the following table shows the data for a hypothetical economy in a specific year

Until the ACFR grants it official status, the XML At the time the staff vaccination IFC was published, LTC facilities had existing regulations at 483.80(d)(3)(v) that required facilities to educate all residents and staff about the COVID19 vaccines and to offer the vaccines, when available. Currently available data do not show that Ivermectin is effective against COVID19 and taking large doses of Ivermectin is dangerous. On November 5, 2021, we issued the interim final rule Medicare and Medicaid Programs; Omnibus COVID19 Health Care Staff Vaccination (86 FR 61555), otherwise known as the staff vaccination IFC. This IFC revised the requirements that most Medicare- and Medicaid-certified providers and suppliers must meet to participate in the Medicare and Medicaid programs to include requirements regarding development and implementation of policies and procedures to ensure COVID19 vaccination of staff. L. 96354), section 1102(b) of the Social Security Act, section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 1995; Pub. Under the RFA, small entities include small businesses, nonprofit organizations, and small governmental jurisdictions. From 1-3 PM/ET,America Reportswith John Roberts and Sandra Smith garnered 1.4 million viewers and 194,000 in the 25-54 demo. 804(2) (Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996, also known as the Congressional Review Act).

[82]

Thus, the recommendations and guidance have similarly changed as well. However, we can estimate with some confidence a range of conditions in a hypothetical future in which the staff vaccination and educate-and-offer IFCs remain unchanged (assuming no new SARSCoV2 variant with higher or lower health effects becoming dominant, no new vaccine with higher protection against the existing variant, no major changes in vaccination practices, and no major changes in treatments), simply by using current data and projecting no major changes in these variables.[74]. [21] We discuss the LTC facility testing requirements of the IFC in section II.C.

efforts by applicable health care providers. https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00059-X/fulltext. ) and have used only a 3-year projection for the cost savings estimates in our Accounting Statement. These estimates remain unchanged in this final rule, which makes no substantive changes to the regulations issued in that interim final rule. As previously discussed in this RIA, about 86 percent of nursing home staff have completed the original primary vaccination series, helping reduce risk to patients.

6. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. The following table shows the data for a hypothetical economy in a specific year.

https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/past-reports/033123.html#:~:text=COVID%2D19%20Community%20Levels*,with%20a%20low%20Community%20Level.

Response: This table of contents is a navigational tool, processed from the We thank commenters for recognizing the efficacy of certain vaccines, like the Hepatitis B, influenza, and pneumococcal vaccines. https://www.covid19treatmentguidelines.nih.gov/therapies/supplements/vitamin-d/. Adding past price and cost changes to allow for possible lags (column 3) lowers the estimated passthrough to about 63 percent. See production, box office & company info.

All figures are in billions of dollars. v.

