COVID-19 Long-Term Care Vaccination

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Updates Regarding Chapter 2 COVID-19 Vaccination Requirements

In August 2021, the Board of Health was asked by Governor Polis to enact a requirement that employees, direct contractors, and support staff who work for licensed healthcare facilities or agencies obtain vaccination against COVID-19. The Board of Health adopted the first set of emergency rules adopting this standard on August 30, 2021. Since that time, the Division has worked with stakeholders to revise these vaccination and reporting requirements in order to balance the necessity to obtain high rates of vaccination among employees, direct contractors, and support staff with the business needs of licensed healthcare facilities and agencies. These revisions have come before the Board of Health twice, once in December 2021 and again in March 2022. The Department does not intend to seek another set of emergency rules, nor does it intend to seek to make the current Chapter 2 regulations permanent. As such, the Chapter 2 COVID-19 Vaccine Requirements shall expire on July 14, 2022. 

When CDPHE began collecting data pursuant to the regulations, the reported vaccination rate was 87.6%. As of June 1, 2022, 94% of all staff in facilities were vaccinated. This number has remained steady over the past 3 months, based on information reported to the Department by licensed facilities. Overall, the Department is proud of the work of its licensed facilities and agencies to ensure compliance with the vaccine requirements and that 653 of facilities achieved 100% vaccination of eligible employees.

Why the change in policy?

First, as previously mentioned, the vaccination rate, as well as medical and religious exemption numbers, have remained steady for the past 3+ months. This indicates that all employees who will get vaccinated have done so.

Second, HB22-1401 was signed into law by Governor Polis on May 18, 2022. While the bulk of this bill pertains to licensed Hospitals, there is language directing the Department to enact requirements for all licensed facilities and agencies related to infection prevention and control. While the Department has not yet determined what these requirements will be, the statute requires that they include provisions related to testing, vaccination, and treatment for COVID-19 in accordance with applicable recommendations and guidance. While the specifics will be worked out with stakeholders in the future, the Department envisions COVID-19 vaccination will be part of this conversation.

Third, while the Department intends to let its state licensure vaccination requirement expire in July, it is important to note that the federal requirement for staff to be vaccinated or obtain a valid medical or religious exemption, through the Centers for Medicare and Medicaid Services (CMS), will still apply to any licensed facility that is certified by CMS to receive federal reimbursement. Approximately one-third of all licensed facilities are certified by CMS, and therefore their staff will still be subject to a vaccination requirement.

Key takeaways for licensed facilities and agencies:

  • Effective July 14, 2022, current obligations under Part 12 of 6 CCR 1011-1, Chapter 2 related to COVID-19 vaccination expire. 
  • This includes the associated obligation to report into Colorado Health Facilities Interactive (COHFI) on a twice-monthly basis. 
  • The requirements of Part 11 of Chapter 2 regarding vaccination against influenza are still in effect and not impacted by the expiration of these emergency rules. 
  • Despite the expiration of these rules, facilities and agencies may maintain any mandatory vaccination policies they have adopted to date. 
  • Long-term and residential care facilities (skilled nursing facilities, assisted living residences, intermediate care facilities, and group homes) are still subject to the requirements of Public Health Order 20-20 and the Comprehensive Mitigation Guidance.
  • Facilities certified by CMS are still subject to the federal government’s vaccine mandate. 
  • The Health Facilities & EMS Division will engage in conversations with stakeholders later in the fall regarding the implementation of HB22-1401, which will likely include some requirements around vaccination and vaccination policies. 
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Vaccination Reporting

Juvare/EMResource


Reporting into Juvare/EMResource is required. The EMResource Access form can be completed here for first-time users in EMResource. Training/support materials by facility type is outlined in th EMResource Guidance Document. Facilities are required to report resident and staff COVID-19 vaccine doses into Juvare/EMResource weekly and as soon as possible after vaccine clinics are completed.

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Find out how many follow-up doses you will need for the highest level of protection with these resources:

CDPHE COVID-19 Vaccine Follow-up Dose Calculator
CDPHE Adult Follow-up Dose Flowcharts

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Long-Term Care Facility Vaccine Clinic Toolkit

This toolkit has been assembled to provide:

  • Guidance for vaccination.
  • Vaccine clinic fact sheet, preparation checklist, and flyer.
  • Vaccine administration forms.
  • Vaccine provider information.
  • What to do after your COVID-19 vaccine clinic.
  • Reporting information.

