Respirators - Medical Clearance

Dear Acting Assistant Secretary Laihow, The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) is the nation's largest association of long-term and post-acute care providers. Our members provide essential care to millions of individuals in more than 15,000 nursing homes, assisted living communities, and centers for individuals with intellectual and developmental disabilities. AHCA/NCAL aims to improve lives by delivering solutions for quality care. We appreciate the opportunity to comment on OSHA's proposed rule, which would remove some medical evaluation requirements in the Respiratory Protection Rule for certain types of respirators. OSHA also notes that this proposed change would only impact filtering facepiece respirators and loose-fitting powered air-purifying respirators. AHCA/NCAL is supportive of the removal of some medical evaluation requirements in the Respiratory Protection rule for certain types of respirators. During the pandemic, OSHA's requirements to conduct medical evaluations for certain respirators and loose-fitting powered air-purifying respirators aimed to help protect healthcare workers from COVID-19 hazards. No healthcare setting felt the impact of COVID-19 more than long term care. We have come a long way since then, and fortunately, the threat of COVID-19 has greatly diminished. Long term care providers are committed to preventing, monitoring, treating, and reporting COVID-19 and other respiratory virus illnesses among their residents and staff. However, we are no longer in the throes of a pandemic. The Public Health Emergency (PHE) for the COVID-19 pandemic ended in May 2023. Maintaining the medical evaluation requirements more than two years later is no longer appropriate. Moreover, as noted in the proposed rule, despite large increases in respirator usage after the emergent of COVID-19, no evidence has surfaced illustrating the need for medical evaluations for filtering facepiece respirator (FFR) or loose-fitting powered air-purifying respirator (PAPR). Removing unnecessary requirements also helps support patients over paperwork. In the proposed rule, OSHA notes an estimated annual cost savings of $75,039,953 annually from the removal of these provisions. While creating government efficiencies is important, creating opportunities for enhancing care is equally important. By relieving nursing homes and assisted living providers of this burdensome requirement, staff can devote more time to delivering high-quality care. Thank you for considering these comments. Please feel free to reach out to Hawley Hunt at hhunt@ahca.org with any questions or for more information.