News From the August 25th National NH Stakeholder Call

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

If you missed this National Stakeholder Call, it will be available on the CMS Podcasts and Transcripts website when the recording and transcript is finalized.  In the interim, I’m passing along what I heard during the 30-minute Zoom call so you have an idea of what to expect in the next month from CMS and CDC regarding mandatory NH staff vaccination.  For background information or to refresh your memory, please review my August 18, 2021 blog – President Biden’s directive on NH staff vaccination. 

If you’ve been on previous National NH Stakeholder calls, you recognized Jean Moody-Williams, Deputy Director of CMS’s Center for Clinical Standards & Quality.  She kicked-off the call with these comments:

  • The FDA approval of the Pfizer COVID-19 vaccine, to be marked under the name of Comirnaty.
  • Reporting of staff vaccination via NHSN and the current rate of about 60% vaccination of staff is a real concern.
  • CMS is in the process of developing policy/regulations regarding staff mandates
    • CMS intends to issue regulations “sometime in late September”
    • There will be another National NH Stakeholder Call before that regulation is released
  • CMS is not allowed to answer many questions (throughout the call, Jean and Evan Shulman spoke to seeing listener questions in the Q&A box with Jean noting that while they were not allowed to answer questions during rulemaking, those questions were very helpful in guiding CMS as they progress through rulemaking).
  • Enforcement of the regulation for staff vaccination mandate will be the same as current enforcement for regulatory non-compliance which is progressive enforcement.  Termination of participation in the Medicare/Medicaid programs will not be the 1st action/remedy.
  • CMS is hearing concerns about staff leaving because of the mandate and is aware that there are many large corporations, healthcare and non-healthcare, that are mandating vaccination of their employees and others that are not mandating vaccination so there could be inequity between employers.  “Because of the absence of a national standard there could be inequities among nursing homes that impact the level of care provided to residents.”  Jean noted that staff should feel safer in a facility where vaccination is mandated. 
  • Booster/3rd doses are now recommended and will likely start in the fall and at least 8 months after the 2nd dose.  More information will be release on this soon.
  • Medicare beneficiaries can now receive vaccinations at home or in small communal settings.

Dr. Nimalie Stone of the CDC spoke to an ample supply of COVID-19 vaccines as well as continuing all infection prevention and control mitigations.

Kara Slifka of the CDC recommended wearing masks during visitations, especially when visitations are held outside of the resident’s room. 

Monica Schroeder of NHSN (CDC) addressed the 2 new questions (#4 and #5) added to NHSN data collection this week regarding vaccinations.  Monica was one of the presenters for the NHSN webinar on these new questions just an hour or so before the National Stakeholder Call.  You can find that slide set here.

Evan Shulman, Director of CMS Division of Nursing Homes ended the call with these comments:

  • The Federal law that prohibits government agencies from discussing rules during the rulemaking process is the Administrative Procedures Act.  (This was news to me – to have the specific name of the law – as I had always heard that agencies couldn’t comment during rulemaking but never heard a name of the actual law.)
  • The upcoming regulation should “help level the playing field”.
  • Before late December 2020, resident COVID cases were much higher than staff cases … now that incidence is reversed.  More residents are vaccinated than are staff at this time, so staff cases are considerably higher.

Community cases impact cases in the NHs.  It is critical to get staff vaccinated.