s hospice subsidiaries.

CommonSpirit Health and its home-based care arm, CommonSpirit Health at Home, also announced that it would require its employees to be fully vaccinated by Nov. 1.

“As health care providers, we have a responsibility to help end this pandemic and protect our patients, our colleagues, and those in our communities – including the most vulnerable among us,” Lloyd H. Dean, CEO of CommonSpirit, said in a press statement. “An abundance of evidence shows that the vaccines are safe and highly effective. Throughout the pandemic, we have made data-driven decisions that will help us best fulfill our healing mission, and requiring vaccination is critical to maintaining a safe care environment.”

OSHA has already submitted its rulemaking on COVID-19 vaccination and testing requirements for private sector businesses of more than 100 employees.

“NAHC remains highly supportive of vaccinations,” Dombi continued. “We appreciate the efforts of the administration to get as many people vaccinated as possible and as quickly as possible. However, we must proceed with plans to address all the likely consequences of a mandate in order to ensure continuity in patient care and access to health care at home.”

Additional reporting by Jordyn Reiland


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