Updates to Weekly COVID-19 Vaccination Data Reporting: Long-term Care Facilities – June 2023

Welcome to the training session on updates to weekly COVID-19 vaccination data reporting for long-term care vaccination models. My name is Lori Haas, and I work with Lydia Tekla in the Division of Healthcare Quality Promotion at CDC. Today, we will be reviewing updates to the long-term care component for both residents and healthcare personnel. There are future webinars scheduled in upcoming weeks that will provide information about the changes to person-level reporting. May 11, 2023 marked the end of the federal COVID-19 public health emergency declaration. Long-term care facilities will continue to report the healthcare personnel and resident weekly long-term care COVID-19 vaccination modules of the LTCF component on a weekly basis. As a reminder, NHSN provides a means to report data, but CDC is not a regulatory enforcement body. Please direct any questions or concerns regarding reporting requirements and penalties to CMS using the email addresses provided on this slide. The objective for today's webinar is to review the simplification and changes to the COVID-19 vaccination reporting forms for long-term care facility residents and healthcare personnel. Throughout the presentation, we will have an in-depth review of the upcoming form changes, the up-to-date definition change, provide example scenarios, and answer frequently asked questions. Please note the slides from today's session have been posted to the NHSN COVID-19 vaccination website. The form changes and up-to-date guidance discussed today will be available to users as of June 26 of 2023. I would like to address the background around the form changes. On April 18, 2023, the Food and Drug Administration announced changes to its emergency use authorization regarding COVID-19 vaccines. Following this announcement, CDC simplified COVID-19 vaccine recommendations. These changes include that everyone ages 6 years and older receives an updated bivalent mRNA COVID-19 vaccine, regardless of whether they previously completed their monovalent primary series. Monovalent COVID-19 vaccines will no longer be recommended for use in the United States. For the purpose of NHSN surveillance, beginning on June 26, 2023, or quarter 3 of 2023, residents and healthcare personnel are considered up-to-date with their COVID-19 vaccinations if they have received an updated bivalent vaccine. The form changes and up-to-date guidance discussed today will be available to users as of June 26, 2023. Let's get started with an overview of how the weekly COVID-19 vaccination data collection forms have been simplified. we will begin by discussing the LTC Residence Form. Here we have a table overviewing the upcoming changes to the questions. In the first column, we have all questions on the current form. The second column shows if the questions will be impacted by the changes for quarter three on June 26th of 2023. You can see there will be a significant reduction in questions and changes to current questions for the Long-Term Care Resident Form. To simplify, reporting questions number two, four, 4.1, 4.2 about primary series and additional dose boosters will be removed. Removing the questions will better reflect the most recent up-to-date instructions, which phase out the concepts of primary series and booster doses. The up-to-date questions will be moved from questions five to question two, and we'll incorporate the new up-to-date definition, which we will review in upcoming slides. We will be keeping questions 3.1 and 3.2, addressing why a person may not be considered up-to-date. These questions previously addressed why a resident did not receive a primary series. The image shown here is the new version of the LTC Residence Form, which will be implemented on June 26th of 2023. As you can see, the new version has been simplified from five questions to only three. The most notable change is to question number two, which is asking for cumulative number of residents up-to-date with COVID-19 vaccines in question one, meaning how many residents have received the most recent recommendation for a vivalent COVID-19 vaccine. We will have a more in-depth review of the up-to-date definition change in upcoming slides. Question one was on the previous form and did not undergo any changes. Questions 3.1 to 3.3 will offer a place to record why a resident is not up-to-date. Previously, these questions reported why a resident did not receive primary series. Question 3.1 will be defined as not up to date due to having a medical contraindication. A medical contraindication will continue to be defined as a diagnosed allergy to the COVID-19 vaccine or to a component of the vaccine or a severe allergic reaction after receipt of a previous COVID-19 vaccine. Question 3.2 will be defined as offered by declined vaccine required to be up to date. Question 3.3 will be defined as unknown up to date vaccination status. Now, we will go over the HCP forms. Here is the table that overviews HCP formed questions and where changes have occurred. You can see there will be questions removed, some modified, and some retained on the current form. Compared to the residence form, there is less reduction of questions and questions that need to stay the same. We will go into more detail on these changes and why on the next