Please see the documents below.
FAQ Staff Vax Requirements 11.04.2021
CMS Press Release Staff Vaccines 11.04.2021
2021-23831
Vaccination-Requirements-Report
Please see the documents below.
FAQ Staff Vax Requirements 11.04.2021
CMS Press Release Staff Vaccines 11.04.2021
2021-23831
Vaccination-Requirements-Report
Long-Term Care (LTC) Facility COVID-19 Testing Requirements (QSO 20-38-NH, revised 9/10/2021)
Please read the memo carefully. CMS has revised testing requirements for nursing homes including testing of symptomatic residents and staff, and routine testing of staff. Two major changes are:
Table 1: Testing Summary
Testing Trigger |
Staff |
Residents |
Symptomatic individual identified |
Staff, vaccinated and unvaccinated, with signs or symptoms must be tested. |
Residents, vaccinated and unvaccinated, with signs or symptoms must be tested. |
Newly identified COVID- 19 positive staff or resident in a facility that can identify close contacts |
Test all staff, vaccinated and unvaccinated, that had a higher-risk exposure with a COVID-19 positive individual. |
Test all residents, vaccinated and unvaccinated, that had close contact with a COVID-19 positive individual. |
Newly identified COVID- 19 positive staff or resident in a facility that is unable to identify close contacts |
Test all staff, vaccinated and unvaccinated, facility-wide or at a group level if staff are assigned to a specific location where the new case occurred (e.g., unit, floor, or other specific area(s) of the facility). |
Test all residents, vaccinated and unvaccinated, facility-wide or at a group level (e.g., unit, floor, or other specific area(s) of the facility). |
Routine testing |
According to Table 2 below |
Not generally recommended |
Table 2: Routine Testing Intervals by County COVID-19 Level of Community Transmission
Level of COVID-19 Community Transmission |
Minimum Testing Frequency of Unvaccinated Staff+ |
Low (blue) |
Not recommended |
Moderate (yellow) |
Once a week* |
Substantial (orange) |
Twice a week* |
High (red) |
Twice a week* |
+Vaccinated staff do not need to be routinely tested.
Please see the full memo for complete details at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/interim-final-rule-ifc-cms-3401-ifc-additional-policy-and-regulatory-revisions-response-covid-19-0.
Interim Final Rule – COVID-19 Vaccine Immunization Requirements for Residents and Staff
CMS has issued QSO-21-19-NH, which outlines the Interim Final Rule – COVID-19 Vaccine Immunization Requirements for Residents and Staff. This rule establishes Long-Term Care (LTC) Facility Vaccine Immunization Requirements for Residents and Staff. This includes new requirements for educating residents or resident representatives and staff regarding the benefits and potential side effects associated with the COVID-19 vaccine, and offering the vaccine. Furthermore, LTC facilities must report COVID-19 vaccine and therapeutics treatment information to the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN). Please read through the memo carefully for facility actions and effective dates.
See the memo or visit https://www.cms.gov/files/document/qso-21-19-nh.pdf for complete details.
The Centers for Medicare and Medicaid Services release two revised QSO memos today. Below is a summary of the major revisions in each memo. Please read each in its entirety for all revisions. DHSS guidance will be updated to reflect the revisions in the CMS Visitation memo, however all facilities may begin using this revised guidance immediately.
CMS QSO-20-38-NH Revised – Updated Guidance Regarding Testing
The major revision to this document is regarding routine testing of staff. Routine testing of unvaccinated staff should be based on the extent of the virus in the community. Fully vaccinated staff do not have to be routinely tested. Facilities should use their county positivity rate in the prior week as the trigger for staff testing frequency.
CMS QSO-20-29-NH Visitation
The major revision to this document is regarding group activities and communal dining. The CDC has provided additional guidance on activities and dining based on resident vaccination status. For example, residents who are fully vaccinated may dine and participate in activities without face coverings or social distancing if all participating residents are fully vaccinated; if unvaccinated residents are present during communal dining or activities, then all residents should use face coverings when not eating and unvaccinated residents should physically distance from others. See the CDC guidance Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination for information on communal dining and activities.
