Statutory Requirement Regarding Immunizing Residents, Registrants and Employees of LTC Facilities

July 19, 2000

DAL: #00-10

Dear Administrator:

Residents and employees should be immunized annually against influenza. Residents and employees who are at high risk for invasive pneumococcal disease should receive the pneumococcal vaccine according to the ACIP guidelines. Please refer to ACIP guidelines for details.

On November 1, 1999, Governor Pataki signed into Law the Long Term Care Resident and Employee Immunization Act. (PDF, 22KB, 3pg.) This Law is effective as of April 1, 2000. It requires that long-term care facilities request all residents and employees to be immunized against influenza virus and, as appropriate, pneumococcal disease, consistent with current guidelines of the Advisory Committee on Immunization Practices (ACIP).

This Law applies to residents and employees of nursing homes, adult homes, enriched housing programs, adult day health care programs, and any other facility providing residential housing and supportive services for five or more persons over the age of sixty-five who are unrelated to the operator. For these purposes, registrants of adult day health care programs are considered to be included in the term "residents."

This letter conveys the requirements of the Long Term Care Resident and Employee Immunization Act. It is not expected that regulations will be promulgated.

1. Arranging for Immunizations and Requisitioning Supplies of Vaccines

   The facility must document each year that it has made reasonable attempts to obtain the necessary supplies of vaccines and/or to make the arrangements necessary for immunizing residents and employees.

2. Notifying Affected Individuals and Providing or Arranging for Immunization

   The facility must notify all residents and employees that the facility will provide or arrange for immunization against the influenza virus annually, and for pneumococcal disease as indicated by the current ACIP guidelines. Immunization is not mandatory; however, the facility must offer to provide or arrange for immunization for all residents and employees.

   Residents and employees should be immunized annually against influenza. Residents and employees who are at high risk for invasive pneumoccocal disease should receive the pneumococcal vaccine. Please refer to ACIP guidelines for details.

   Annual immunizations against influenza, and immunizations for pneumococcal disease as indicated by ACIP recommendations, must be documented by the facility for each resident and each employee in that individual' s record at the facility. Please refer to Section 4 of this letter for information about record keeping. If a resident or employee refuses to be immunized or is not immunized for any of the reasons listed in Section 3 of this letter, the reason for not being immunized must be documented.

   Immunization and documentation must take place no later than November 30^th of each year. If an individual becomes a resident or an employee after November 30^th but before April 1^st and has not been immunized or if documentation is not available for such immunization, the facility must request that the individual be immunized, and the facility must provide or arrange for such immunization no later than April 1^st.

3. Exceptions

   No individual is required to be immunized for either influenza virus or pneumococcal disease if:

   • He or she refuses the vaccine after being fully informed of the health benefits and risks of such action;
   • Such immunization is medically contraindicated for that individual; or
   • Such immunization is against the individual's religious beliefs.
     
     
4. Documentation and Reports Required By the Law

   The Law requires facilities to document their immunization efforts. It also requires the Department of Health to report to the Governor and Legislature on outbreaks and hospitalizations. To that end, each facility must:

   • For each resident and each employee who receives an influenza or pneumococcal immunization from facility staff, document in that individual's record the date, site of administration, type of vaccine, dose, manufacturer and lot number of the vaccine, reactions if any, and the name of the person administering the vaccine.
   • For each resident and each employee who receives an influenza or pneumococcal immunization from other than facility staff, document in that individual's record the date, type of vaccine, dose and name of the person administering the vaccine.
   • For each resident and each employee who is not immunized as described by the Long Term Care Resident and Employee Immunization Act, document the refusal to receive the vaccine and the reason for the refusal as listed in Section C.
5. Reimbursement

   Free or low cost community proqrams

   Some communities offer influenza and other vaccinations to the general public. Providers may contact their local health department to find out whether there is a local program.

   Medicare reimbursement

   Providers that participate in the Medicare program have been informed by their fiscal intermediary that they may bill Medicare Part B for immunizing individuals who are eligible for Medicare. Medicare HMOs (or their providers) provide these immunizations to enrollees.

   Medicare reimbursement

   Nursing homes and adult day health care programs sponsored by nursing homes may not bill Medicaid for immunizations. Clinics, physicians and nurse practitioners that participate in the Medicaid program were informed in the October, 1999 Medicaid Update that they may bill for immunizing individuals who are eligible for Medicaid. However, there is an exception for nursing home residents and adult day health care registrants. Clinics, physicians and nurse practitioners may submit immunization claims to Medicaid for nursing home residents and registrants in a nursing home's adult day health care program(s) only if the nursing home's Medicaid rate does not include physician services. Nursing homes that do not know if physician services are in their Medicaid rate may find this information on their Medicaid rate sheets. On the first page of the rate sheets, on the bottom, there is a section titled "Ancillary Services Included in the Rate." If there is a check for Physicians' services, it is included in the rate.

   Other Health Care Insurance

   Residents, registrants and employees who are not eligible for Medicaid or Medicare may have health care insurance or a health care plan that covers immunizations.

6. Helpful Information

   To assist you in completing the required Influenza/Pneumococcal Immunization Data Report, an optional chart is included with this letter that can be used as a model for maintaining ongoing immunization-related statistics during the year. This chart can be used as a convenient repository for keeping the cumulative data necessary for completing the required Influenza/Pneumococcal Immunization Data Report. Please note that facilities are not required to use this optional chart.

   A summary of the Advisory Committee on Immunization Practices (ACIP) recommendations for influenza and pneumococcal immunization is also enclosed. For facilities with internet access, the complete documents can be downloaded from http://www.cdc.gov/vaccines/pubs/ACIP-list.htm.

   Questions on compliance with documentation requirements or on completing the Influenza/Pneumococcal Immunization Data Report should be directed to the appropriate Office of Continuing Care Regional/Field Office or Regional Office staff: Long-term Care Resident and Employee Immunization Act - NYSDOH Contacts.

   	Robert W. Barnett	Dale Morse, M.D., M.S.
   	Director	Interim Director
   	Office of Continuing Care	Center for Community Health

Text of the Long-term Care Resident and Employee Immunization Act

• ACIP Recommendations on Influenza Vaccination
• ACIP Recommendations on Pneumococcal Vaccination