slide. For the HCP form, we will be simplifying the form by removing questions 2.1 and question four, which are the questions about partial primary series and additional boosts or doses. The up-to-date questions will be moved from question five to question four. We will be keeping the questions one, 2.2, and 3.1 through 3.3. Unlike the residence form, the HCP form will keep question 2.2, which includes the concept of complete primary series. As of now, it is required to continue reporting on complete primary series for healthcare workers due to the CMS Quality Reporting Program requirements. The Quality Reporting Program measures will transition from primary series to up-to-date later this year for most programs. Here is the revised HCP form after removing and modifying questions. The most notable changes for the form are continuing to report on primary vaccine series for healthcare workers in question two and question four using the newest definition of up-to-date for healthcare workers. We also wanted to highlight that because updated bivalent vaccines are now approved for all individuals, including those who did not receive primary series, the definition of complete primary series has been updated to reflect this. This update is documented in footnote G on the form, as shown in this screenshot. The update is also documented in the key terms document. Complete primary series as of June 26, 2023 is defined as receiving a two dose series of a monovalent COVID-19 vaccine or a single dose of Janssen or a single dose of bivalent vaccine. This will impact how you report for the few unique cases out there. Now, let's dive into the up-to-date vaccination questions revised for both residents and health care personnel reporting. As stated earlier, on April 18th, the Food and Drug Administration announced changes to its emergency use authorization regarding COVID-19 vaccines. Following this announcement, CDC simplified the COVID-19 vaccine recommendations. These changes include, the CDC recommends that everyone ages six and older receive an updated COVID-19 vaccine, regardless of whether they've previously completed their primary series. For NHSN specifically, beginning on June 26th, 2023, residents and healthcare personnel are considered up-to-date with their COVID-19 vaccinations if they have received an updated bivalent vaccine. The form changes and up-to-date guidance discussed today will be available to users as of June 26th of 2023. An individual is considered up-to-date once they have received one updated bivalent Pfizer or bivalent Moderna COVID-19 vaccine. This up-to-date definition is the same for all individuals, regardless of age and immunocompromised status. Please note that this definition may change over time. Therefore, facilities should refer to the definition on the first day of the reporting quarter. The CDC NHSN team will be posting a document to the NHSN website with the current definition of up-to-date and users should review this document at least once per quarter to check for the definition updates. The images on this slide show the new questions on up-to-date COVID-19 vaccination status for both residents and HCP forms. Facilities will report the cumulative number of individuals who are up-to-date with COVID-19 vaccines. Remember to refer to the document to the NHSN website with the current definition of up-to-date and users should review this document at least once per quarter to check for definition updates. I will now pass over to Lydia to review different scenarios regarding the form changes. To help understand this change, let's review various scenarios about the new up-to-date vaccination question added for both residents and health care personnel reporting. Feel free to put your guesses in the chat box. As a reminder, all residents counted in Question 1 should also be captured in Questions 3.1, 3.2, and 3.3. As mentioned earlier, please review the up-to-date guidance document on the NHSN website for the current definition of up-to-date. Users should continue to review this document at least once per quarter for definition updates. Mary is a nursing home resident who completed her primary COVID-19 vaccine series in May 2021, an original monovalent booster in October 2021, and an updated bivalent dose on November 3, 2022. Is this individual considered up to date with COVID-19 vaccines for quarter three 2023? Yes. Mary is considered up to date for weeks during quarter three of 2023 since she received an updated bivalent dose. Where to document? Question two, cumulative number of residents in question one who are up to date with COVID-19 vaccines. Tom, a nursing home resident, completed his primary vaccine series on February 1st, 2021, and received a monovalent booster dose October 2021, but has not received an updated bivalent dose. Is this individual considered up to date with COVID-19 vaccines for quarter 3, 2023? No. Tom is not considered up to date with COVID-19 vaccines for weeks during quarter 3 of 2023 since he did not receive the most recent recommended updated bivalent dose. Where to document? Question 3.2 Offered but declined COVID-19 vaccine As a reminder, in the simplified healthcare personnel form, we're maintaining the complete primary series question. All healthcare personnel counted in question 2, cumulative number of healthcare personnel in question 1 who have received