On May 13, 2021, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule with comment period, updating the infection control requirements that long-term care (LTC) facilities and intermediate care facilities for individuals with intellectual disabilities (IFCs-IID) must meet to participate in the Medicare or Medicaid programs.
The interim final rule mandates education about COVID-19 vaccines for facility clients, ICF-IID clients, and staff serving both populations. It also requires that vaccines, when available, be offered to all residents, clients, and staff, and the LTC facilities must report COVID-19 vaccination status of residents and staff to the Centers for Disease Control and Prevention (CDC). While reporting is not required for ICF-IID, voluntary reporting is “strongly encouraged.”
CMS notes that immunization education, delivery, and reporting for influenza and pneumococcal vaccines are currently part of LTC facilities’ infection control and prevention plans and that LTC facilities are also required to provide education on influenza and pneumococcal vaccines and to allow residents the ability to accept or refuse the vaccines. Therefore, CMS notes, to “standardize” COVID-19 infection control and prevention, the agency is issuing those same requirements for COVID-19 vaccine education, vaccination, and reporting of vaccinations for LTC facility residents and staff.
For the purposes of COVID-19 vaccine education, offering, and reporting, we consider LTC facility staff to be those individuals who work in the facility at least once a week. Those staff members must be educated about the benefits and risks, as well as potential side effects, of the COVID-19 vaccine. CMS is encouraging facilities to educate the staff even further by discussing the development of the vaccine, how the vaccine works, and the particulars of the multi-dose vaccine series. Through the education, staff should be instructed about the importance of the vaccine for residents, their personal health, and community health.
CMS notes that CDC and the Food and Drug Administration (FDA) have developed a variety of clinical educational and training resources for health care professionals related to COVID-19 vaccines, and CMS recommends that nurses and other clinicians use those resources as sources of information for their vaccination education initiatives. For example, the “LTC Facility Toolkit: Preparing for COVID-19 Vaccination at Your Facility” has information and resources for both staff and residents.
The rule also notes that providers who manage Medicare and/or Medicaid participating congregate living settings (such as psychiatric hospitals or PRTFs) or settings in which Medicaid-funded HCBSs are provided (ALFs, group homes, shared living/host home settings, supported living settings, and others) are encouraged to voluntarily engage in the provision of the culturally and linguistically appropriate and accessible education and vaccine-offering activities.
As it is an interim final rule with comment period, CMS is seeking public comments on the potential application of these requirements (or others) to other congregate living settings over which CMS has regulatory or other oversight authority.
CMS notes that “some other congregate living settings, such as dormitories, prisons, and shelters for people experiencing homelessness, have also faced higher risks of disease transmission, [but] these settings are not within our scope of authority.” Therefore, the comments CMS is seeking should focus on the feasibility of implementing vaccination policies for other Medicare/Medicaid participating shared residences in which one or more people reside such as but not limited to the following: Psychiatric residential treatment facilities (PRTFs), psychiatric hospitals, forensic hospitals, adult foster care homes (AFC homes), group homes, assisted living facilities (ALFs), supervised apartments, and inpatient hospice facilities.
Specifically, CMS is interested in comments on potential barriers that facilities may face in meeting the requirements, such as staffing issues or characteristics of the resident or client population, as well as potential unintended consequences.
Comments must be received by 5 PM on July 12, 2021.