CMS has provided updated guidance for the emergency preparation regulations (Appendix Z). This update is effective immediately.
Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/updated-guidance-emergency-preparedness-appendix-z-state-operations-manual-som.
CMS continues to review the need for existing waivers issued in response to the Public Health Emergency (PHE). Over the course of the PHE, nursing homes have developed policies or other practices that we believe mitigates the need for certain waivers.
For more details, please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/updates-long-term-care-ltc-emergency-regulatory-waivers-issued-response-covid-19.
Yesterday- CMS, in conjunction with the Centers for Disease Control and Prevention (CDC), updated visitation guidance with emphasis on the importance of maintaining infection prevention practices, given the continued risk of COVID-19 transmission. The new guidance includes the impact of COVID-19 vaccination. DHSS will be updating its guidance as well and it will be consistent with the CMS guidance. Facilities certified for Medicare and Medicaid are required to follow the CMS memo. All long-term care communities (SNF, ICF, ALF and ICF) may utilize the CMS guidance until the DHSS guidance is updated. CMS hosted a Stakeholder Discussion today regarding the new guidance. A transcript of the session will be uploaded to CMS’ website on 3/12/20 at: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.
Key Changes include:
Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination
CDC has released new guidance, related to vaccinated individuals and the need to quarantine in LTCF. The Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination guidance can be used by LTCF. In using this guidance, long-term care communities should carefully think about how they will determine if the person has had prolonged close contact with someone who was positive.
“Quarantine is no longer recommended for residents who are being admitted to a post-acute care facility if they are fully vaccinated and have not had prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days.”
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-after-vaccination.html
The revised guidance is attached.
CMS has revised the criteria requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the quality of care. In addition, CMS has provided Frequently Asked Questions related to health, emergency preparedness and life-safety code surveys.
See the memo for details.
The Centers for Medicare & Medicaid Services (CMS) is committed to being transparent with the public about changes in publicly reported information related to long-term care facilities (i.e., nursing homes) through the COVID-19 public health emergency (PHE).
Changes to the Nursing Home Compare Website and Five Star Quality Rating System:
Please see the full memo for details.
Compliance with Residents’ Rights Requirement related to Nursing Home Residents’ Right to Vote
Memorandum Summary
Please see the full details in the memo.
Guidance related to the Emergency Preparedness Testing Exercise Requirements- Coronavirus Disease 2019 (COVID-19)
Memorandum Summary
Please see the full details in the memo.
Certified Skilled and Intermediate Care Facility Providers
CMS issued the memo, QSO 20-39-NH regarding Nursing Home Visitation late yesterday afternoon. Please read through this memo carefully. SLCR will provide guidance next week on how to apply for the CMP funds for tents and partitions.
Please read this memo carefully. This memo outlines testing requirements for nursing homes including testing of symptomatic residents and staff, testing in response to an outbreak and routine testing of staff. A revised focused infection control survey protocol is also included which incorporates the requirements in this memo. If attempts to meet the 48-hour turn-around time cannot be met, it is very important that homes document their specific attempts to comply with the testing requirements as outlined in the memo. Routine testing frequency for staff is based on the county-level positivity rates which will be updated weekly (see section titled, “COVID-19 Testing”): https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg. NOTE: This memo applies to homes certified for Medicare and/or Medicaid. It does not apply to residential care or assisted living facilities.
COVID-19 LTCF Guidance
This document has been revised to include guidance on the use of antigen tests and updates to guidance made over the last several weeks (specifically related to the change in timeframes for transmission-based precautions and updated reporting guidelines). The guidance can be found at: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/professionals.php#collapseSix.
Guidance on Reopening of Long-Term Care Facilities
This document has been revised to include guidance on the use of antigen tests. The guidance can be found at: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/professionals.php#collapseSix.
CMS Memo – QSO-20-38-NH
Missouri Interim Guidance for LTCF COVID-19 8-31-2020
Missouri Guidance on Reopening of Long-Term Care Facilities 8-31-20
Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, Frequently Asked Questions, and Access to Ombudsman (REVISED)
Please see the memo or visit https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/nursing-home-five-star-quality-rating-system-updates-nursing-home-staff-counts-frequently-asked.
