CMS Reducing "Off-Cycle" CMS Healthcare Worker COVID-19 Vaccine Surveys

On June 14, 2022, CMS released QSO-22-17-ALL - Surveys for Compliance with Omnibus COVID-19 Health Care Staff Vaccination Requirements" which addresses the frequency in which State Survey Agencies (SAs) and Accrediting Organizations (AOs) must survey COVID-19 vaccination requirements for staff at applicable Medicare and Medicaid certified providers and suppliers like hospitals, ambulatory surgical centers (ASCs), home health and others.

In this new memo, CMS states that "SAs and AOs will now only be expected to perform compliance reviews of the staff vaccination requirement during initial and recertification surveys and in response to specific complaint allegations that allege non-compliance with the staff vaccination requirement. SAs and AOs are no longer expected to perform these reviews on every survey. This reduction in survey frequency is in keeping with the normal process for oversight of any Medicare requirement, and is supported by the high rates of compliance in initial surveys."

Essentially, "off-cycle" reviews of worker-vaccination status would only be done in response to a specific complaint, rather than as part of every single survey. There would also still be "on-cycle" (initial and recertification surveys) reviews.

As a reminder, CMS's vaccination requirements were set forth in the November 5, 2022 interim final rule. It was subject to challenges by some states, which went up to the Supreme Court. This delayed the related effective dates. However, by February 20, 2022, the requirement that staff be vaccinated at all CMS-certified providers and suppliers was in effect in all states. CMS states that "[n]early 12,000 providers and suppliers have been surveyed for compliance with the requirement. To date, 95.0% of those providers and suppliers surveyed by states have been found to be in substantial compliance with this requirement."

Overall, it remains important for CMS certified providers and suppliers to continue to meet the vaccine requirements, but it may not be checked as often.