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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations developing serious complications from COVID19, as they choose facilities from which to seek treatment. Under CMS Meaningful Measures Framework, the COVID19 measure addresses the quality priority of Promote Effective Prevention and Treatment of Chronic Disease through the Meaningful Measure Area of Preventive Care.
b. Overview of Measure The COVID19 Vaccination Coverage Among HCP measure COVID19 HCP
vaccination measure is a process measure developed by the CDC to track COVID19 vaccination coverage among HCP in facilities such as IPFs.
1. Measure Specifications The denominator is the number of HCP eligible to work in the IPF for at least 1 day during the reporting period, excluding persons with contraindications to COVID19
vaccination that are described by the CDC.98
The numerator is the cumulative number of HCP eligible to work in the IPF for at least 1 day during the reporting period and who received a completed vaccination course against COVID19 since the vaccine was first available or on a repeated interval if revaccination on a regular basis is needed.99 Vaccination coverage for the purposes of this measure is defined as the estimated percentage of HCP eligible to work at the IPF for at least 1 day who received a completed vaccination course. A completed vaccination course may require one or more doses depending on the EUA for the specific vaccine used.
The finalized specifications for this measure are available at https
www.cdc.gov/nhsn/nqf/index.html.
2. Review by the Measure Applications Partnership The COVID19 HCP vaccination measure was included on the publicly available List of Measures under Consideration for December 21, 2020, 100 a list of measures under consideration for use in various Medicare programs. When the Measure Applications Partnership MAP
Hospital Workgroup convened on January 11, 2021, it reviewed the MUC

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98 Centers
for Disease Control and Prevention.
Contraindications and precautions. https
www.cdc.gov/vaccines/covid-19/info-by-product/
clinical-considerations.htmlContraindications.
99 Measure Application Partnership Coordinating Committee Meeting Presentation. March 15, 2021.
2021 Accessed March 16, 2021 at: http
www.qualityforum.org/Project_Pages/MAP_
Coordinating_Committee.aspx.
100 https www.qualityforum.org/WorkArea/
linkit.aspx?LinkIdentifier=id&ItemID=94212.

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List and the COVID19 HCP vaccination measure. The MAP recognized that the proposed measure represents a promising effort to advance measurement for an evolving national pandemic and that it would bring value to the IPFQR Program measure set by providing transparency about an important COVID19 intervention to help prevent infections in HCP and patients.101 The MAP also stated that collecting information on COVID19
vaccination coverage among HCP and providing feedback to facilities would allow facilities to benchmark coverage rates and improve coverage in their IPF, and that reducing rates of COVID19 in HCP may reduce transmission among patients and reduce instances of staff shortages due to illness.102
In its preliminary recommendations, the MAP Hospital Workgroup did not support this measure for rulemaking, subject to potential for mitigation.103 To mitigate its concerns, the MAP believed that the measure needed welldocumented evidence, finalized specifications, testing, and NQF
endorsement prior to implementation.104 Subsequently, the MAP Coordinating Committee met on January 25, 2021, and reviewed the COVID19 Vaccination Coverage Among HCP measure. In the 20202021
MAP Final Recommendations, the MAP
offered conditional support for rulemaking contingent on CMS bringing the measures back to MAP once the specifications are further refined.105 The MAP specifically stated, the incomplete specifications require immediate mitigation and further development should continue. 106 The spreadsheet of final recommendations 101 Measure Applications Partnership. MAP
Preliminary Recommendations 20202021.
Accessed on January 24, 2021 at: http
www.qualityforum.org/Project_Pages/MAP_
Hospital_Workgroup.aspx.
102 Measure Applications Partnership. MAP
Preliminary Recommendations 20202021.
Accessed on January 24, 2021 at: http
www.qualityforum.org/Project_Pages/MAP_
Hospital_Workgroup.aspx.
103 Measure Applications Partnership. MAP
Preliminary Recommendations 20202021.
Accessed on January 24, 2021 at: http
www.qualityforum.org/Project_Pages/MAP_
Hospital_Workgroup.aspx.
104 Measure Applications Partnership. MAP
Preliminary Recommendations 20202021.
Accessed on January 24, 2021 at: http
www.qualityforum.org/Project_Pages/MAP_
Hospital_Workgroup.aspx.
105 Measure Applications Partnership. 20202021
MAP Final Recommendations. Accessed on February 3, 2021 at: http www.qualityforum.org/
Setting_Priorities/Partnership/Measure_
Applications_Partnership.aspx.
106 Measure Applications Partnership. 20202021
MAP Final Recommendations. Accessed on February 23, 2021 at: http www.qualityforum.org/
Project_Pages/MAP_Hospital_Workgroup.aspx.

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no longer cited concerns regarding evidence, testing, or NQF
endorsement.107 In response to the MAP
final recommendation request that CMS
bring the measure back to the MAP once the specifications were further refined, CMS and the CDC met with MAP
Coordinating committee on March 15th.
Additional information was provided to address vaccine availability, alignment of the COVID19 Vaccination Coverage Among HCP measure as closely as possible with the data collection for the Influenza HCP vaccination measure NQF 0431, and clarification related to how HCP are defined. At this meeting, CMS and the CDC presented preliminary findings from the testing of the numerator of COVID19 Vaccination Coverage Among HCP, which was in process at that time. These preliminary findings showed numerator data should be feasible and reliable. Testing of the numerator of the number of healthcare personnel vaccinated involves a comparison of the data collected through NHSN and independently reported through the Federal pharmacy partnership program for delivering vaccination to LTC facilities. These are two completely independent data collection systems. In initial analyses of the first month of vaccination, the number of healthcare workers vaccinated in approximately 1,200
facilities, which had data from both systems, the number of healthcare personnel vaccinated was highly correlated between these 2 systems with a correlation coefficient of nearly 90
percent in the second two weeks of reporting.108 The MAP further noted that the measure would add value to the program measure set by providing visibility into an important intervention to limit COVID19 infections in healthcare personnel and the patients for whom they provide care.109
We value the recommendations of the MAP and considered these recommendations carefully. Section 1890Aa4 of the Act requires the Secretary to take into consideration input from multi-stakeholder groups in selecting certain quality and efficiency measures. While we value input from the MAP, we believe it is important to propose the measure as quickly as 107 Ibid.
108 For more information on testing results and other measure updates, please see the Meeting Materials including Agenda, Recording, Presentation Slides, Summary, and Transcript of the March 15, 2021 meeting available at https
www.qualityforum.org/
ProjectMaterials.aspx?projectID=75367.
109 Measure Applications Partnership. 20202021
MAP Final Recommendations. Accessed on February 23, 2021 at: http www.qualityforum.org/
Project_Pages/MAP_Hospital_Workgroup.aspx.

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