CMS Issues Additional Nursing Home Staff Vaccination Guidance for Some States

After the nursing home staff vaccination mandate was upheld by the United States Supreme Court on January 13, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a new QSO Memo, “Guidance for the Interim Final Rule – Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination” (Ref: QSO-22-09-ALL). CMS had previously published a QSO Memo on December 28, 2021 with the same title (Ref: QSO-22-07-ALL) that excluded the states where the injunction was in place regarding the vaccine mandate.

The January 14, 2022 QSO Memo is only for the following states:

  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • Georgia
  • Idaho
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • New Hampshire
  • North Dakota
  • Ohio
  • Oklahoma
  • South Carolina
  • South Dakota
  • Utah
  • West Virginia
  • Wyoming

The Memo states that Texas is not included in the guidance provided at this time and that surveyors in Texas should not surveyor for compliance there. The Memo also notes that if providers are in a state not listed above, then they should follow the guidance provided in the December 28, 2021 QSO Memo. Confused yet? Let’s break it down.

What’s the Main Difference in the Two QSO Memos?

The two Memos essentially contain the same guidance, however, the January 14, 2022 guidance gives providers in the states mentioned above additional time to meet the vaccination mandate. CMS notes that it expects all providers’ staff to have received the appropriate number of doses by the timeframes specified in QSO-22-07 unless exempted as required by law or delayed as recommended by CDC.

  • If you are in a state covered under the December 28, 2021 Memo: Your 30-day timeframe for compliance is January 27, 2022.
  • If you are in a state covered under the newly-issued January 14, 2022 Memo: You will see that the new Memo states that the timeframe is “30 days after issuance of this memorandum,” which is 30 days from January 14, 2022. The 60-day and 90-day timeframes will be based off that date as well. So, if you fall into this category, you still have less than a month to get your staff fully vaccinated, but a little more time than those providers listed in the initial Memo.

To understand what’s required for compliance, please view CMSCG’s “Ftag of the Week” for F888 COVID-19 Vaccination of Facility Staff (Pt 1. can be viewed here and Pt 2 can be reviewed here). The main difference is that the compliance dates for some states will be sooner than others, but the criteria remains the same. Calculate out the appropriate 30-day timeframe and start getting things in order. If you vaccination rate is under 100%, this will be considered non-compliance with the requirements.


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