DOH Issues Updated Return to Work Guidance
The Department of Health (DOH) released new return to work guidance on Feb. 4th for nursing homes, adult care facilities (ACFs), home care, hospice, diagnostic and treatment centers, and other health care providers. This guidance supersedes the Jan. 4th return to work guidance and aligns with Centers for Disease Control and Prevention (CDC) guidance.
Implications for Members
All health care settings must now follow the CDC guidance on Managing Healthcare Personnel (HCP) with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 and Strategies to Mitigate HCP Staffing Shortages. Nursing homes were already directed by DOH to follow the CDC guidance.
Accordingly, the prior DOH guidance that had required a prolonged work exclusion in contingency situations for infected, not fully vaccinated personnel in non-nursing home settings is rescinded. All health care facilities should follow appropriate Centers for Medicare and Medicaid Services (CMS) and CDC guidance regarding HCP return to work after SARS-CoV-2 infection or after exposure to SARS-CoV-2, found here and here.
Conventional, Contingency, and Crisis Staffing
In addition to aligning with the CDC guidance, the DOH directive includes instructions regarding transitioning from contingency to crisis staffing strategies. A transition from conventional to contingency to crisis strategies for HCP shortages should be based on ability to provide essential services, as determined by the facility. Providers with an actual or anticipated inability to provide essential patient services despite instituting contingency strategies should notify DOH of the need to follow CDC crisis capacity strategies by calling the Surge and Flex Operations Center at 917-909-2676. Callers will be asked to provide a description of mitigation strategies already employed (Strategies to Mitigate HCP Staffing Shortages), a description of crisis strategies regarding HCP return to work which they intend to implement, and their planned prioritization strategy.
Before moving to crisis strategies, providers must ensure that:
- They have implemented appropriate contingency strategies as outlined in the CDC’s Strategies to Mitigate HCP Staffing Shortages.
- They are properly applying the criteria for identifying higher-risk HCP exposures in health care settings according to CDC guidance (e.g., missing personal protective equipment (PPE) or inappropriate wearing of PPE while caring for a patient with suspected or confirmed COVID-19 or during aerosol-generating procedures).
Other Notable Aspects of CDC Guidance
In addition to reviewing the DOH guidance, it is important for members to note that the updated CDC guidance has shifted to using “up to date” (rather than “fully vaccinated” or “boosted”) in relation to COVID-19 vaccination status and return to work. Additionally, the CDC guidance does not require work restrictions for an asymptomatic worker who is exposed and is “not up to date” if the worker has recovered from COVID-19 in the prior 90 days. It states: “In general, asymptomatic HCP who have recovered from SARS-CoV-2 infection in the prior 90 days do not require work restriction following a higher-risk exposure.”