In November 2021, the Centers for Medicare & Medicaid Services (CMS) published their requirements regarding COVID-19 vaccine immunization. It mandates that staff among Medicare- and Medicaid-certified providers and suppliers must be fully vaccinated against COVID-19 as of March 15, 2022.

Confirming You Are in Compliance with the CMS Vaccine Mandate

The CMS vaccine mandate only applies to CMS-certified providers and healthcare settings regulated by CMS for health and safety. It does not cover other recipients of Medicare and Medicaid funds. If, however, your company’s employees work in CMS-certified facilities or care for patients of CMS-certified providers, the CMS-certified healthcare provider may require your employees to be fully vaccinated.

Under the terms of the CMS COVID vaccine mandate:

  • CMS-certified facilities must have policies and procedures in place ensuring all employees are fully vaccinated while providing for exemptions and tracking vaccination compliance.
  • All staff must be fully vaccinated against COVID-19 through either single-dose or series-dose vaccinations. Exceptions include staff members granted exemptions or staff experiencing temporary vaccination delays (as recommended by the CDC).

Understanding How the CMS COVID Vaccine Mandate Is Enforced

Failure to comply with the CMS COVID vaccine mandate has consequences. Federal and state-level accreditation organizations evaluate facility compliance. The CMS instructs site surveyors to determine facility compliance or non-compliance and assign levels of deficiency in the event of non-compliance. Citations break down into “standard-level,” “condition-level,” and “immediate jeopardy” non-compliance.

Standard-Level Citation

  • Facility has less than a 100% staff vaccination rate but is making good-faith efforts to reach compliance.
  • Facility has 100% vaccination rates but has not implemented policies or procedures to oversee and track CMS vaccine mandate compliance.

Condition-Level Citation

  • Facility has a staff vaccination rate of only 61 to 79% (21 to 39% of staff unvaccinated), creating the likelihood of serious harm.
  • Facility has less than 100% vaccination and no evidence for developing or implementing policies and procedures.

Immediate Jeopardy

  • 40% or more staff members remain unvaccinated, creating the likelihood of serious harm.
  • Facility does not meet the 100% vaccination rate, the surveyor observes non-compliant infection control practices, and the facility has no policies or procedures related to the CMS COVID vaccine mandate.

Penalties for non-compliance with the CMS vaccine mandate vary depending on the nature of the facility. Nursing homes, home health agencies, and hospices may face monetary penalties, denial of Medicare and Medicaid payments, or termination of participation in Medicare and Medicaid programs. Termination of participation is the only enforcement applied to hospitals and certain acute and continuing care providers. Steps taken to remedy non-compliance may allow facilities to avoid penalties.

Setting Your Healthcare Facility Up for Success

In response to the CMS vaccine mandate, healthcare facilities need a way to track the vaccination status of their staff and the many vendors who visit CMS-certified locations regularly and to provide compliance reports when CMS audits occur.

IntelliCentrics offers a new vaccine management solution - the COVID-19 and flu vaccine credential - to help facilities enforce their vaccine policies, be audit-ready anytime and protect their CMS reimbursement. It’s part of IntelliCentrics’ digital provider and vendor credentialing services and is offered to facilities at no cost, setting new standard for the lowest total-cost credentialing solution in the industry.

We hope you enjoyed reading this article. At IntelliCentrics, we have helped over 10,000 facilities improve their operational efficiencies, grow their revenue, and improve their compliance. Our digital technology has been optimized over 20 years to deliver best-in-class vendor and medical credentialing, as well as payer enrollment. If you would like to learn more, please click on the button below and schedule 15 minutes with one of our team members.

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