CMS Releases New QSO on Nursing Home Vaccine Mandate

Posted on October 27, 2022 by Kari Everson

On Oct. 26, the Centers for Medicare and Medicaid Services (CMS) released QSO 23-02-ALL, replacing QSO 22-07-ALL and QSO 22-11-ALL. The new version revises guidance for staff vaccination requirements and includes multiple attachments for each provider type. Nursing homes should continue to refer to Attachment A.

Update to Enforcement Actions

The facility vaccination rate for compliance continues to be 100% of all staff who do not have a qualifying medical or religious exemption. Organizations that are under that percentage and considered non-compliant may not be subject to enforcement actions if there is a plan to achieve a 100% staff vaccination rate and that plan is implemented. 

Discretion to Choose Additional Precautions

Additional infection prevention and control precautions are required for staff with an approved medical or religious exemption. The memo clarifies that the organization can choose which additional precautions to implement. There are no choices listed in this QSO as in previous QSO memos. Nursing homes should ensure these additional precautions should be determined based on the organization's assessment of the best interventions to mitigate the transmission and spread of COVID-19 for all staff who are not fully vaccinated.

Surveyor Guidance Updated

Vaccine mandate surveys will occur during initial certification surveys, standard recertification surveys, and only for complaint surveys where the complaint explicitly alleges noncompliance with the vaccine mandate. Surveyors have the discretion to verify the accuracy of NHSN data on surveys based on a complaint alleging the organization is not following the vaccine mandate. Procedures for doing this are updated and available in the surveyor resources folder found on the CMS website. Surveyors are directed to also survey at F880 to check for adherence to appropriate infection control practices regardless of the organization's compliance with the vaccine mandate.

Citing Scope and Severity

If the organization is out of compliance with the vaccine mandate, the surveyors will cite the deficient practice at F888. CMS further dictates the scope and severity of the citation with a severity level of one and a scope of C. This survey citation will be based on the failure of the organization to implement the appropriate policies and procedures per the vaccine mandate. This scope and severity level would change to level two with a scope of F only if there were significant noncompliance where it appears the organization disregarded the mandate altogether.

If you have additional questions, please contact Kari Everson.