Executives say reporting COVID vaccination data to CMS would be ‘cumbersome’, ‘redundant’ for assisted living

To require assisted living providers to report weekly COVID-19 vaccination data to the federal government would be asking too much of operators already grappling with the effects of the pandemic and could even prevent some operators from continuing to operate. providing services to Medicaid recipients, according to representatives of several national associations. provide feedback to the Centers for Medicare & Medicaid Services.

“Requiring LA providers to report immunizations directly would only add administrative and financial burdens to providers already facing dire financial situations and workforce issues,” wrote Cory Kallheim, LeadingAge vice president of legal affairs and social responsibility, in comments echoed by the National Center for Assisted Living, Argentum and the American Seniors Housing Association in separate letters. “Basically, the feasibility of requiring additional reporting requirements for LA providers at this point seems too burdensome, unnecessary and redundant compared to what may already exist in many states,” Kallheim added in his letter to CMS administrator Chiquita Brooks-LaSure.

The associations sent comments in response to an announcement in May of a new CMS interim rule requiring qualified nursing facilities and intermediate care facilities for people with developmental disabilities to report status data weekly. COVID-19 vaccine for residents and staff. Although the announcement is specific to these types of facilities, CMS said at the time that it was seeking comments on “opportunities to expand these policies to encourage vaccination and access to other facilities. group care ”, including assisted living communities, group homes and psychiatric residences. treatment facilities.

The deadline for comments was Monday.

Only Medicaid participants or all providers?

Some of the associations representing operators of retirement homes have asked CMS to clarify whether the agency plans to extend the requirements to assisted living operators who provide home and community services through Medicaid exemptions or through Medicaid exemptions. all operators of assisted living facilities, including those who exclusively receive private payments.

If the reporting requirements were only extended to assisted living providers who participate in the state’s Medicaid HCBS exemption programs – currently about 17% of not, ”said Kallheim. “The resulting data would be of little value and this only highlights the jurisdictional issues facing a federal approach to regulating LA providers that are regulated at the state level.”

On the other hand, wrote Sara Rudow, senior director of regulatory services for NCAL and the American Health Care Association, “extending these reporting requirements to private fee-paying collective care facilities would, in our view, exceed l current statutory authority of CMS. “

President and CEO of Argentum James Balda asked that CMS specifically state that the requirements would not apply to assisted living communities that do not participate in Medicare or Medicaid programs, “because they are not subject to the regulatory or supervisory authority of CMS.”

But even for assisted living operators who provide services to beneficiaries of Medicaid, a jointly funded federal and state program, “any future reporting requirements should be considered under state exemption programs.” existing ones, giving states the power to implement, ”said Rudow of NCAL.

And because assisted living communities already have to comply with various state-level requirements, Balda said, any additional CMS requirements could be redundant. In addition, the president of the American Seniors Housing Association, David Schless, said in his letter: “[o]Verlaying a federal assisted living license requirement could interfere with state requirements or at the very least, create confusion.

No medical parameters

Beyond the question of the authority of CMS, however, there is the question of whether assisted living providers would be able to comply with a reporting obligation without an administrative or financial burden that would result, according to associations.

Assisted living communities, unlike nursing homes, “do not provide intensive medical care or nursing services, but rather are home environments where a resident can get help with activities of daily living. such as bathing, dressing and managing medications, ”Schless explained. Medical care is often provided by external health care providers, and operators “are generally not equipped to store and manage the supply of vaccines and necessarily have to rely on a third party for these services and all the responsibilities of the vaccine. associated reporting, ”he added.

Assisted living communities, Balda said in his letter, “focus primarily on promoting an independent lifestyle with assistance personalized to each resident’s needs and limited medical care, while nursing homes prioritize the provision of medical care “.

Additionally, LeadingAge’s Kallheim wrote in his letter, a requirement to report vaccines in assisted living facilities could exacerbate current workforce challenges and “involves a level of control over employees that does not exist at all. simply not “.

“The possibility of finding employment in other industries that do not require vaccination can only hamper the recruitment and retention of LA and other long-term care providers,” he said. “This is a potential unintended consequence of extending these requirements to other parameters such as LA providers.”

And operators are already facing financial challenges, executives said. Assisted living providers, Balda d’Argentum noted, “have not received the same level of federal and state assistance as other types of providers.” Assisted living communities, he said, suffered collective losses of $ 30 billion due to the pandemic and yet received only about $ 1 billion in aid from the Provider Relief Fund. which represents less than 1% of the global fund.

“Many are still waiting for help, and others have been inexplicably turned away,” Balda said. “As a result, almost half are operating at a loss and more than half are reporting closures imminent.”

Potential solutions

All of the letter writers said the associations support efforts to reduce the spread of COVID-19 through the promotion of immunization and other means, and they offered potential solutions outside of reporting immunization data. to CMS by assisted living service providers and in addition to having States be responsible for implementation.

CMS could make compliance with reporting requirements voluntary, Argentum suggested.

“This framework would allow facilities most in need of immunization resources to notify CMS of such a need, without subjecting all Medicaid participating ALFs to penalties for potential non-compliance with weekly reporting requirements,” he said. declared Balda. “Argentum welcomes the opportunity to work with CMS to establish such a voluntary program.”

Likewise, ASHA’s Schless suggested that, “[i]Rather than making vaccination notification mandatory for all settings, consideration should be given to providing a means for elderly care providers to request help with resources such as vaccine and supplies, educational materials. and other technical supports to ensure adequate access to these necessary and vital items. tools.”

Noting that some states and the federal government have discouraged employers from mandating COVID-19 vaccination as a condition of employment, LeadingAge’s Kallheim said, “If the goal is to increase vaccination rates, either mandatory vaccinations, a unique educational push that does not punish providers. All of this must be done with an understanding of the current workforce challenges that AL and other long-term care providers face. “

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