After requiring healthcare providers to ensure their staff are fully vaccinated for COVID-19 in a series of QSO Memos over the past few weeks (QSO-22-07-ALL, QSO-22-09-ALL, QSO-22-11-ALL) the Centers for Medicare & Medicaid (CMS) has finally issued guidance requiring surveyors to be vaccinated as well. In recent months, providers have objected to Federal guidance that did not require survey team members to provide proof of vaccination prior to entering a facility. CMS may or may not have taken that criticism into account, but the Agency issued a January 25, 2022 QSO Memo that sets out vaccination expectations for surveyors.
In the QSO Memo, CMS notes that although some States have implemented their own vaccination requirements for surveyors, that national guidance was required to ensure the safety not only of patients/residents and staff, but also the surveyors. CMS had previously set out requirements for precautions when surveyors were on-site for inspections, but is now enhancing its requirements. Per the Memo, surveyors who are not fully vaccinated should not participate as part of the on-site survey team performing oversight. Exceptions to this requirement include if the vaccine is medically contraindicated or the surveyor is the legally entitled to a reasonable accommodation due a disability or sincerely held religious belief/practice/observance that conflicts with the vaccination mandate. CMS states that State Survey Agencies (SAs) should use unvaccinated staff in an off-site capacity for survey or enforcement activities.
Per the Memo, surveyors who are not fully vaccinated should not participate as part of the on-site survey team performing oversight (with some exceptions).
What is interesting to note is that CMS is not giving the SAs any flexibility related to performance or timeliness standards, even if they do not have enough vaccinated surveyors to complete the required workload. This may be a position reflective of the Office of the Inspector General’s (OIG) recently issued report, “CMS Should Take Further Action to Address States with Poor Performance in Conducting Nursing Home Surveys” (OEI 06-19-00460 January 2022), wherein the OIG identified that CMS has not done much in the way of trying to keep State Agencies on track for conducting surveys timely. In that study, OIG found that States commonly missed performance targets related to survey timeliness, and CMS and State Agencies often attributed these missed targets to surveyor staffing shortages. So, whether this means that survey teams will be comprised of more hybrid teams of on-site (vaccinated) and off-site (unvaccinated exempt) surveyors remains to be seen, CMS is turning the screws on States to ensure as many people as possible are vaccinated, including those entering healthcare facilities.
OIG found that States commonly missed performance targets related to survey timeliness, and CMS and State Agencies often attributed these missed targets to surveyor staffing shortages.
If a surveyor has an identified, valid COVID-19 vaccination exemption, he/she is allowed to continue participating in on-site survey activities, but need to observe additional protective measures. In these cases, States may determine which additional safeguards to add and document them. Actions could include limiting survey activities to ones that limit patient/resident contact, such as through record review, limiting the surveyor to conducting offsite activities, or implementing mandatory testing requirements. Surveyors are expected to use appropriate PPE when on-site.
Does This Mean We Have to Check Surveyors’ Vaccination Status?
To answer the question on everyone’s mind, no, providers are not allowed to ask surveyors for vaccination status as a condition of entry to the building. Instead, the SAs are responsible for ensuring compliance with the CMS surveyor vaccination requirement. CMS further directs providers to their State Agency for questions about what process the individual State is using to implement the guidance.
This policy is effective 30 calendar days from the date of issue, January 25, 2022. Read CMS QSO Memo, “Vaccination Expectations for Surveyors Performing Federal Oversight” (Ref: QSO-22-10-ALL) here.