The U.S. Centers for Medicare & Medicaid Services (CMS) announced a new emergency regulation Wednesday requiring staff COVID-19 vaccinations within all nursing homes reimbursed by Medicare and Medicaid.
Up until now, health care providers in many states have been left to develop their own in-house vaccination policies for workers. In some instances, however, health care providers across the continuum of care have had to adhere to state-mandated vaccine policies.
Wednesday’s announcement from CMS was made in collaboration with the U.S. Centers for Disease Control and Prevention (CDC). No other health care settings serving older adults, including home health care, were mentioned.
“Keeping nursing home residents and staff safe is our priority,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “The data are clear that higher levels of staff vaccination are linked to fewer outbreaks among residents, many of whom are at an increased risk of infection, hospitalization or death.”
Overall, there are more than 15,000 nursing homes that participate in the Medicare and Medicaid programs. Effectively, making COVID-19 vaccinations a requirement suggests nursing homes could be cut off from reimbursement within those two channels if they do not comply.
“If you visit, live or work in a nursing home, you should not be at a high risk for contracting COVID from unvaccinated employees,” President Joe Biden said in a White House address.
So far, different health care settings have seen varying vaccination rates, with home health care often being cited among the least vaccinated sub-sectors. As with the general population, all corners of the health care world have seen a small portion of the workforce firmly against getting vaccinated.
If nursing homes are pressured into implementing mandatory vaccination policies, operators may ultimately see their vaccine holdouts leave for other health care jobs, industry insiders fear.
“Focusing only on nursing homes will cause vaccine hesitant workers to flee to other health care providers and leave many centers without adequate staff to care for residents,” Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), said in a statement. “It will make an already difficult workforce shortage even worse. The net effect of this action will be the opposite of its intent and will affect the ability to provide quality care to our residents.”
Leaders from LeadingAge similarly noted that vaccinations should be required for health care workers in all settings.
“[To] penalize nursing homes by withholding or withdrawing funding is not the right way to increase vaccination rates,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement. “Without Medicaid and Medicare funding, nursing homes cannot provide the quality care that our nation’s most vulnerable older adults need.”
As of Aug. 8, about 62% of nursing home staff were vaccinated, with vaccination rates ranging from a high of 88% in some states to a low of 44%.
The new emergency regulation for Medicare and Medicaid nursing homes comes as the Delta variant spreads, leading to a rise in COVID-19 cases among nursing home residents. Nursing home cases have jumped from a low of 319 on June 27 to nearly 2,700 cases on Aug 8, according to CMS.
“As we advance these new requirements, we’ll work with nursing homes to address staff and resident concerns with compassion and by following the science,” Brooks-LaSure added.
While home health providers weren’t part of the CMS announcement, it could produce a trickle-down effect on the referral front as well.
Since the pandemic started, many facilities have been reluctant to open their doors to outside staff. Linking vaccination status to reimbursement is likely to exacerbate those anxieties, especially for home health providers with poor vaccination rates among workers.
As of last week, nearly one-quarter of all U.S. hospitals required staffers to get a COVID-19 vaccine.
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