Elevating the Post-Acute and
Long Term Care Profession

May 20, 2021

Vaccination Education Requirements. On the eve of the new Centers for Medicare and Medicaid Services (CMS) COVID-19 vaccination rule taking effect, we are highlighting the vaccine education requirements for SNFs and ICFs/IID. While the vaccination reporting requirements for SNFs (strongly encouraged for ICFs) have received the most attention, providers also must comply with the education requirements. Many undoubtedly already are in compliance, but it is worth a review to make sure.

First of all, it is important to note the definition of staff for the rule's education and vaccine offering requirements is different than it is for SNF testing. The rule definition includes personnel (who can be employees, contractors, or volunteers) who enter the facility at least once a week, not individuals who come in less frequently.

The education requirements for both SNFs and ICFs are very similar and are stated in summary form in the regulatory text, but the preamble contains more detail. See pages 27-33 for SNFs and 40-44 for ICFs. Additional information is available in QSO-21-19-NH, which applies only to SNFs. Facility policies and documentation must address the required elements of the education, which include:

  • Benefits "such as reduced risk of COVID-19 illness and related serious COVID-19 outcomes, including hospitalization and death, the bolstered protection offered by completing a full series of multi-dose vaccines if used, and other benefits identified as research continues. Early data also suggests that vaccination offers reduced risk of inadvertently transmitting the virus to patients and other contacts."
  • Risks such as common side effects and rare reactions like anaphylaxis. "The low likelihood of severe side effects should be included in this education."
  • The need for and value of a second dose, if required for the specific vaccine.
  • QSO 21-19 specifies that everyone must be provided a copy of the Emergency Use Authorization fact sheet for the vaccine. CMS lists a number of other resources for vaccination education in the rule preamble.
  • Ongoing opportunities for vaccination if the person misses a clinic or changes their mind.
  • For staff, CMS writes, "[f]acilities can determine where they keep the documentation that demonstrates educational efforts and offering the vaccine to staff. Some examples of evidence of compliance may include sign in sheets, descriptions of materials used to educate, summary notes from all-staff question and answer sessions. There may be posters and flyers announcing appointments for vaccine clinic days or other opportunities to be vaccinated." 
  • For residents and their representatives, CMS adds requirements to explain risks and benefits in a way they can understand and to document their consent or assent to vaccination.
  • The preamble specifically requires informing residents/representatives that vaccinations are at no cost to them.
  • Another specific requirement for residents and representatives is the opportunity to ask questions.
  • For ICFs, the preamble specifies that staff education should cover "culturally appropriate ways to educate and share information with clients to prevent misinformation, confusion, or loss of credibility."
  • The documentation must show that each staff person and resident/representative has been educated.

Neither the rule itself nor the preamble specifies a frequency with which staff or residents who previously refused the vaccine must be re-educated, which suggests that re-education is not required, although it obviously may be helpful in convincing someone who is a "soft refusal."

Additional NHSN Vaccination Reporting Training Opportunities. Speaking of the vaccination reporting requirement for SNFs, there are two more opportunities to view a recording of the National Healthcare Safety Network's (NHSN's) webinar on the reporting module. These replays are at 3:30 p.m. on Tuesday, May 25, and Thursday, May 27. You may register for either session at this link.

Do Staff Have the Right to Refuse Vaccinations Under the New Rule? In both the SNF and ICF sections, the new CMS vaccination rule contains nearly identical requirements that facility policies must specify that "[t]he resident, resident representative, or staff member has the opportunity to accept or refuse a COVID-19 vaccine, and change their decision ...." The preamble, however, very clearly states that the resident (or client, the term CMS uses for ICFs) has the right to refuse, a stronger term than "opportunity." There is no such rights language for staff. CMS provides the answer in QSO 21-19 by restating the resident's right to refuse and following it with, "[f]acilities should follow state law and facility policies with respect to staff refusal of vaccination." At the present time, Ohio law does not give staff the right to refuse. While QSO 21-19 applies to SNFs and not to ICFs, CMS's interpretation of near-identical language in the SNF regulation would seem to carry over to ICFs.

Self-Insured Providers and Testing Costs. Earlier this spring, the Department of Aging offered SNFs that are self-insured for health care coverage an opportunity to submit documentation to a portal to support reimbursement for COVID-19 testing costs paid by the self-insurance plan. This opportunity was limited to paid claims from state-assigned labs, not labs selected and contracted by the provider. If your organization or facility is self-insured and paid claims for mandated testing at a non-state-assigned lab, please email Pete Van Runkle. We are attempting to quantify the scope of this situation among OHCA members.

APSI Asks Providers to Register Clients for Vax-a-Million. Kristen Henry of Advocacy and Protective Services, Inc. (APSI), guardian for many Ohioans with disabilities, asked us to encourage providers to register vaccinated people for the state's Vax-a-Million contest. Her message stated:

[W]e are hoping to get your help to register APSI's clients for the vaccine lottery. Because we don't have information about where most of our clients received the vaccine, we are wondering if providers would be willing to register our clients with that information. If so, I have provided information below that can be used for that registration.

If providers are not able to assist, I completely understand, especially given the current staffing situation. Please just let me know what you would suggest for us to cooperatively make this happen as efficiently as possible.

I also just want to thank all of you again for the amazing work you, your members, and your DSPs are doing every day. Our clients are especially dependent on your services and we are so grateful for your commitment to meeting their needs.

APSI Consent and Instructions re Ohio Vax-a-Million

APSI appreciates the support of providers and staff who are able to assist in registering APSI clients for the Ohio Vax-a-Million lottery. This email serves as my consent on behalf of APSI for staff to check the required boxes to accept the official rules and allow ODH to verify vaccination information. Since the rules require a legal guardian's approval to accept a prize, please use my email address (kristen.henry@apsiohio.org) and direct phone number (614-300-9800), but use the client's name, date of birth, mailing address, and vaccine information.

If an APSI client wins a prize, APSI will make a request to the probate court for the appointment of a guardian of the estate, and APSI will work with the guardian of the estate to establish any trust, STABLE account, or other financial planning options that are in the individual's best interests.

Long-Term Care COVID-19 Cases Creep Up Slightly. This week's Department of Health dashboard on COVID-19 cases in long-term care showed a small increase from last week, from 311 total current cases to 324. Unfortunately, this change was driven by resident cases, which increased by 40, more than offsetting at 27-case reduction for staff. Staff cases still make up 56% of the total.

NIH to Host Monoclonal Antibodies Facebook Live Event (from AHCA/NCAL). The National Institutes of Health (NIH) has updated the guidance on monoclonal antibodies (mAb) to treat COVID-19. Ms. Cicely Waters, Dr. Raj Ganhdi, and Dr. H. Clifford Lane will discuss the April 2021 guidelines  released by the NIH COVID-19 Treatment Guidelines Panel on the use of the mAb.    

The webinar will be held on Wednesday, May 26, 2021 at 10 AM ET/7 AM PT and can be accessed via Facebook

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