As a result of the U.S. Supreme Court’s January 13 decision staying the preliminary injunctions issued for 24 states by the District Courts for the Eastern District of Missouri and the Western District of Louisiana, healthcare providers in every state except Texas must comply with the Centers for Medicare & Medicaid Services’ (CMS) Omnibus COVID-19 Health Care Staff Vaccination rule. The deadlines for compliance vary, however, depending on the state in which a provider is located.
On January 14, CMS published state survey guidance regarding the vaccine mandate applicable to providers in these 24 states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia, and Wyoming.
For providers in these states (with certain exceptions noted below), all staff (defined below) must receive the first dose of the vaccine (or have a pending request for, or have been granted qualifying exemption from, or have been identified as having a temporary delay as recommended by the CDC) by February 14. All staff (with the exceptions noted below) must receive any required second dose by March 15. Presently, there is no requirement regarding booster shots. The rule does not provide any alternative to vaccination (e.g., routine testing, antibodies).
For providers in all other states (except Texas), the deadlines listed in the December 28 state survey guidance remain in effect: first dose (or exception/temporary delay) by January 27; any required second dose by February 28.
Key considerations:
- The mandate applies to all provider types subject to CMS Conditions of Participation, Conditions for Coverage, or Requirements for Participation. It does not apply to physician offices, EMS providers, assisted living facilities, and home and community-based services.
- Staff includes all employees; licensed practitioners (medical staff); students, trainees, and volunteers; and individuals who provide care, treatment, or other services for the provider and/or its patients, under contract or by another arrangement.
- Excepted from the mandate are staff who exclusively provide telehealth services outside the hospital setting and have no direct contact with patients and other staff; staff who provide hospital support services performed exclusively outside the hospital setting and have no direct contact with patients and other staff; and vendors, volunteers, or professionals who infrequently provide ad hoc, non-healthcare services or services that are performed exclusively offsite and not at or adjacent to any site of patient care.
- The rule requires providers to develop and implement the following written policies and procedures by the first-dose deadline:
1. Process to ensure all staff have received an initial dose prior to providing any services for provider and/or its patients and thereafter are fully vaccinated (unless exempt/temporary delay)
2. Process to ensure the implementation of additional precautions for all staff not fully vaccinated (in process of becoming fully vaccinated or granted exemption)
3. Process for tracking and securely documenting vaccination status of all staff (including temporary delays and receipt of booster doses)
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- Providers have the flexibility to use the appropriate tracking tools of their choice. Acceptable forms of proof of vaccination include the Centers for Disease Control and Prevention (CDC) COVID–19 vaccination record card (or legible photo), documentation of vaccination from healthcare provider or electronic health record, or state immunization information system record.
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4. Process by which staff may request exemption based on the Americans with Disabilities Act (ADA) disability, medical condition, or sincerely held religious belief, including a process for tracking and securely documenting information provided by those requesting and receiving exemptions
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- For each medical exemption, the provider must have from a state-licensed practitioner acting within the scope of practice a signed and dated recommendation that lists recognized clinical reasons that vaccination is contraindicated.
- For religious belief exemptions, a provider is not required to validate the sincerity of the staff member’s stated belief. The Safer Federal Workforce Task Force has developed templates for medical and religious belief exemptions.
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- Regarding enforcement, state surveyors will conduct on-site compliance reviews as part of re-certification surveys and complaint surveys. Accreditation organizations also will assess for compliance. The aforementioned state survey guidance includes the interpretive guidelines these surveyors are directed to follow in conducting these reviews.
- Penalties for non-compliance are the same as those for any violation of CMS Conditions of Participation, Conditions for Coverage, or Requirements for Participation. For nursing homes, home health agencies, and hospices, this includes civil monetary penalties, denial of payments, and—as a final measure—termination of participation from the Medicare and Medicaid programs. For hospitals and certain other acute and continuing care providers, the only remedy is termination. CMS notes, however, that its primary goal is to bring providers into compliance; termination would generally occur only after providing a facility with an opportunity to make corrections.
If you have questions related to compliance with the healthcare worker vaccine mandate, or need assistance with any matter involving compliance, valuation, or strategy and integration, one of our executive contacts would be happy to assist. You may email them below, or call (800) 270-9629.
