MDS Alert

Hint: Anyone over 18 living or working in a high-risk setting like long-term care is eligible.

Many long-term care facilities and other stakeholders have been juggling vaccination mandates along with resident well-being and staffing woes.

More information is now available for how federal agencies plan to make vaccination a requirement for healthcare staff, and the method encapsulates facilities.

Background: In August, the Centers for Medicare & Medicaid Services (CMS) issued a staff vaccination requirement for more than 15,000 Medicare and Medicaid-participating nursing homes, citing statistics that showed higher staff vaccination rates correlate to fewer residents contracting the virus.

On Sept. 9, the White House announced another round of COVID-19 vaccination mandates in its “Path Out of the Pandemic” action plan. “The Biden-Harris Administration will require COVID-19 vaccination of staff within all Medicare and Medicaid-certified facilities to protect both them and patients from the virus and its more contagious Delta variant,” CMS says in the release. “Facilities across the country should make efforts now to get health care staff vaccinated to make sure they are in compliance when the rule takes effect.”

Under this latest decree, CMS is expanding its emergency regulations to include “hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies, among others,” and making the vaccination requirement “a condition for participating in the Medicare and Medicaid programs,” an agency release says.

“As the Delta variant continues to spread, we know the best defense against it lies with the COVID-19 vaccine,” says CMS Administrator Chiquita Brooks- LaSure in a release. “Data show that the higher the level of vaccination rates among providers and staff, the lower the infection rate is among patients who are dependent upon them for care.”

Heads up: As of press time, CMS had yet to offer an implementation timeline or insight on how providers should deal with the costs associated with employee mandates. The agency also hasn’t mentioned how it intends to enforce the requirement in regard to Medicare Costs of Participation, but according to the release, an interim final rule is expected sometime in October to explain the logistics.

Residents Should Be Covered, Though

Although figuring out who’s responsible for paying for staff vaccination may still be tricky, you can rest assured that residents are still covered, even for their third injection, if they’re Medicare beneficiaries.

Context: On Sept. 22, “the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine to allow for use of a single booster dose, to be administered at least six months after completion of the primary series,” an FDA release said. The following individuals — who completed their first vaccination series at least six months ago — are recommended to receive a booster, according to Centers for Disease Control and Prevention (CDC) guidance:

• 65 years and older
• Age 18+ who live in long-term care settings
• Age 18+ who have underlying medical conditions
• Age 18+ who work or live in high-risk settings

Soon after the FDA and CDC updates, CMS announced again that it would fully cover COVID-19 vaccinations for Medicare beneficiaries, including the booster shots.

“The Biden-Harris Administration has made the safe and effective COVID-19 vaccines accessible and free to people across the country. CMS is ensuring that cost is not a barrier to access, including for boosters,” Brooks-LaSure said in a Sept. 24 release. “CMS will pay Medicare vaccine providers who administer approved COVID-19 boosters, enabling people to access these vaccines at no cost.”

The Medicare payment rates for a single dose of the “COVID-19 vaccines administered on or after March 15, 2021, additional doses of the COVID-19 vaccine administered to immunocompromised individuals on or after August 12, 2021, and booster doses administered to certain populations on or after September 22, 2021” are about $40 for single-dose vaccines and $40 for additional doses and boosters, CMS indicates in its COVID-19 vaccination payment guidance.

Resources: See the White House plan at www.whitehouse.gov/covidplan and review the CMS release at www.cms.gov/newsroom/press-releases/biden-harris-administration-expand-vaccination-requirements-health-care-settings.

Review Medicare guidance on vaccination administration at www.cms.gov/newsroom/press-releases/cms-will-pay-covid-19-booster-shots-eligible-consumers-can-receive-no-cost.

Review the FDA authorization at www.fda.gov/news-events/press-announcements/fda-authorizes-booster-dose-pfizer-biontech-covid-19-vaccine-certain-populations.

Find CDC guidance at www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html.