Nursing homes participating in the Medicare and Medicaid programs will be required to have all staff vaccinated against COVID-19 in order to continue receiving federal funding for the programs. 

President Joe Biden is expected to make the announcement later today, with guidance from the Centers for Medicare & Medicaid Services expected to come shortly after, according to an Associated Press report citing CNN as an original source. 

Providers could be expected to meet the mandate as soon as next month, according to the report.  

On a call with her members this afternoon, Ruth Katz, senior vice president of public policy and advocacy for LeadingAge, confirmed that her organization had heard from CMS about the mandate.

She said agency officials expect to release details in writing tonight and are “still working out details in real-time” about effective dates and penalties.

Although the CNN report indicated the change would come as part of Medicare’s Rules of Participation, Katz said it was unclear whether providers would be removed from the program or financially penalized for having unvaccinated workers.

Currently, about 60% of nursing home staff nationwide are vaccinated against COVID-19, according to federal data. That’s compared to 82.4% of residents.

Nursing homes, by far, have been the deadliest places affiliated with COVID-19, accounting for approximately one-third of all coronavirus deaths in the U.S.

Regulatory lever

Earlier this month, a trio of prominent health policy experts called on the Centers for Medicare & Medicaid Services to “tap the levers” of its regulatory powers and use the Rules of Participation to require frontline nursing home workers to get vaccinated against the coronavirus.

“Unvaccinated healthcare workers put patients at high risk, given that their jobs require close interaction with unvaccinated patients and others who are immunocompromised and at higher risk for complications,” wrote Jill Rosenthal, Emily Gee and Maura Calsyn of the Public Health Policy at the liberal-leaning Center for American Progress. “CMS should now update (the Rules of Participation) to mandate that healthcare and LTC staff and contractors, as well as healthcare providers with hospital privileges, are vaccinated against COVID-19.”

The Rules of Participation govern the operations of all U.S. nursing homes receiving Medicaid or Medicare payments in exchange for caring for beneficiaries. Those that violate the rules are subject to penalties, and repeated infractions can lead to loss of certification and removal from the federal system.

To update such rules, CMS normally uses a notice-and-comment rulemaking process, but the authors noted the agency can instead adopt changes by issuing interim final rules when it finds there is “good cause” and the traditional process is “impracticable, unnecessary, or contrary to the public interest.”

On Aug. 10, CMS told McKnight’s the agency remained dedicated to ensuring nursing home staff and residents have the information they need to improve vaccination rates, but affirmed its ability to enact a mandate.

 “CMS has authority to establish requirements to ensure the health and safety of individuals receiving care from all providers and suppliers participating in the Medicare and Medicaid programs,” a spokeswoman said.

Federal regulators previously used a rule change to force hospitals into action: In 1965, federal officials ushered in desegregation by making it a requirement for Medicare eligibility. 

Some providers already mandating

Some providers’ self-imposed mandate deadlines already are staged to kick in from August 23 through Nov. 1, as of press time, setting up potential showdowns at staffing-strapped facilities around the country.

Many providers have struggled with what many have called an ethical imperative to mandate the vaccine in their buildings, while others fret what that might do to resistant workers who could walk away from the job rather than get the shots. An industry survey in June said that 94% of providers were already reporting worker shortages. 

LeadingAge is part of a coalition of nearly 60 healthcare groups that on July 26 called for vaccine mandates. The American Health Care Association has not issued a similar call but eventually has expressed support for the growing list of providers issuing mandates.

The biggest shoe regarding long-term care providers and mandates dropped when Genesis, the nation’s largest nursing home chain, announced Aug. 2 that it was giving employees three weeks to get at least a first vaccination shot. Others, including PruittHealth followed with similar announcements, though the majority of U.S. long-term care providers have not announced mandates on their own.

Please check our update on the actual announcement from the White House and providers’ reactions.