These markup elements allow the user to see how the document follows the All of the requirements of the educate and offer IFC are being finalized, except for the language referring to LTC facility staff refusing the COVID19 vaccine originally set forth at 483.80(d)(3)(v). 71. Additionally, Cavuto Live at 10 AM/ET rounded out the top three programs in both categories with 1.2 million viewers and 142,000 in the 25-54 demo. Many commenters shared their belief that vaccines are unsafe and that they contain dangerous or potentially dangerous chemicals. We also note that the regulation is not a government vaccine mandate placed on individuals but rather a Medicare and Medicaid funding condition for certain health care facilities that participate in either or both of those programs. https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/summary-recommendations/. At the time of publication, these provisions were necessary to protect the health and safety of both residents and health care personnel of LTC facilities, as there were limited treatments for COVID19 and vaccines were not yet available. These are all variables that interact, and their understanding by healthcare personnel depends substantially on the effectiveness of education and offering Some commenters asked for clarification on exemption requirements and recommended that CMS promulgate guidance. Perhaps the simplest way to understand these effects is to consider that in the roughly 18 months since the staff vaccination IFC rule was issued, much and perhaps most of the originally estimated costs (implementation) and benefits (lives saved) have already been realized. Response: 53. Subsequently, in the Medicare and Medicaid Programs; CY 2022 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model Requirements and Model Expansion; Home Health and Other Quality Reporting Program Requirements; Home Infusion Therapy Services Requirements; Survey and Enforcement Requirements for Hospice Programs; Medicare Provider Enrollment Requirements; and COVID19 Reporting Requirements for Long-Term Care Facilities final rule (86 FR 62240), we finalized the LTC facility reporting requirements from the educate and offer IFC at 483.80(g)(1) through (3) with some minor modifications. We note that this includes those individuals who may not be physically in the LTC facility for a period of time due to illness, disability, or scheduled time off, but who are expected to return to work. It then turned 100 worth of trees into 150 worth of lumber. Collection of Information Requirements, PART 441SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES, PART 460PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE), PART 482CONDITIONS OF PARTICIPATION FOR HOSPITALS, PART 483REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES, PART 485CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS, PART 486CONDITIONS FOR COVERAGE OF SPECIALIZED SERVICES FURNISHED BY SUPPLIERS, PART 491CERTIFICATION OF CERTAIN HEALTH FACILITIES, PART 494CONDITIONS FOR COVERAGE FOR END-STAGE RENAL DISEASE FACILITIES, https://www.federalregister.gov/d/2023-11449, MODS: Government Publishing Office metadata, https://mmshub.cms.gov/measure-lifecycle/measure-implementation/pre-rulemaking/lists-and-reports, https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html, https://www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html#recommendations, https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Flong-term-care.html, https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html, coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html, https://www.cdc.gov/coronavirus/2019-ncov/lab/lab-biosafety-guidelines.html, https://www.cdc.gov/coronavirus/2019-ncov/lab/pooling-procedures.html#anchor_1625241118971, https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html, https://aspr.hhs.gov/legal/PHE/Pages/Public-Health-Emergency-Declaration.aspx, https://aspr.hhs.gov/legal/PHE/Pages/default.aspx, https://www.statnews.com/2021/09/20/covid-19-set-to-overtake-1918-spanish-flu-as-deadliest-disease-in-american-history/, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety.html, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/index.html, https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-changes-simplify-use-bivalent-mrna-covid-19-vaccines, https://qualitynet.cms.gov/inpatient/public-reporting/public-reporting, https://www.federalregister.gov/documents/2021/11/09/2021-23993/medicare-and-medicaid-programs-cy-2022-home-health-prospective-payment-system-rate-update-home, https://www.cdc.gov/coronavirus/2019-ncov/your-health/understanding-risk.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Findex.html, https://www.cdc.gov/coronavirus/2019-ncov/community/community-congregate-living-settings.html, https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2024-skilled-nursing-facility-prospective-payment-system-proposed-rule-cms-1779-p, https://leadingage.org/workforce-vaccine-mandates-state-who-who-isnt-and-how/, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html, https://www.yalemedicine.org/news/covid-19-variants-of-concern-omicron#:~:text=Omicron%20and%20its%20subvariants,and%20multiply%20in%20other%20countries, https://www.cdc.gov/media/releases/2021/p0308-vaccinated-guidelines.html, https://www.supremecourt.gov/opinions/21pdf/21a240_d18e.pdf, https://www.cms.gov/newsroom/press-releases/statement-cms-administrator-chiquita-brooks-lasure-us-supreme-courts-decision-vaccine-requirements, https://jamanetwork.com/journals/jama-health-forum/fullarticle/2794727?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=072922, https://www.kff.org/coronavirus-covid-19/issue-brief/nursing-facility-staff-vaccinations-boosters-and-shortages-after-vaccination-deadlines-passed/, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html#:~:text=COVID%2D19%20vaccines%20are%20safe,safety%20monitoring%20in%20US%20history, https://www.fda.gov/vaccines-blood-biologics/vaccines/emergency-use-authorization-vaccines-explained#:~:text=Under%20an%20EUA%2C%20FDA%20may,are%20no%20adequate%2C%20approved%2C%20and, https://www.fiercehealthcare.com/hospitals/supreme-court-vaccine-covid-19-healthcare-upholds-hhs-vaccine-requirement-for-healthcare#:~:text=Supreme%20Court%20upholds%20HHS'%20vaccine,large%20employer%20mandate%20%7C%20Fierce%20Healthcare, https://www.hrsa.gov/vaccine-compensation/about, https://www.cms.gov/outreach-education/partner-resources/coronavirus-covid-19-partner-resources, https://www.cdc.gov/coronavirus/2019-ncov/your-health/reinfection.html, https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00059-X/fulltext, https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351#:~:text=Why%20does%20COVID%2D19%20cause,immune%20system%20can%20also%20happen, 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https://publichealthmdc.com/blog/did-you-test-negative-when-sick-or-exposed-to-covid-heres-what-it-means#:~:text=If%20you%20test%20negative%20soon,be%20found%20on%20a%20test, https://www.whitehouse.gov/wp-content/uploads/2023/01/SAP-H.R.-382-H.J.-Res.-7.pdf, https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm, https://www.kff.org/policy-watch/over-200000-residents-and-staff-in-long-term-care-facilities-have-died-from-covid-19/, https://www.yalemedicine.org/news/covid-19-variants-of-concern-omicron, https://covid.cdc.gov/covid-data-tracker/#health-care-personnel_healthcare-deaths, https://www.bls.gov/news.release/pdf/cfoi.pdf, https://www.cdc.gov/mmwr/volumes/71/wr/mm7137a4.htm, https://www.cdc.gov/nhsn/covid19/ltc-vaccination-dashboard.html, https://www.idsociety.org/covid-19-real-time-learning-network/emerging-variants/emerging-covid-19-variants/, https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489049/, https://covid.cdc.gov/covid-data-tracker/#trends_weeklydeaths_select_00, https://www.cdc.gov/nhsn/covid19/ltc-vaccination-dashboard.html#anchor_1638315381394, https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html, https://pubmed.ncbi.nlm.nih.gov/35482572/, https://covid.cdc.gov/covid-data-tracker/#health-care-personnel, Percentage of patients aged 18 years and older seen for a visit during the performance period who have ever completed or reported having ever completed a COVID19 vaccination series and one booster dose. Although the wording of such authority differs slightly between provider and supplier types, we have interpreted all of these provisions as at minimum permitting the Secretary to establish mandatory requirements to enhance the health and safety of patients. It is not an official legal edition of the Federal The IFC established requirements that these facilities provide COVID19 vaccination education to residents, clients, and staff, and to offer COVID19 vaccines to these populations, referred to as the educate and offer provisions. of this final rule, we discuss the comments and responses regarding the requirements for LTC facilities and ICFsIID to educate residents, clients, and staff about COVID19 vaccines and to offer COVID19 vaccines when available. Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-language Pathology Services (Organizations)485.725(f).

