Medicare Compliance & Reimbursement

CMS plans to issue finalized guidance in October.

As COVID cases trend ever upward, the feds try to reset the playing field with another vaccination mandate. Read on for details.

Refresher: Last month, 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. The Aug. 18 nursing home mandate followed a Department of Health and Human Services (HHS) vaccination requirement for all HHS healthcare workers and auxiliary agencies’ health workforce, noted an Aug. 12 release (see Medicare Compliance & Reimbursement, Vol. 47, No. 15).

Now: 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.

Here’s Why the Feds Are Ramping Up Vax Efforts

The Delta variant has been pummeling the U.S., and “COVID-19 cases, hospitalizations, and deaths have generally increased throughout most of the country since the beginning of summer,” cautions the Center for Disease Control and Prevention (CDC) in its weekly COVID summary on Sept. 10. Lackluster vaccination rates are causing the spikes, the CDC suggests.

According to CMS data, nursing homes with vaccination rates below 75 percent have more preventable COVID cases. Another issue: CMS “is seeing lower staff vaccination rates among hospital and End Stage Renal Disease (ESRD) facilities,” and it wants to “use its authority to establish vaccine requirements for all providers and suppliers that participate in the Medicare and Medicaid programs,” the 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.”

Details: Though CMS’ requirement is fairly straightforward, the implementation of this latest vaccination rollout is fuzzy. Medicare providers who receive federal funding must comply, but an interim final rule isn’t expected until October to explain a timeline, costs, or how this mandate will impact CoPs.

The Biden administration has tasked the Occupational Safety and Health Administration (OSHA) with devising another Emergency Temporary Standard (ETS) for this latest plan, explains a White House release. This new ETS will likely build on OSHA’s June update on COVID-19 safety requirements and hopefully offer providers more guidance on how to implement the mandate.

Caveat: “The Plan does not establish the timeline for the ETS to be issued nor does it address details about important questions, including how employers should verify employee vaccination status, how medical and religious exemptions should be addressed, who pays for the weekly testing for employees who are unvaccinated and whether that testing time must be compensated,” points out law firm Hall Render in online analysis.

“There are many more questions than answers at this point, and it may remain that way until the ETS and CMS Final Rule are issued,” Hall Render surmises.

Industry organizations like the AMA, the American Hospital Association (AHA), and the National Hospice and Palliative Care Organization (NHPCO) have long advocated for this mandate, but the groups are waiting for more information to be released before lending their opinions.

“Ensuring hospitals, dialysis, home health, and ambulatory surgical centers also require vaccinations … will help us reach vaccination thresholds necessary to defeat COVID-19. We look forward to reviewing and providing input on the Administration’s full plan,” says AMA President Gerald E. Harmon, MD, in a statement on the mandate.