We also created COVID-19 vaccination and treatment materials in English and Spanish, including posters/flyers to provide messaging at your facilities. 

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Vaccination and Treatment Plans

Remaining up to date with all recommended COVID-19 vaccine doses is critical to protect both staff and residents against SARS-CoV-2 infection. Current COVID-19 vaccine recommendations are available in the Interim Clinical Considerations for Use of COVID-19 Vaccines CDC

COVID-19 treatments (monoclonal antibodies and antivirals) are authorized or approved for treatment of residents who are diagnosed with COVID-19 and have a high risk of progression of disease but are not yet ill enough to require hospital admission. Both vaccinated and unvaccinated people should be evaluated for treatment immediately after diagnosis. Treatment with monoclonal antibodies or antivirals has the potential to alleviate symptoms and limit progression to severe disease in residents with mild to moderate COVID-19.

For more information on COVID-19 treatments and information on supplies in Colorado, consult the CDPHE COVID-19 Treatments webpage and the Outpatient COVID-19 Treatments for Long-Term Care facilities webpage.

Each facility must establish and maintain a COVID-19 mitigation, vaccine, and treatment plan that promotes vaccine confidence and acceptance. Facilities must continue to offer vaccinations and access to treatments to all consenting staff and residents. A template for this plan is available in the Residential Care Facility Comprehensive Mitigation Guidance under the heading Vaccination (page 16). At a minimum, this information must include:

  • How the facility assesses and addresses the vaccination status of new staff and residents;
  • The identification of designated staff who coordinate vaccination information, administration, and tracking of the vaccination status of staff and residents on an ongoing basis;
  • Ongoing measures to promote vaccine confidence and acceptance; 
  • The vaccination status of all current staff and residents, and;,
  • The name and location of the COVID-19 vaccine and treatment provider(s) that will be used by your facility to get vaccines and treatments (antivirals and monoclonal antibodies).

Information previously submitted must be updated no later than August 1, 2022, kept current by the facility, and presented for review upon request during health facility inspections. Facilities that need help completing the updated plan should email residentialcarestriketeam@state.co.us.

Additionally, EMResource/Juvare must be updated with the COVID-19 Vaccine Provider and COVID-19 Treatment Provider used by your facility beginning July 15, 2022. 

Highly Recommended: Facility COVID-19 Vaccination Coordinator and Backup Coordinator complete Colorado Immunization Information System (CIIS) training and obtain access to the CIIS system by following these start to finish steps and these instructions. Additionally, see the CIIS Enrollment Requirement Presentation.
 

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Continuing Vaccination:

The Residential Care Strike Team has outlined the following next steps for LTC facilities to continue vaccinations:

  • The facility identifies residents and/or staff requiring vaccination (we encourage you to work with other LTC facilities in geographic areas to run coordinated clinic(s), when possible, to meet vaccine minimums).

  • The facility contacts LTC pharmacy or retail pharmacy it typically utilizes for routine resident medications to determine vaccine availability.  

  • If the LTC pharmacy or retail pharmacy the facility typically utilizes is unable to meet the request or the facility does not have a relationship with an LTC pharmacy or retail pharmacy, the facility contacts a LTC pharmacy from this mapped  list of LTC pharmacies willing to service facility location (geographically). Alternatively, here is a list of providers (.pdf). 

  • LTC pharmacy fulfills request and schedules vaccinations with the facility contact (or in some instances LTC pharmacy provides vaccine/vital supplies and facility nurse(s) vaccinates identified residents and/or staff at facility).

  • If LTC pharmacies near a facility location are unable to meet the request, the facility should utilize the following:

  • If unable to locate a vaccinator through available resources provided, the facility should contact residentialcarestriketeam@state.co.us

  • For residents and staff who are able to go to an offsite vaccine clinic, use the Where can I get vaccinated? site to locate available options.

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Strike Team Assistance:

If your LTC pharmacy would like to become a COVID-19 vaccine provider, please email: residentialcarestriketeam@state.co.us and cdphe_covidvax@state.co.us to get started.