Most Recent Updates Related to Covid-19
White House Releases Vaccine Mandate for Health Care Facilities, Updated COVID-19 Action Plan
The Biden-Harris Administration announced last Thursday that it will require COVID-19 vaccination of staff within all Medicare and Medicaid-certified facilities to protect both them and patients from the virus and its more contagious Delta variant. Facilities across the country should make efforts now to get health care staff vaccinated to make sure they are in compliance when the rule takes effect. The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), announced that emergency regulations requiring vaccinations for nursing home workers will be expanded to include hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies, among others, as a condition for participating in the Medicare and Medicaid programs. The decision was based on the continued and growing spread of the virus in health care settings, especially in parts of the U.S. with higher incidence of COVID-19. CMS is developing an Interim Final Rule with Comment Period that will be issued in October. Facilities are urged to use all available resources to support employee vaccinations, including employee education and clinics, as they work to meet new federal requirements.
Other elements of the COVID-19 Action Plan include:
- Requiring All Employers with 100+ Employees to Ensure their Workers are Vaccinated or Tested Weekly
- Requiring Employers to Provide Paid Time Off to Get Vaccinated
- Calling on All States to Adopt Vaccine Requirements for All School Employees
- Calling on Large Entertainment Venues to Require Proof of Vaccination or Testing for Entry
- Getting Students and School Staff Tested Regularly
- Providing Every Resource to the FDA to Support Timely Review of Vaccines for Individuals Under the Age of 12Making At-Home Tests More Affordable
Expanding Free, Pharmacy Testing
Back to School: Districts Look to Pediatricians for Guidance - August 24th, 2021
The American Academy of Pediatrics Vermont Chapter (AAPVT) has been working with the Agency of Education, School Nurses, Superintendents (VSA), School Boards (VSBA), and Principals (VPA) on recommendations for back to school (attached guidance). Schools were sent the following information from VSBA, VSA, VPA on Return to School COVID-19 Prevention Measures, which included the guidance from AAPVT.The chapter is now working to connect pediatric practitioners to schools to spread the message about keeping students safe and IN school! If you are interested in talking to your school board email Stephanie at firstname.lastname@example.org.The key points in the AAPVT guidance are:The American Academy of Pediatrics Vermont Chapter fully supports the administration’s emphasis on getting students in-person full-time this school year and with the recommendation that schools require universal masking of all students and staff regardless of vaccination status to begin the school yearVermont pediatricians continue to support universal masking regardless of vaccination status as an important mitigation strategy to prevent spread of COVID-19 in the school setting. We feel strongly that universal masking should continue for students and staff in each school building until those under 12 years of age have had the opportunity to be vaccinated and when epidemiologic data tells us it is safe to remove them.AAPVT support schools not implementing distancing measures, but strongly recommend that schools pay special attention to distancing at times when students are eating in groups unmasked. The stay home when sick guidance is imperative as outlined in the Agency of Education/Department of Health memo. Students and staff who are sick should stay home.
Vermont Now Reporting COVID Cases by Vaccination Status - July 27, 2021
At today’s press conference by the Scott Administration, Commissioner of the Department of Financial Regulation Mike Pieciak shared new slides as a part of his modeling report that track Vermont’s COVID-19 cases by vaccination status (slides 5 & 6). He stated that while the absolute number of cases per 14 days among vaccinated Vermonters looks higher in July compared to April, as a percent of the population, the case rate among vaccinated Vermonters has fallen. Commissioner of Health Mark Levine added that over the course of the pandemic the state is aware of five fully vaccinated Vermonters who have been hospitalized and one who has died and that vaccination is the best protection against hospitalization and death. In response to questions, Governor Scott and Commissioner Levine stated they do not believe the Vermont will need to reinstitute mandatory mitigation measures although Commissioner Levine stated that people who had traveled to high prevalence areas might want to be tested when they return to Vermont, regardless of vaccination status. Levine also stated that more information about requirements for schools for the fall can be expected at next week’s press conference. Notes from the press conference can be found here. Today, the CDC also announced new mask guidelines recommending indoor masking even for those who are vaccinated in “high” or “substantial” COVID-19 transmission counties – none of which are in Vermont – and for all students and staff in school.