All figures are in billions of dollars. We appreciate the support from commenters and agree that a requirement for COVID19 vaccination of health care staff was necessary to ensure timely access to care for patients. As discussed in the LTC facility testing IFC, we note that there are many different tests available, and facilities have the flexibility and discretion to select the test that best suits their needs so long as the tests are conducted in accordance with nationally recognized standards and meet the response time for the test results as specified by the Secretary. Several of these commenters explained that a high community rate may be skewed by isolated populations, such as incarcerated individuals or college and university students.
Hence, we are finalizing the provision as amended by the staff vaccination IFC, which provides, at 483.80(d)(3)(vii) that the facility maintains documentation related to staff COVID19 vaccination. Other commenters supported additional educational outreach, time-limited testing options, and flexibility for good-faith efforts for facilities as they work toward compliance with the rule. 40. 13. legal research should verify their results against an official edition of To support ongoing access to vaccinations for COVID19, we are finalizing the provisions at 483.80(d)(3), 483.430(f), and 13175. within the 3-year time limit imposed by section 902 of the MMA. documents in the last year, 286 LTCHQRP. This report showed a two thirds reduction in mortality from the Delta period to the Omicron period. 80. New Documents With regard to health care staff, the progress has been even more rapid, with staff deaths attributed to COVID19 trending downward since late 2021 and remaining relatively low over the past year. The following providers and suppliers were regulated by the staff vaccination IFC, listed in the numerical order of the relevant Code of Federal Regulations (CFR) sections: We discuss the specific requirements of the staff vaccination IFC in section II.A. Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. Federal Register

