DOH Releases New RTW Guidance for Exposed Staff and Travelers
New guidance from the Department of Health (DOH) expands exemptions from work exclusion for staff who are exposed to COVID-19 and are fully vaccinated or recently recovered. In addition, the new guidance modifies furlough and testing requirements for staff who travel to other states or foreign countries. The guidance applies to personnel in all health care settings, but includes special provisions for staff in nursing homes, enhanced assisted living residences (EALRs), and assisted living programs (ALPs). The following are some highlights of the return to work guidance, but providers are urged to read the guidance in its entirety.
Work Exclusions for Asymptomatic, Exposed Staff
Under the new guidance, asymptomatic staff who are exposed to COVID-19 must be excluded from work if they are not fully vaccinated or recently recovered from COVID-19. Nursing home, EALR, and ALP staff who are exposed and not fully vaccinated or recently recovered must be excluded for 14 days. Staff in all other health care settings, including home care and other adult care facilities (ACFs), must be excluded for 10 days. Notably, the new guidance expands the exemptions from work exclusion for vaccinated staff and recently recovered staff.
- Vaccinated Staff: Like the prior guidance, the new guidance allows asymptomatic, exposed staff who are fully vaccinated to return to work without a period of exclusion. However, the new guidance modifies the definition of 'fully vaccinated.' 'Fully vaccinated' is defined as “being 2 weeks or more after either receipt of the second dose in a 2-dose series or receipt of one dose of a single-dose vaccine.” The new guidance eliminates the prior requirement that the last dose in the regimen be administered no more than three months prior to the exposure. In addition, by contrast to the prior guidance, it recommends (but does not require) that these staff in nursing homes, EALRs, or ALPs be assigned to areas where they will have contact only with vaccinated residents. All vaccinated health care personnel (HCP) working in a nursing home or ACF must continue to participate in the mandated staff testing – twice weekly in the nursing home, and once weekly in the ACF. Despite the confusing wording in the guidance, ACF and assisted living providers must continue to test once a week, not twice a week.
- Recently Recovered Staff: The new guidance also exempts recently recovered, asymptomatic staff from work exclusion after an exposure. The guidance provides that asymptomatic HCP who have recovered from COVID-19 “may not need to undergo quarantine, if they were exposed to COVID-19 within 3 months after the date of symptom onset from their initial SARS-CoV-2 infection or the date of their first positive diagnostic test if asymptomatic during [the infection].” Like the vaccinated HCP, it is recommended that they be assigned only to vaccinated residents. These HCP must continue to be tested twice weekly, if working in a nursing home. Again, although the wording in the guidance is confusing, ACF and assisted living providers must continue to test once a week, not twice a week.
The new guidance also relaxes requirements for staff returning from domestic travel. As of April 1, 2021, asymptomatic HCP arriving in New York State from other U.S. states and territories are not required to test or quarantine. However, quarantine, consistent with the Centers for Disease Control and Prevention (CDC) recommendations for international travel, is still recommended, unless the HCP is fully vaccinated or has recovered from COVID-19 within the previous three months.
The guidance governing asymptomatic staff returning from international travel is particularly confusing. Although it states that travelers must follow the CDC guidance for international travel, the CDC guidance was modified the day after the release of this DOH guidance. As a result, the DOH guidance is not consistent with the CDC guidance. We have asked the Department to clarify its intentions but have not yet received a response.
- Home Care and Other HCP: For staff who travel internationally and who do not work in a nursing home, EALR, or ALP, the DOH guidance provides: "Asymptomatic HCP returning from travel to another country must follow CDC’s international travel requirements including showing proof of negative diagnostic test result no more than 3 days before flight departure or documentation of recovery from COVID-19 prior to boarding, and must either quarantine for 7 days with a test 3-5 days after travel or quarantine for 10 days with no test." Unlike the CDC guidance and other New York State guidance, this guidance appears to have omitted an exemption for staff who are vaccinated or recently recovered.
- Nursing Home, EALR, and ALP Staff: For asymptomatic staff who work in nursing homes, EALRs, or ALPs and travel internationally, the guidance is even more bewildering. Please note that, as explained below, the interpretation of this portion of the guidance that we shared on our April 5th COVID-19 update webinar may be incorrect. This provision states that nursing home, EALR, and ALP staff "cannot return to their workplace (must furlough) through the 14th day after return from international travel, unless they are fully vaccinated or have recovered from COVID-19 within the previous 3 months." We initially believed that this paragraph should be interpreted consistent with the CDC guidance to mean that nursing home, EALR, and ALP staff returning from international travel who are fully vaccinated or recently recovered are exempt from furlough and that that the omission of a similar exemption for staff who do not work in nursing homes, EALRs, or ALPs was inadvertent. However, we now believe that the Department may have intended to require all nursing home, EALR, and ALP staff returning from international travel to furlough, including those who are vaccinated and recently recovered. However, the duration of that furlough for vaccinated and recently recovered staff should be 7 days with a test 3-5 days after travel or 10 days with no test, and the duration of furlough for all other staff should be 14 days. Although we have not received confirmation from the Department of its interpretation, we believe that from a regulatory compliance perspective, the second approach would be the safest.
Workforce Shortage Waivers and Surge Staffing Hotline
The new guidance continues the option for providers to request a waiver from DOH to allow asymptomatic, exposed HCP to return to work without completing their work exclusion period. However, nursing homes, EALRs, and ALPs should first return to work unvaccinated exposed HCP who have completed a 10-day quarantine but are still on furlough through day 14 before bringing back any other unvaccinated exposed HCP who have not yet completed 10 days of quarantine.
In addition to seeking a waiver, providers are required to contact DOH’s Surge and Flex Operations Center at 917-909-2676 when there is concern about staffing, patient care capacity, or other triage concerns. The Center is available 24 hours a day, seven days a week. New York City (NYC) providers may also seek staffing agency support through the NYC Staffing Group Purchasing Organization (GPO). Information is available here under COVID-19 Surge Staffing GPO.
Contact: Karen Lipson, firstname.lastname@example.org, 518-867-8838