The Centers for Medicare & Medicaid Services (CMS) is now requiring long-term care facilities to report the weekly COVID-19 vaccination status of residents and staff, with the goal of monitoring vaccine uptake and identifying facilities in need of resources or assistance to respond to the pandemic.

The interim final rule, announced Tuesday, will require long-term care facilities to report weekly COVID-19 vaccination data of both residents and staff to the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN).

Nursing homes already are required to report COVID-19 testing, case, and mortality data to NHSN for staff and residents. The vaccination data requirement also applies to intermediate care facilities for individuals with intellectual disabilities (ICF-IID).

“Today’s announcement directly aids nursing home residents and people with intellectual or developmental disabilities who have been disproportionately affected by COVID-19,”  Dr. Lee Fleisher, CMS chief medical officer and director of CMS’ Center for Clinical Standards and Quality (CCSQ), said in a press release announcing the requirement. “Our goal is to increase COVID-19 vaccine confidence and acceptance among these individuals and the staff who serve them.”

CMS will post facility-specific vaccination status information reported to the NHSN on its COVID-19 Nursing Home Data website, and the agency is also seeking comment on opportunities to expand reporting requirements, “to help encourage vaccine uptake and access in other congregate care settings, such as psychiatric residential treatment facilities (PRTFs), group homes and assisted living facilities.”

Enforcement will be similar to requirements around influenza and pneumococcal vaccines, with civil money penalties (CMPs) imposed for failing to report vaccination data, CMS said in the rule.

According to the interim final rule from CMS, while many long-term care facilities across the U.S. are educating staff, residents, and resident representatives on COVID-19 vaccination, participating in vaccine distribution and voluntarily reporting vaccination data, “participation in these efforts is not universal.”

Specifically, internal CDC data indicate that about 2,500 Medicare or Medicaid-certified long-term care facilities, or about 16% of such facilities, did not participate in the pharmacy partnership program for COVID-19 vaccinations, CMS wrote.

Nursing home operators consistently reported that staff vaccine uptake lags that of residents; an early CDC study revealed that out of 11,460 SNFs with at least one vaccination clinic in the first month of the partnership, a median of 37.5% of staff members received a dose, compared with a median of 77.8% of residents.

The two largest nursing home trade groups, the American Health Care Association, and LeadingAge, in February, announced a goal of achieving a staff vaccination rate of 75% by the month of June, through a combination of education initiatives and campaigns.

While some states ended up crafting their own plans for COVID-19 vaccination in nursing homes, such as West Virginia, CMS believes that more action can be taken given the current COVID-19 incidence among long-term care residents.

Under the interim final rule, every SNF and ICF also must have a vaccination program that meets the needs of residents and staff, as well as resident representatives and family members, and provide COVID-19 vaccines, when available, to all residents and staff who choose to receive them. An SNF’s vaccination policies and procedures have to be part of its infection prevention and control (IPC) program, according to the rule.

CMS noted that long-term care facilities do not have to provide COVID-19 vaccines directly, though they are allowed to do so.

“Consistent vaccination reporting by LTC facilities via the NHSN will help to identify LTC facilities that have potential issues with vaccine confidence or slow uptake among either residents or staff or both,” the agency wrote.

The rule defines LTC facility staff as individuals who work in the facility on a regular, or at least weekly, basis.

“We are requiring that LTC facility staff (that is, individuals who work in the facility on a regular basis) be educated about the benefits and risks and potential side effects of the COVID-19 vaccine,” CMS wrote. “Educating staff further about the development of the vaccine, how the vaccine works, and the particulars of the multi-dose vaccine series is encouraged but not required.”

The agency also noted that because of the high turnover among long-term care facility workers, COVID-19 vaccination will be an ongoing issue for SNFs.

“Even if two-thirds of all newly hired staff and newly admitted residents have been vaccinated when they start employment or begin residency, turnover is so high that we estimate an excess of two million persons may still need vaccination in the first year after this rule takes effect,” the agency wrote. “It is critically important that facilities are required to continue to offer vaccination to their residents and staff on an ongoing basis.”

LeadingAge President and CEO Katie Smith Sloan, whose group represents nonprofit senior living and care providers, said in a statement that the association encourages vaccination for all staff and residents, as well as encouraging providers to report this information.

“But to meet CMS’ goal of increased vaccination rates, more must be done,” she said. “There are varied and valid reasons — that are out of providers’ control — why residents, families, and staff may not yet feel comfortable with vaccines … Continued education about and support for vaccines must come from many different voices to achieve success.
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