The Biden administration announced yesterday that his administration will require COVID-19 vaccinations for workers in most health care settings that receive Medicare or Medicaid reimbursement. NAHC is currently studying the administration’s announcement and we look forward to receiving more details in the very near future.
“NAHC has encouraged vaccinations throughout the pandemic. We look forward to seeing the details of the President’s Executive Order,” said NAHC President Bill Dombi in response to the news.
That said, we believe the policy will include, but is not limited to:
- home health agencies
- dialysis facilities
- ambulatory surgical settings.
According to the White House, these requirements will apply to approximately 50,000 providers and cover over 17 million health care workers, a majority of health care workers across the country. “This action will create a consistent standard across the country, while giving patients assurance of the vaccination status of those delivering care,” said the White House in a statement released Thursday.
The Administration’s plan is to include the mandate as part of the federal Medicare Conditions of Participation (CoPs). The CoPs also affect state Medicaid programs as federal requirements incorporate those standards into the conditions under which states are entitled to receive federal matching supports for a state’s Medicaid spending.
In response to a question from NAHC President Bill Dombi, the CMS told NAHC that the “staff vaccination requirement would only apply to Medicare and Medicaid-certified provider and supplier types that are regulated under the Conditions of Participation. If an entity is not regulated under the CoPs, then this requirement would not apply.”
Noncompliance with the Conditions of Participation can trigger a range of penalties including termination from Medicare and/or Medicaid, Civil Monetary Penalties as high as $20,000 per day, suspension of Medicare and/or Medicaid payments, and the insertion of temporary management.
Notably for Medicaid home care, not all providers are subject to CoPs. Federal Medicaid standards specify CoP application only for “home health services” and “hospice” care. While states can require other home care services to be provided through entities that meet Medicare CoPs, most do not. This means that the vaccination mandate is not likely to apply to a host of Medicaid home services such as private duty nursing, personal care services, home and community-based services (HCBS) optional services for the elderly, and section 1915 waiver programs for HCBS.
CMS is developing an Interim Final Rule with Comment Period that will be issued in October to lay out the vaccination requirements for health care providers. Nevertheless, CMS expects Medicare and Medicaid facilities to comply with the new vaccination requirements now and health care workers in covered facilities are being urged to begin vaccination without further delay. Facilities are urged to use all available resources to support employee vaccinations, including employee education and clinics, as they work to meet new federal requirements.
“There is no question that staff, across any health care setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health,” said Xavier Becerra, Secretary for Health & Human Services. “Ensuring safety and access to all patients, regardless of their entry point into the health care system, is essential.”
Additionally, the Department of Labor, through the Occupational Safety and Health Administration (OSHA), will issue an Emergency Temporary Standard requiring all businesses with more than 100 employees to either mandate vaccinations for all workers or require them to take weekly COVID-19 tests. Each violation of the OSHA standard could trigger a $14,000 penalty. The White House believes the OSHA standard will cover 80 million workers, or two-thirds of the nation’s workforce.
The announcement leaves some important questions unanswered. Such as:
- When will Interim Final Rule and the OSHA Emergency Temporary Standard be published?
- What will be the vaccination deadline for employees in the Interim Final Rule?
- What vaccination exemptions will exist in the Interim Final Rule?
- How will the vaccination exemptions be managed and monitored?
- How will employees be counted? Full-time, FTE, all individuals regarding duration of a workday?
- How will the mandate apply to franchise operations that individually do not have 100 employees, but exceed that number in combination?
- Are there other ways beside the federal CoPs that the Administration can use to expand the reach of the mandate?
- How does the mandate apply to self-directed care programs where the state or locality may be considered a joint employer?
- What are the penalties for non-compliance outside of the $14,000 penalty referenced for an OSHA requirement?
You can expect NAHC to be in frequent contact with the administration and health care officials to obtain answers to these questions. When we receive answers, we will pass them on to NAHC members as quickly as possible. Please stay tuned to NAHC Report and other NAHC communications for updates.
The home care, home health, and hospice sectors of our health care system already suffer from severe staffing shortages and here is the very real possibility of even more significant staffing shortages should workers walk off the job rather than submit to vaccination. Shortages in staff will inevitably impact patients and patient care. This is a delicate balancing act in trying to keep patients and the workforce safe. NAHC hopes the Biden administration couples this action with efforts to help providers attract and retain more employees.
This action by the Biden administration builds on the vaccination requirement for nursing facilities recently announced by the Centers for Medicare & Medicaid Services (CMS), and will apply to:
- nursing home staff
- hospital staff
- staff in other CMS-regulated settings
- clinical staff
- persons providing services under arrangements
- staff not involved in direct patient, resident, or client care.