complete primary series, should also be captured in questions 3.1, 3.2, 3.3, and 4. Healthcare worker Mark completed his primary vaccine series on January 18th, 2021, and received an additional dose in June 2021, and an updated bivalent dose in October 2022. Is this individual considered up to date with COVID-19 vaccines for quarter 3, 2023? Yes. He is considered up to date with COVID-19 vaccines for weeks during quarter 3 of 2023 since he has received the most recent recommended updated bivalent dose. Where to document? Question 2.2 Cumulative number of healthcare personnel in question 1 who have received complete primary series in question 4. Cumulative number of healthcare personnel in question 1 who are up to date with COVID-19 vaccine. Healthcare worker Jessica did not complete her primary vaccine series, but chose to receive an updated bivalent dose in May of 2023. Is this individual considered up to date with COVID-19 vaccines for quarter 3, 2023? Yes. She is considered up to date with COVID-19 vaccines for weeks during quarter 3 of 2023 since she has received the most recent recommended updated bivalent dose. Where to document? Question 2.2 Cumulative number of healthcare personnel in question 1 who have received complete primary series in question 4. Cumulative number of healthcare personnel in question 1 who are up to date with COVID-19 vaccine. Healthcare worker Harry received one dose of the primary vaccine series in February of 2021 and then received an updated bivalent dose in June, 2023. Is this individual considered up to date with COVID-19 vaccines for quarter three, 2023? Yes, he is considered up to date with COVID-19 vaccines for weeks during quarter three of 2023 since he has received the most recent recommended updated bivalent dose. Where to document? Cumulative number of healthcare personnel in question one who have received complete primary series in question four. Cumulative number of healthcare personnel in question one who are up to date with COVID-19 vaccines. As a reminder, the new footnote G at the bottom of the form states complete primary series as of June 26, 2023 is defined as receiving a two dose series of a monovalent COVID-19 vaccine or a single dose of Janssen or a single dose bivalent vaccine. We will now review some frequently asked questions for more general FAQs and example scenarios. These will also be included in the FAQs posted on the NHSN website. Question one, when do the new form changes take effect? Beginning on June 26, 2023, the new weekly summary form changes will take effect. At this time, please use the new up-to-date definition when reporting COVID-19 vaccination data through NHSN. Question two, with the public health emergency ending, do long-term care facilities need to continue reporting? If so, how often? Yes, as mentioned earlier, weekly reporting of COVID-19 vaccination data for healthcare personnel and residents will remain required for CMS-certified facilities following the ending of the public health emergency. Please note that COVID-19 vaccination data should continue to be reported weekly for long-term care healthcare personnel and residents. Question three, is a 66-year-old who has received a recommended bivalent dose in September of 2022, but no other bivalent dose is considered up-to-date? Yes, per NHSN's definition, they are considered up-to-date. No, individuals who are 65 years of age and older or immunocompromised eligible to receive additional COVID-19 vaccine doses because of the clinical benefit, but it is not mandatory. Whether or not the individual receives additional, updated bivalent doses, they are still up-to-date. Question four, where do I document a healthcare worker who only received partial primary series, a single dose of monovalent Moderna or Pfizer? On the simplified healthcare personnel form, this healthcare worker would be documented in question 3.3, unknown or other COVID-19 vaccination status. As a reminder, partial primary series, formerly question 2.2, was removed from the healthcare personnel form. Let's summarize the main changes to the COVID-19 vaccination reporting forms that we reviewed today. The simplifications include, the up-to-date definition has been revised. Residents and healthcare personnel are considered up-to-date if they have received an updated bivalent vaccine. For residents, COVID-19 vaccination data will no longer be reported for primary vaccine series and any additional or booster doses. For healthcare personnel, it is important to continue to report on complete primary series, but no longer partial primary series or booster doses. The person-level long-term care resident and healthcare personnel forms will also have changes made to reflect these summary form changes and will be reviewed in a future webinar. We will now review how to access the additional resources that are available to facilities. The long-term care component website contains links to a variety of training materials, including quick reference guides, training slides, and information on CSV upload. If you have any questions about NHSN, please send an email to usersupport at NHSN at cdc.gov. Please include weekly COVID-19 vaccination in the subject line of the email, along with your facility type. This concludes the presentation. Thank you so much for your time. We will now have the opportunity to answer your questions.