DOH Delays Enforcement of New "Up-to-Date" COVID-19 Booster Definition Until Oct. 16th

The Department of Health (DOH) has notified nursing homes and adult care facilities (ACFs) that facilities may continue to treat staff and residents who are eligible for a bivalent COVID-19 booster as up-to-date under the prior definition through Oct. 15, 2022. As previously reported, the Centers for Disease Control and Prevention (CDC) recommended the use of updated COVID-19 bivalent boosters for people ages 12 years and older earlier this month and modified its definition of "up-to-date" with COVID-19 vaccines to reflect the new bivalent boosters. The bivalent boosters were developed to target the Omicron BA.4 and BA.5 variants, helping to combat variants that are more transmissible. The change in the "up-to-date" definition affects quarantine requirements, work exclusion for health care personnel who are exposed to the virus, and routine screening testing of personnel in nursing homes.

In a Dear Administrator Letter (DAL) to nursing homes and ACFs last week, DOH notified providers that it would not enforce the new definition of "up-to-date" in relation to various infection prevention measures through Oct. 15^th. After Oct. 15^th, the new definition of "up-to-date" will be enforced in connection with routine testing, quarantine, and work exclusion as applicable. DOH noted that nursing homes and ACFs should be continually reviewing the vaccination status of all residents and staff and offering and arranging for booster doses for them. The Department strongly encouraged ongoing outreach to residents and staff and documentation of these efforts.

A similar DAL was sent to hospitals, nursing homes, and ACFs three days later, reiterating much of the information in the prior letter, but also requiring hospitals to offer and administer COVID-19 vaccination to all consenting and eligible patients before discharge to a long term care facility. Further, hospitals were instructed to provide clear documentation to receiving nursing homes and ACFs of the patient’s vaccination status, including the specific vaccine administered, the date administered, whether a second dose needs to be administered, and the time frame for the second dose or booster dose.

Providers should be aware of the following implications of the new up-to-date definition effective on Oct. 16^th:

The new up-to-date definition eliminates the distinction between adults over age 50 and other individuals. In order to be considered "up-to-date," individuals over age 12 must receive a new bivalent booster when at least two months have elapsed since their last booster, whether or not they are over age 50 and have already received a second booster.
In nursing homes, staff who are not "up-to-date" with their COVID-19 vaccines remain subject to routine screening testing. At this time, based on current COVID-19 community transmission rates in New York State, nursing home staff who are not up-to-date must be tested twice weekly, unless they have recovered from COVID-19 in the past 90 days.
In nursing homes, newly admitted residents must be quarantined if they are not up-to-date with their COVID-19 vaccines, unless they have recovered from COVID-19 in the past 90 days. DOH recommends the same for ACFs.
In ACFs and nursing homes, residents who have been exposed to COVID-19 must be quarantined if they are not up-to-date with their COVID-19 vaccines, unless they have recovered from COVID-19 in the past 90 days.
In ACFs and nursing homes, health care personnel who are exposed to COVID-19 must be excluded from work if they are not up-to-date with their COVID-19 vaccines, unless the health care provider has activated contingency or crisis workforce capacity strategies.
Home care and hospice personnel who are exposed to COVID-19 are also subject to work exclusion if they are not up-to-date with their COVID-19 vaccines. Although the recent DALs were not addressed to home care and hospice providers, we believe that DOH will likewise delay enforcement of the new definition for these providers.
Health care personnel are not required to receive the bivalent booster in order to work in regulated health care settings. They are required to receive only the primary vaccination series (unless they have a medical exemption). However, if they have not received the recommended booster when eligible, they are subject to the additional requirements and restrictions set forth above.

The follow are the relevant guidance documents that set forth these requirements:

In addition to the new DALs, DOH released updated clinical guidance that includes the bivalent boosters. It is available here. The updated DOH information about the screening checklist is here, and the updated screening checklist and consent form is here.

The DALs also reminded providers that the state is entering flu season, and annual influenza vaccination requirements remain in effect. According to the CDC, influenza and COVID-19 vaccines can be administered at the same time.

Contact: Karen Lipson, klipson@leadingageny.org