CMS Issues Updated Vaccine Mandate Survey Guidance

Centers for Medicare and Medicaid Services (CMS) has posted updated interpretive guidance concerning the staff vaccination mandate, with a revision date of April 5. We encourage care centers to review QSO 22-07-ALL (Revised) and the changes to Attachment A.

In the updated, CMS does the following:

• Revises the definition of “Temporarily delayed vaccination” to include known COVID-19 infection until recovery from the acute illness (if symptoms were present) and criteria to discontinue isolation have been met.
• Indicates that facility staff who have been suspended or are on extended leave, such as FMLA or worker’s compensation leave, would not count as unvaccinated staff for determining compliance.
• Confirms that Attachment A's list of “additional precautions” with unvaccinated staff is not explicit or all-inclusive. The list identifies actions that can be taken; however, facilities can choose other precautions that support mitigation of the transmission and spread of COVID-19 for all staff who are not fully vaccinated.

Notably, CMS has not updated the definition of “fully-vaccinated.” Attachment A states that this term refers to staff for whom it has been two weeks or more since the completion of their primary vaccination series for COVID-19.

CMS also addresses the survey process for F888, including that surveyors may modify the staff vaccination compliance review if a facility was determined to be in substantial compliance with this requirement within the previous six weeks. Given the high level of survey activity in Minnesota, we have been concerned that surveyors would be doing a complete review for compliance with the vaccination mandate on every visit. This update suggests that may not be the case. This would be good news, and we will work to obtain additional information. Also, as MDH has shared previously, CMS is confirming here that contract staff must provide evidence of vaccination status, under the requirement to ensure that all staff are fully vaccinated, except for those with exemptions or a temporary delay.

Please contact Jonathan Lips or Kari Everson with any questions about this new material from CMS.

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