We described these documentation requirements in the IFC as an ongoing process due to the onboarding of new staff, and we provided examples of: (1) appropriate places for vaccine documentation, such as an immunization record, health information files, or other relevant documents; and (2) acceptable forms of proof of vaccination, such as a CDC COVID19 vaccination record card (or a legible photo of the card) or documentation of vaccination from a health care provider, electronic health record, State immunization information system record, or a reasonable equivalent for those individuals vaccinated outside of the United States. documents in the last year. Additionally, since this IFC was initially published, CMS and other agencies across HHS have released additional guidance in an effort to address some of these questions and concerns about how to comply with these requirements. https://covid.cdc.gov/covid-data-tracker/#health-care-personnel_healthcare-deaths. [9192] spread and impact of SARSCoV2. These tools are designed to help you understand the official document FNCs 8 PM/ET addition to its Saturday primetime lineup,One Nationhelmed by Brian Kilmeade, garnered 1.1 million and 122,000 in the 25-54 demo. Based on the termination of the COVID19 PHE and withdrawal of the vaccination and testing requirements, these estimates are reduced to zero in all succeeding months and years.[68]. In this final rule, we are finalizing the infection control requirements that LTC facilities must meet to participate in the Medicare and Medicaid programs as issued in the educate and offer IFC and amended by the staff vaccination IFC. The best of the best: the portal for top lists & rankings: Strategy and business building for the data-driven economy: Industry-specific and extensively researched technical data (partially from exclusive partnerships). While rates of infection, illness, and hospitalization have significantly declined, COVID19 remains a public health challenge throughout the world. 10. On November 5, 2021, we published the staff vaccination IFC, which revised the health and safety requirements that most providers and suppliers must meet to participate in the Medicare and Medicaid programs. Category Due to the high volume of public comments, we have grouped them by themes and similarities for analysis and response. The educate and offer provisions were written in a manner that allows for flexibility by covering a broad set of residential care entities. These uncertainties also impinge on benefits estimates. The following analysis covers the ICRs for the Staff Vaccination, Educate and Offer, and LTC testing requirements. This is the rounded weighted average annual cost of healthcare employees as estimated in the Totals line of Table 4 of the mandated vaccination interim final rule issued in November of 2021, op cit. Specifically, in the last year (beginning of February 2022 through end of January 2023) the number of known healthcare worker deaths per week has ranged from 0 to 4 (CDC says less than 5) and therefore has averaged about 2 per week, or a rate of approximately 100 per year. 91. The CDC has also released guidance for health care facilities that are expecting or experience staffing shortages due to COVID19 and provides recommendations on mitigation strategies and contingency strategies at This final rule addresses the disposition of regulations issued through three IFCs, specifically: the health care staff vaccination requirements issued in the staff vaccination IFC; the education and vaccine offering requirements issued in the educate and offer IFC; and the LTC testing IFC. [40] that agencies use to create their documents. a) The term gross domestic product refers to the situation, A: Nominal GDP: averaged nearly 2 million viewers 326,000 with A25-54 this month, outpacing ABCsJimmy Kimmel Live! 2. As discussed in section I. of this final rule, those requirements were established by the educate and offer IFC. By doing so, ICFsIID must continue to educate clients, client representatives, and staff about COVID19 vaccines and offer a COVID19 vaccine to residents and staff, as well as document these activities. LTC facilities and ICFIIDs are not required to educate and offer vaccination to individuals who provide services less frequently, but they may choose to extend such efforts to them.