OSHA Rule Requires COVID 19 Safety Measures in Health Care Settings
June 22, 2021
Last week, the Occupational Safety and Health Administration (OSHA) released new standards for health care settings “where suspected or confirmed COVID-19 patients are treated.” According to the OSHA fact sheet, the Emergency Temporary Standard (ETS) is aimed at protecting workers facing the highest COVID-19 hazards. This includes employees in hospitals, nursing homes, and assisted living facilities; emergency responders; home healthcare workers; and employees in ambulatory care facilities where suspected or confirmed COVID-19 patients are treated. For more information see the “Is your workplace covered by the COVID-19 Healthcare ETS?” flow chart
Some of the key requirements of the ETS are:
- COVID-19 plan: Develop and implement a COVID-19 plan (in writing if more than 10 employees)
- Patient screening and management: Limit and monitor points of entry to settings where direct patient care is provided; screen and triage patients, clients, and other visitors
- Develop and implement policies and procedures to adhere to Standard and Transmission-Based precautions based on CDC guidelines
- Personal protective equipment (PPE): Provide and ensure each employee wears a facemask when indoors*
- Physical distancing: Keep people at least 6 feet apart when indoors*
- Physical barriers: Install cleanable or disposable solid barriers at each fixed work location in non-patient care areas*
- Health screening and medical management: Screen employees before each workday and shift
- Ventilation: Requirements for employer-owned or controlled existing HVAC systems
- Vaccination: Provide reasonable time and paid leave for vaccinations and vaccine side effects
- Training: Ensure all employees receive training so they comprehend COVID-19 transmission, tasks and situations
- Recordkeeping: Establish a COVID-19 log (if more than 10 employees) of all employee instances of COVID-19
* There are exceptions to masking, distancing, and barrier requirements for fully vaccinated staff when in well-defined areas with no reasonable expectation that a COVID-19 patient will be present
The ETS is effective immediately upon publication in the Federal Register (OSHA is working to have the standard published “as soon as possible”). Employers must comply with most provisions within 14 days, and with provisions involving physical barriers, ventilation, and training within 30 days. OSHA will use its enforcement discretion for employers who are making a good faith effort to comply with the ETS.
State Has Reached 80% Vaccination Goal – Health Care Practices Still Must Follow CDC Guidance, New OSHA Rule
June 22, 2021
As has been well publicized by the media, Governor Phil Scott announced last week that 80.2% of Vermont’s eligible population - those age 12 and older - have received at least one dose of the COVID-19 vaccine, making it the first state to reach this major milestone. Governor Scott also announced he has rescinded all state COVID-19 restrictions. Additionally, Vermont’s State of Emergency, slated to expire at midnight tonight, June 15, will not be renewed.
At this time, Vermont will no longer require sector-specific guidance for health care settings, such as the Guidance for Inpatient and Outpatient Procedures and Hospital Visitor Guidance. Instead, health care settings may establish their own guidance and are expected to follow CDC guidance, including Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination. This document includes updated testing recommendations for health care workers, visitation guidance and guidance for communal gatherings/activities in the health care setting. Some sectors, such as hospitals and long-term care settings, may be required to follow CDC guidance by federal accreditation/inspection standards.
Practices should note that last week OSHA released a new Emergency Temporary Standard (ETS) for health care workers related to minimizing the risk of exposure to COVID-19. See article below for further details regarding these requirements and compliance dates.
With Vermont ending the State of Emergency related to COVID-19, members are reminded that there are some regulatory flexibilities pegged to the State of Emergency, although S. 117/Act 6 extended many to a date certain and are not dependent on the State of Emergency. A summary of Act 6 is available here. Note the following that are linked to the State of Emergency:
- Waiver of obtaining/documenting a patient’s informed consent for use of telemedicine (sunsets 60 days after the State of Emergency or August 14, 2021) (informed consent for audio-only telehealth currently required, see sample);
- Liability protections for health care providers engaged in emergency management services or response activities.
The following will continue to a date certain:
- Health insurance companies must continue to reimburse for audio-only telehealth services at parity with in-person services (through the remainder of 2021);
- Ability for out-of-state licensed health care professionals to provide services to patients located in Vermont by telehealth (through March 2022);
- Buprenorphine prescription renewals without an office visit (through March 2022); and
- Waiver of using HIPAA compliant telehealth platforms (through March 2022, if federal waiver continues to allow – dependent on Federal Public Health Emergency).
Waiver of licensure requirements for telehealth services provided to patients located in other states, such as New Hampshire or New York, are determined by those states’ laws, and in many cases are dependent on the status of a declared emergency in those states. See the charts from the Federation of State Medical Boards to confirm if you will need to seek licensure to provide services to patients located in other states when the state of emergencies end in those jurisdictions. New Hampshire announced last week that all COVID-19 Emergency Licenses issued prior to June 12, 2021, expired on that date with the expiration of the State of Emergency. All healthcare COVID-19 Emergency Licenses will automatically be converted to a temporary license that will be valid for a period not to exceed 120 days (October 20, 2021) from June 12, 2021. As of publication, New York State continues to waive licensure requirements for telehealth under and executive order. For questions or concerns regarding this transition, contact email@example.com.