On July 1, 2020, CMS revised the billing instructions on page 12 of the MLN Matters Article SE20011. Changes include instructions to readmit the beneficiary on day 101 to start the SNF benefit period waiver. All other information remains the same.
Changes to Staffing Information and Quality Measures Posted on the Nursing Home Compare Website and Five Star Quality Rating System due to the COVID-19 Public Health Emergency
The Centers for Medicare & Medicaid Services (CMS) is committed to transparency about changes in publicly reported information on nursing homes during the COVID-19 public health emergency.
Changes to the Nursing Home Compare Website and Five Star Quality Rating System:
Please see the full details of the memo at https://www.cms.gov/files/document/qso-20-34-nh.pdf.
The March 27, 2020 Medicare Learning Network Newsletter (MLN) Exceptions and Extensions for QRP Requirements that includes SNFs applies only to Quarter 4 of 2019 (October 1-December 31, 2019) and Quarters 1 and 2 of 2020 (January 1-June 30, 2020). Providers are expected to report data and meet the QRP requirements beginning with Quarter 3, 2020 that starts July 1, 2020.
As stated in that March 27, 2020 MLN Newsletter, “In some instances, these exceptions and extensions are granted because the data collected may be greatly impacted by the response to COVID-19 and therefore should not be considered in the quality reporting program. CMS is closely monitoring the situation for potential adjustments and will update exception lists, exempted reporting periods, and submission deadlines accordingly as events occur.”
Starting with Quarter 3 that begins July 1, 2020, CMS expects providers to report their quality data. CMS will analyze the data recognizing that the COVID-19 public health emergency (PHE) remains in effect and could impact the quality data submitted. CMS will closely monitor the situation for public reporting of the data and provide any updates.
This update is posted on the CMS SNF QRP Spotlights and Announcements webpage.
Interim Final Rule Updating Requirements for Notification of Confirmed and Suspected COVID-19 Cases Among Residents and Staff in Nursing Homes
Please see the full details of the memo.
Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, and Frequently Asked Questions
Please see the memo for further details.
Upcoming Requirements for Notification of Confirmed COVID-19 (or COVID-19 Persons under Investigation) Among Residents and Staff in Nursing Homes
Please see the memo for details.
2019 Novel Coronavirus (COVID-19) Long-Term Care Facility Transfer Scenarios
CMS has released QSO 20-25, which provides supplemental information related to transferring or discharging residents between facilities for the purpose of cohorting residents based on COVID-19 status (i.e., positive, negative, unknown/under observation).
Please see the memo for details.
CMS Memo QSO-20-20-ALL: https://www.cms.gov/files/document/qso-20-20-all.pdf
Infection Control Survey Checklist
CMS is prioritizing surveys by authorizing modification of timetables and deadlines for the performance of certain required activities, delaying revisit surveys, and generally exercising enforcement discretion for three weeks. During this three-week timeframe, beginning March 20, 2020, only the following types of surveys will be prioritized and conducted:
CMS is disseminating the Targeted Infection Control Survey checklist developed by CMS and CDC so facilities can educate themselves on the latest practices and expectations. CMS expects facilities to use this new process, in conjunction with the latest guidance from CDC, to perform a voluntary self-assessment of their ability to prevent the transmission of COVID-19. The checklist is attached.
Though the contents of the memo and checklist are provided by CMS, DHSS is adhering to the same requirements for all facilities. All facilities should complete the infection control self-assessment.
Guidance for use of Certain Industrial Respirators by Health Care Personnel
Please see the memo for further details.
For additional information, please visit the Department’s website at health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/. This site also contains a link specific to long-term care communities.
Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes (REVISED)
Please see the memo for further details.
For additional information, please visit the Department’s website at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/.
Release of Additional Toolkits to Ensure Safety and Quality in Nursing Homes
The Centers for Medicare & Medicaid Services (CMS) is announcing the release of two toolkits that align with the CMS strategic initiative to Ensure Safety and Quality in Nursing Homes.
Please see the full memo download at www.cms.gov/httpswwwcmsgovmedicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and/release-additional-toolkits-ensure-safety-and-quality-nursing-homes.