Federal Register/Vol. 86, No. 91/Thursday, May 13, 2021/Rules

26306 Federal Register / Vol. 86, No. 91 / Thursday, May 13, 2021 / Rules and Regulations DEPARTMENT OF HEALTH AND of the following three ways (please territories. The virus has been named HUMAN SERVICES choose only one of the ways listed): ‘‘severe acute respiratory syndrome 1. Electronically. You may submit coronavirus 2’’ (SARS–CoV–2), and the Centers for Medicare & Medicaid electronic comments on this regulation disease it causes has been named Services to http://www.regulations.gov. Follow ‘‘coronavirus disease 2019’’ (COVID– the ‘‘Submit a comment’’ instructions. 19). On January 30, 2020, the 42 CFR Part 483 2. By regular mail. You may mail International Health Regulations written comments to the following Emergency Committee of the World [CMS–3414–IFC] address ONLY: Centers for Medicare & Health Organization (WHO) declared Medicaid Services, Department of the outbreak a ‘‘Public Health RIN 0938–AU57 Health and Human Services, Attention: Emergency of International Concern.’’ Medicare and Medicaid Programs; CMS–3414–IFC, P.O. Box 8010, On January 31, 2020, pursuant to COVID–19 Vaccine Requirements for Baltimore, MD 21244–1850. section 319 of the Public Health Service Long-Term Care (LTC) Facilities and Please allow sufficient time for mailed Act (PHSA) (42 U.S.C. 247d), the Intermediate Care Facilities for comments to be received before the Secretary of the Department of Health Individuals With Intellectual close of the comment period. and Human Services (Secretary) Disabilities (ICFs–IID) Residents, 3. By express or overnight mail. You determined that a public health Clients, and Staff may send written comments to the emergency (PHE) exists for the United following address ONLY: Centers for States to aid the nation’s health care AGENCY: Centers for Medicare & Medicare & Medicaid Services, community in responding to COVID–19 Medicaid Services (CMS), Department Department of Health and Human (hereafter referred to as the PHE for of Health and Human Services (HHS). Services, Attention: CMS–3414–IFC, COVID–19). On March 11, 2020, the ACTION: Interim final rule with comment Mail Stop C4–26–05, 7500 Security WHO publicly declared COVID–19 a period. Boulevard, Baltimore, MD 21244–1850. pandemic. On March 13, 2020, the For information on viewing public President of the United States declared SUMMARY: This interim final rule with comments, see the beginning of the the COVID–19 pandemic a national comment period (IFC) revises the SUPPLEMENTARY INFORMATION section. emergency. The January 31, 2020 infection control requirements that long- FOR FURTHER INFORMATION CONTACT: determination that a PHE for COVID–19 term care (LTC) facilities (Medicaid Diane Corning, (410) 786–8486, Lauren exists and has existed since January 27, nursing facilities and Medicare skilled Oviatt, (410) 786–4683, Kim Roche, 2020, lasted for 90 days, and was nursing facilities, also collectively (410) 786–3524, or Kristin Shifflett, renewed on April 21, 2020; July 23, known as ‘‘nursing homes’’) and (410) 786–4133, for all rule related 2020; October 2, 2020; and January 7, intermediate care facilities for issues. 2021. Pursuant to section 319 of the individuals with intellectual disabilities PHSA, the determination that a PHE SUPPLEMENTARY INFORMATION: Inspection (ICFs–IID) must meet to participate in continues to exist may be renewed at of Public Comments: All comments the Medicare and Medicaid programs. the end of each 90-day period.1 Data received before the close of the This IFC aims to reduce the spread of from the Centers for Disease Control and comment period are available for SARS–CoV–2 infections, the virus that Prevention (CDC) and other sources viewing by the public, including any causes COVID–19, by requiring have determined that some people are at personally identifiable or confidential education about COVID–19 vaccines for higher risk of severe illness from business information that is included in LTC facility residents, ICF–IID clients, COVID–19.2 a comment. We post all comments and staff serving both populations, and Individuals residing in congregate received before the close of the by requiring that such vaccines, when settings, regardless of health or medical comment period on the following available, be offered to all residents, conditions, are at greater risk of website as soon as possible after they clients, and staff. It also requires LTC acquiring infections, and many have been received: http:// facilities to report COVID–19 residents and clients of long-term care www.regulations.gov. Follow the search vaccination status of residents and staff (LTC) facilities and Intermediate Care instructions on that website to view to the Centers for Disease Control and Facilities for Individuals with public comments. CMS will not post