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ACL Policy Update: What ACL’s networks need to know about CMS’ new COVID-19 vaccine rule

May 11, 2021

By Alison Barkoff, Acting ACL Administrator and Assistant Secretary for Aging

COVID-19 has been devastating for people living in congregate settings, with residents experiencing among the highest rates of infection and comprising nearly one-third of deaths. They have been isolated from friends and families throughout the pandemic, and many who wanted to transition to smaller, safer settings in the community have faced barriers due to COVID-19.

The COVID-19 vaccine is providing hope. As residents and staff of congregate settings have begun to get vaccinated, infection and death rates have dropped, visitation has started to resume, and transitions to the community are picking up (helped by the recently reauthorized Money Follows the Person program). That is why today’s announcement by the Centers for Medicare & Medicaid Services (CMS) of a new rule to improve COVID-19 vaccine access for older adults and people with disabilities in congregate settings is so significant.

This new policy is a powerful step in furthering the Biden Administration’s commitment to equitable vaccine access and ensuring that those who are most at risk – including people living in congregate settings – have access. It also advances the Administration’s focus on racial equity by improving access to vaccines for staff, the majority of whom are women of color.

Today’s rule builds upon prior requirements for COVID-19 testing and reporting in long-term care (LTC) facilities – nursing facilities and skilled nursing facilities. It requires LTC facilities to:

  • Educate residents, clients, and staff about COVID-19 vaccinations;
  • Offer vaccines to all residents, clients, and staff (when vaccines are available); and
  • Report vaccination of residents and staff to the CDC’s National Health Care Safety Network (NHSN) database.

The new rule also recognizes the high risks – and importance of vaccines – in other types of congregate settings. The rule requires Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IIDs) to provide vaccine education to residents and staff and to offer them vaccines. Because ICF-IIDs do not yet have the infrastructure to report into CDC’s database (unlike LTC facilities), the rule encourages ICF-IIDs to report vaccinations to CDC and seeks public comment on mandating this requirement.

Finally, the rule seeks public comment on applying the vaccine education, access, and reporting requirements to other congregate settings, like assisted living and group homes that are funded through Medicaid home and community-based services (HCBS) programs, and psychiatric residential treatment facilities. In the interim, the rule encourages these congregate settings to voluntarily adopt culturally and linguistically appropriate and accessible vaccination education and to support individuals in accessing vaccines.

This rule also asks for input from the public on future actions CMS could take to help ensure the health and well-being of individuals living in congregate settings. Your input is important! There is a list of questions CMS has for stakeholders in the rule, but they include:

  • What barriers exist to the implementation of a COVID-19 vaccination policy for residents and staff of all congregate living facilities? 
  • How can equitable access to COVID-19 vaccines be ensured for residents of congregate settings?
  • How can regulations be revised to ensure that congregate settings are able to reduce the spread of COVID-19?
  • Whether your state or county has included residential and adult day health or day habilitation staff on the vaccine-eligible list of health care providers? What other impediments do staff face in getting access to vaccines? 

Your knowledge and expertise are crucial, and I encourage you to weigh in before the comment period closes in 60 days. Instructions for how to submit comments can be found in the Federal Register notice.

ACL is pleased to have worked with our colleagues at CMS on this important new rule. This rule reflects the strong advocacy by the disability and aging communities about the need to protect the lives of people with disabilities and older adults in all congregate settings. This new policy is an important step in our fight together against COVID-19, in ensuring that the people most at risk have access to vaccines, and in putting systems in place to protect that the health and safety of people in congregate settings moving forward.

You can find more information about today’s rule on CMS’ website.

For COVID-19 information and resources for people with disabilities and older adults, visit ACL’s COVID-19 website.


Last modified on 05/11/2021

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