Opinion: Infection Prevention Control and Immunization CEP (1/22) (CMS-20054)

Here is Clearpol’s opinion on CMS-20054, which can be found on our Policies.ai website here alongside the CMS text:


Updated to investigate compliance at F tags 880, 881, 882, 883, 885, 886, 887 and 888. Surveyors will use it when conducting a COVID-19 (FIC) survey for a SNF (that is not with a recertification survey), to evaluate compliance at all critical elements except for #9, antibiotic stewardship, and #10, qualified IP. Also used for E0024 at Appendix Z if a full EP survey isn’t being conducted.


For any complaint survey, surveyors will use it to evaluate compliance at #13, policies and procedures for COVID-19 vaccination for staff, #14, implement policy and have a process to track and securely document the COVID-19 vaccination status for all staff, and #15, implement policy and procedures to ensure all staff are vaccinated for COVID-19, there is a process to request an exemption, vaccination status is tracked, and documentation is secure for staff with an exemption or temporary delay and contingency plans are developed and followed.

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