Lieutenant Commander Kara Jacobs-Slifka, MD, MPH, of the Centers for Disease Control and Prevention (CDC) joined the LeadingAge Nursing Home Advisory Group on February 22 to discuss healthcare setting and nursing home recommendations.

CDC Recommendations for Healthcare Settings and Nursing Homes

CDC updated recommendations for healthcare settings and nursing homes on February 2. Lieutenant Commander Kara Jacobs-Slifka reviewed changes to quarantine and isolation recommendation, the use of N95 respirators, and the recent switch to “up to date / not up to date” to describe vaccination status. LeadingAge notes that while CMS often defers to CDC recommendations, CMS guidance documents and regulation have generally not been updated to reflect the new vaccination status language.

Jacobs-Slifka noted that a “test out” option has been added to quarantine recommendations for residents and clarified that visitors to the nursing home should follow resident guidelines for the duration of quarantine and isolation in determining when it is safe to visit after infection or exposure. Jacobs-Slifka discussed that while N95 respirators generally provide a greater level of protection than a surgical mask, either option is recommended for source control and unvaccinated staff in a healthcare setting could opt to utilize an N95 respirator as an additional precaution to mitigate the spread of COVID-19.

In addition to reviewing these changes, Jacobs-Slifka discussed the rationale behind recommendations. Increased transmissibility of the omicron variant necessitated many of these changes as CDC continues to evaluate the impact on healthcare settings. Jacobs-Slifka acknowledged that some recommendations feel like a step back, such as the recommendation to test all new admissions and readmissions to the nursing home regardless of vaccination status.

Because omicron spreads so quickly, it has become necessary to once again consider that individuals have a higher likelihood of exposure in certain situations. Jacobs-Slifka noted that although recommendations around outbreak testing have not changed and providers may continue to use a contact tracing-based approach to inform outbreak testing, providers may be better served by a broader approach of testing an entire unit or nursing home if feasible to get ahead of the spread.

CDC has further updated recommendations to follow up negative antigen tests in symptomatic individuals with a nucleic acid amplification test (NAAT) to confirm COVID status, while advising that antigen tests may be preferred for testing individuals with previous COVID infection in the past 90 days to avoid positive results in individuals who are no longer contagious.

Jacobs-Slifka reiterated that while CDC continues to evaluate recommendations for healthcare settings and nursing homes, recommendations remain more conservative than general public health recommendations due to the relative fragility of the populations served by these settings.

Policy Updates

Testing of Unvaccinated Staff While CDC’s updated recommendations include testing of all staff who are not up to date with COVID-19 vaccination, the CMS requirements still call for testing of unvaccinated staff. CMS has confirmed that nursing homes should continue to follow the testing requirements outlined in CMS memo QSO-20-38-NH-REVISED, last updated in September 2021, that currently requires routine screening testing of unvaccinated staff.

Vaccine Status of Contractors – Attestations The CMS vaccine mandate requires nursing homes to have a process for tracking and securely documenting the vaccination status of all staff, including contractors. CMS has clarified that providers will not be expected to maintain proof of vaccination on-site for contractors, provided the identified process enables them to continue to meet requirements. As a result, many providers have begun to incorporate attestations into this process. CMS clarified in conversation with LeadingAge and other stakeholders that acceptable attestations must be specific to the individual staff member and the staff member’s vaccination status and blanket attestations will not be sufficient.

CMS Surveyor Resources The CMS surveyor resources have been updated to include the CMS vaccine mandate. Updated documents include the entrance conference worksheet, F888 staff matrix, and long-term care survey process procedure guide. Resources are available in the “downloads” section of the CMS Quality, Safety & Oversight Group Nursing Homes page.

CMS Expectations for Surveying Vaccine Mandate CMS released memo QSO-22-12-ALL on February 9 reminding state survey agencies of responsibilities to survey to the fullest extent of requirements. It is assumed that this memo comes in response to various states vowing not to enforce the CMS vaccine mandate. The memo advises states that those who fail to fulfill obligations may see budget cuts and, as necessary, CMS will enlist contractors to complete survey activities. Providers should be advised that a state ban on mandates or refusal to enforce the mandate will not relieve the provider from the federal requirement.

Visitation FAQ Update CMS updated the Nursing Home Visitation FAQs located at the end of CMS memo QSO-20-39-NH-REVISED on February 2. Updates include best practices to improve air quality and air flow during visitation, an announcement that providers may apply to states for CMP funds for environmental changes to reduce transmission of COVID-19, and clarification that nursing homes required by the state to test visitors for COVID-19 prior to entry may do so but may not deny visitation due to a lack of testing.

Provider Relief Fund Reporting Provider Relief Fund second period reporting is due March 31. This report will reflect funds received from July 1, 2020 to December 31, 2020. The Human Resources & Services Administration (HRSA) presented a webinar for LeadingAge members on February 2 and for the general public on February 17. For more information, check out the HRSA Provider Relief Fund reporting site.

Kronos Ransomware Attack and PBJ Reporting In recognition of the impact of the Kronos ransomware attack that occurred in December 2021, CMS has announced that providers impacted by this attack will not be penalized for missing payroll-based journal (PBJ) data submissions during the impacted timeframe (mid-December through mid-January). CMS urges providers to upload all available data by March 31, as data will be utilized to calculate the new staff turnover quality measure beginning in July 2022.

Coding National Guard in PBJ CMS has clarified that National Guard, Medical Reserve Corps, and other volunteers providing emergency staffing support can be coded and reported through PBJ. Volunteer hours should be coded according to the appropriate credentials of the volunteer and duties performed during their time in the nursing home. CMS further clarifies that in order to report these hours, the nursing home must have written documentation from the assisting group verifying the names and hours of the individuals working in these capacities.

LeadingAge Leadership Summit Registration is now open for the LeadingAge Leadership Summit. This 3-day event is scheduled for March 28-30 in Washington, DC and will include opportunities to advocate with members of Congress. Go here to learn more and register for this event.

Member Feedback

As CDC continues to revise recommendations, nursing home providers are struggling to navigate the areas between state requirements, federal recommendations, and public expectations. Some expressed frustration with a seeming inconsistent application of recommendations across healthcare settings, noting that resident exposure to COVID-19 in these settings due to this inconsistency is a greater risk than exposure during a therapeutic (social) leave of absence from the nursing home. Members also shared early experiences with surveys on the vaccine mandate.

The LeadingAge Nursing Home Advisory Group call takes place on the last Tuesday of every month. If you are a LeadingAge nursing home member and would like to join this group, please email Jodi Eyigor jeyigor@leadingage.org. Our next monthly call will take place Tuesday, April 26 at 2pm ET.