Requiring Employers to Provide Paid Time Off to Get Vaccinated
OSHA is developing a rule torequire employers with more than 100 employees to provide paid time off for the time it takes for workers to get vaccinated or to recover if they suffer post-vaccination illness. This requirement will be implemented through the ETS.
New Support for Small Businesses Impacted by COVID-19
Small Business Administration (SBA) will increase the maximum amount of funding a small business can borrow through the COVID Economic Injury Disaster Loan (EIDL) program, which provides long-term, low-cost loans, from $500,000 to $2 million. (An SBA analysis of current COVID EIDL borrowers who qualify for the increase shows that more than 80 percent have 25 employees or less.)
SBA will ensure that no small business has to start repaying these loans until two years after they receive the funding, so small businesses can get through the pandemic without having to worry about making payments.
Next, SBA will make it easier for small businesses with multiple locations in hard-hit sectors like restaurants, hotels, and gyms to access these loans.
SBA will offer a 30-day exclusive window of access where only small businesses seeking loans of $500,000 or less will receive awards after the new improved loan product launches.
Paycheck Protection Program (PPP) Loan Forgiveness Process
The administration’s plan is to make it easier for more than 3.5 million PPP borrowers with loans of $150,000 or less to get their loans wiped clean. Under the new streamlined approach, SBA sends a pre-completed application form to the borrower who can review, sign, and send back to SBA, which then works with the lender to complete the forgiveness process.
SBA expects more than 2.5 million additional small businesses to take advantage of this streamlined process in the months ahead, helping them avoid needless bureaucracy and avoid costly principal and interest payments on their loans.
Launching Community Navigator Program to Connect Small Businesses to Assistance
The ARP invested $100 million to establish a new SBA Community Navigator program, which will deploy trusted community partners in underserved communities to better connect business owners to federal, state, and local resources. Community Navigators will work with small business owners every step of the way to ensure that they are able to access the help that they need. Under the President’s plan, the SBA will complete the competitive review process to select Community Navigators and put them to work in underserved communities this Fall.
Access to Booster Shots
The Administration is preparing for COVID-19 vaccine boosters to start as early as the week of September 20th, subject to authorization or approval by the FDA and a recommendation from the CDC’s Advisory Committee on Immunization Practices (ACIP). Booster shots will be free and are to be made available at 80,000 locations around the country.
The National Association for Home Care & Hospice has strongly communicated to HHS how important it is that shipments of booster vaccines be sent directly to home care providers, so that safe and efficient booster vaccinations of the elderly and disabled – the most at-risk population – can take place in the home. NAHC will continue to make this case and we will keep our members up to date on this critically important topic.
Affordable and Available At-Home Tests
Walmart, Amazon, and Kroger will offer to sell rapid at-home tests at-cost for the next three months. In addition, Medicaid must cover at-home tests for free for beneficiaries, and states should ensure that any tools they use to manage at-home testing do not establish arbitrary barriers for people seeking care. The administration also plans to expand the number of retail pharmacy sites around the country where anyone can get tested for free through the HHS free testing program to 10,000 pharmacies.
The administration is also urging:
- states to require school employees to be vaccinated;
- schools to set up regular testing in their schools for students, teachers, and staff consistent with CDC guidance.
Getting Monoclonal Antibody Treatment to Those Who Need It
The Administration will increase the average weekly pace of shipments of free monoclonal antibody treatment to states by a further 50 percent in September. Monoclonal antibody treatments have been shown to reduce the risk of hospitalization by up to 70 percent for unvaccinated people at risk of developing severe disease. As hospital systems experience increased COVID-19 cases, many have identified monoclonal antibody treatment as a key tool to improve health outcomes, prevent hospitalizations and reduce the strain on overburdened hospitals.
Expanding the Pool of Health Care Professionals Providing Treatment by Deploying Federal Monoclonal Antibody Strike Teams
The COVID-19 Surge Response Teams have conducted in-person technical assistance and virtual trainings for physicians and health system officials to increase education and interest in administering these treatments. To ensure that more patients can access these lifesaving COVID-19 therapeutics, the Administration’s COVID-19 surge response effort will launch monoclonal antibody strike teams to deploy clinical personnel through HHS, FEMA, and DOD to help hospitals and health systems stand up the delivery of this key treatment option. HHS will also take action to amend the Public Readiness and Emergency Preparedness (PREP) Act declaration to allow more providers, including pharmacists, to administer this treatment.
This is a critical topic for our industry and our country and NAHC is heavily engaged in both studying and communicating concerns on this topic. Please stay tuned for updates.