on Prevention (CDC). These requirements Intellectual Disabilities (ICFs–IID) face Regulations.gov public comments that are necessary to help protect the health higher risk of severe illness due to age, make threats to individuals or and safety of ICF–IID clients and LTC disability, or underlying health institutions or suggest that the facility residents. In addition, the rule conditions. Nursing home residents are individual will take actions to harm the solicits public comments on the less than 1 percent of the American individual. CMS continues to encourage potential application of these or other population, but have historically individuals not to submit duplicative requirements to other congregate living accounted for over one-third of all comments. We will post acceptable settings over which CMS has regulatory COVID–19 deaths.3 comments from multiple unique or other oversight authority. commenters even if the content is 1 DATES: https://www.phe.gov/emergency/events/ These regulations are effective identical or nearly identical to other COVID19/Pages/2019-Public-Health-and-Medical- on May 21, 2021. comments. Emergency-Declarations-and-Waivers.aspx. Comment date: To be assured 2 Centers for Disease Control and Prevention. consideration, comments must be I. Background (2020). People at Increased Risk. Retrieved from: received at one of the addresses https://www.cdc.gov/coronavirus/2019-ncov/need- Currently, the United States (U.S.) is extra-precautions/index.html. provided below, no later than 5 p.m. on responding to a public health 3 See The Long-Term Care COVID Tracker at July 12, 2021. emergency of respiratory disease caused https://covidtracking.com/nursing-homes-long- ADDRESSES: In commenting, please refer by a novel coronavirus that has now term-care-facilities, and the KFF State COVID–19 Data and Policy Actions at https://www.kff.org/ to file code CMS–3414–IFC. been detected in more than 190 coronavirus-covid-19/issue-brief/state-covid-19- Comments, including mass comment countries internationally, all 50 States, data-and-policy-actions/#longtermcare. These data submissions, must be submitted in one the District of Columbia, and all U.S. may understate the problem because some states do VerDate Sep<11>2014 17:44 May 12, 2021 Jkt 253001 PO 00000 Frm 00002 Fmt 4701 Sfmt 4700 E:\FR\FM\13MYR2.SGM 13MYR2 Federal Register / Vol. 86, No. 91 / Thursday, May 13, 2021 / Rules and Regulations 26307 A. COVID–19 in Congregate Living comment on the feasibility of homes or communities rather than Settings implementing vaccination policies for institutions or other isolated settings. Since there is no single official other Medicare/Medicaid participating These programs serve a diverse definition of congregate living settings, shared residences in which one or more population, including people with also referred to as residential people reside such as but not limited to intellectual or developmental habilitation settings, for purposes of this the following: Psychiatric residential disabilities, physical disabilities, mental discussion we describe them as shared treatment facilities (PRTFs), psychiatric illness, and HIV/AIDS. Shared living residences of any size that provide hospitals, forensic hospitals, adult foster arrangements within, and the sharing of services to clients and residents. People care homes (AFC homes), group homes, staff across these and other settings can living and working in these living assisted living facilities (ALFs), lead to increased risk of COVID–19 situations may have challenges with supervised apartments, and inpatient outbreaks. In addition, individuals social distancing and other mitigation hospice facilities. living in these settings often have measures, like mask use and We considered extending the multiple chronic conditions that can handwashing, that help to prevent the requirements included in this rule to increase the risk of severe disease and spread of SARS–CoV–2. Residents, other congregate living settings for complicate treatment of, and recovery clients, and staff typically may gather which we have regulatory authority, from, COVID–19. This makes the together closely for social, leisure, and including inpatient psychiatric vaccination of clients and staff in these recreational activities, shared dining, hospitals (which are subject to the congregate living settings a critical and/or use of shared equipment, such as majority of Hospital Conditions of component of a jurisdiction’s vaccine kitchen appliances, laundry facilities, Participation, including § 482.42, implementation plan. vestibules, stairwells, and elevators. ‘‘Infection Control’’) and PRTFs, but In an effort to facilitate a Residents in some congregate living have not included such requirements in comprehensive vaccine

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