The President of the United States declared the COVID19 pandemic a national emergency on March 13, 2020. The service a homeowner performs when she mows her yard is not included in GDP because. Response: Given experiences to date, however, we believe that the future benefits (lives saved) of continuing the staff vaccination requirements would have been low at the time of our estimate and very low if made in the light of recent experience. When a COVID19 vaccine is available to the facility, each resident and staff member is offered a COVID19 vaccine unless the immunization is medically contraindicated or the resident or staff member has already been immunized. Readers may find more information regarding pooled testing at If any one of these categories of regulatory changes were stayed or invalidated by a reviewing court, the remaining categories would continue to effectuate the agency's intent to align its regulations with current public health conditions and would be independently administrable. Many commenters also reported that the time frame to report test results was too limited and requested a 72-hour window to report test results. Spread over 13 million full-time equivalent health care employees, this is about $53 per employee. In, Variety. 62. Response: Instructions: Enter your answer as a whole number. CMS has great appreciation for health care workers and other frontline workers across the world as they have dealt with limited resources and extraordinary demand for their time and services. While it can be challenging to convey vaccine information clearly, this is especially important, as many ICFIID clients have multiple chronic conditions and psychiatric conditions in addition to their intellectual disability, and many LTC Facility residents experience impaired mental status, which can impact a client's and resident's understanding or acceptance of the need for vaccination. The FDA has not authorized or approved Ivermectin for use in preventing or treating COVID19 in humans or animals. The accuracy of our estimate of the information collection burden. In section IV.A. [3] ", Variety, Total number of viewers of the most watched television shows in the United States in the 2021/2022 season (in millions) Statista, https://www.statista.com/statistics/804812/top-tv-series-usa-2015/ (last visited June 03, 2023), Total number of viewers of the most watched television shows in the United States in the 2021/2022 season (in millions) [Graph], Variety, May 31, 2022. The majority of commenters discussed the financial burden of the COVID19 testing requirements and noted that this burden was unsustainable considering the staffing shortages and economic impacts of the PHE. We have examined the impacts of this rule as required by Executive Order 12866 on Regulatory Planning and Review (September 30, 1993), Executive Order 13563 on Improving Regulation and Regulatory Review (January 18, 2011), Executive Order 14094 on Modernizing Regulatory Review (April 6, 2023), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. 78. Omnibus COVID19 Health Care Staff Vaccination, 1. As discussed in the IFC, some staff are not subject to the vaccination requirements, including but not limited to those who provide services 100 percent remotely and one-off vendors, volunteers, and professionals who infrequently provide ad hoc non-health care services, such as annual elevator inspection, delivery, and repair personnel. Several individual commenters expressed concerns that the vaccination requirements may run afoul of certain fundamental medical ethics doctrines around informed consent and freedom from coercion. better and aid in comparing the online edition to the print edition. Assuming a fully loaded average wage and support cost per employee of $90,000,[88] It used 100 worth of that lumber to produce $250 worth of bookshelves. We are finalizing this requirement as amended by the staff vaccination IFC. Vaccinating staff protects both staff and patients, as does vaccinating patients. We expected facilities to take measures, including resident cohorting, to mitigate the transmission of the virus within the facility when facility residents presented with symptoms consistent with COVID19 or who tested positive for COVID19. [6] 69. On January 30, 2020, the International Health Regulations Emergency Committee of the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID19) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV2) a Public Health Emergency of International Concern. On January 31, 2020, pursuant to section 319 of the Public Health Service Act (PHSA) (42 U.S.C. For example, several commenters shared that they were spending upwards of $28,000 per month on testing, in addition to their fixed costs. The Super Bowl-champion . https://www.hrsa.gov/cicp. The Bureau of Labor Statistics estimates that there were about 5,000 annual fatal workplace injuries to workers in recent years. Other comments suggested streamlining funding to LTC facilities in areas with greater prevalence of COVID19. The President of the United States issues other types of documents, including but not limited to; memoranda, notices, determinations, letters, messages, and orders.

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