The Centers for Medicare & Medicaid Services (CMS) has issued an emergency rule that requires COVID-19 vaccination for workers at healthcare facilities that participate in Medicare and Medicaid programs.
Covered Facilities and Staff:
Facilities:
The CMS emergency rule applies to the following Medicare and Medicaid certified providers and suppliers:
- Home Health Agencies
- Home Infusion Therapy Suppliers
- Hospices
- Long Term Care Facilities
- Hospitals
- Ambulatory Surgery Centers
- Community Mental Health Centers
- Comprehensive Outpatient Rehabilitation Facilities
- Critical Access Hospitals
- End-Stage Renal Disease Facilities
- Intermediate Care Facilities for Individuals with Intellectual Disabilities
- Public Health Agencies as Providers of Outpatient Physical Therapy and Speech-Language Pathology Services
- Psychiatric Residential Treatment Facilities
- Programs for All-Inclusive Care for the Elderly Organizations
- Rural Health Clinics/Federally Qualified Health Centers
Staff coverage:
The vaccination requirement applies to eligible staff working at a facility that participates in Medicare and Medicaid programs, regardless of clinical responsibility or patient contact. The requirement includes all current staff as well as any new staff who provide any care, treatment, or other services for the facility and/or its patients. This includes facility employees, licensed practitioners, students, trainees, volunteers, and individuals under contract or other arrangements.
Compliance Deadlines:
By December 6, 2021, all covered staff must have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine.
By January 4, 2022, all covered staff must have received the second dose of two-dose COVID-19 vaccine (if applicable).
Exemptions:
Covered facilities must allow exemptions for staff with recognized medical conditions for which vaccines are contraindicated or for sincerely-held religious beliefs or practices. Facilities must establish a process by which staff may request an exemption from COVID-19 vaccination requirements.
CMS says that no exemption should be provided where it’s not legally required under federal law or when a staff member requests an exemption solely to evade vaccination. For religious accommodation requests, CMS recommends that facilities follow U.S. Equal Employment Opportunity guidance.
For staff members who request a medical exemption, all documentation confirming recognized clinical contraindications to COVID-19 vaccines, and supporting the staff member's request, must be signed and dated by a licensed practitioner who isn’t the individual requesting the exemption, and who is acting within their respective scope of practice.
Note: Staff members who have previously had COVID-19 aren’t exempt from the vaccination requirement.
Documentation:
Covered facilities must track and securely document the vaccination status of each staff member. Facilities must also document vaccine exemption requests and outcomes.
Preemption of State Laws:
CMS says the emergency rule preempts any state or local law that would prohibit a vaccine mandate. Additionally, the emergency rule preempts any state or local law that provides broader exemptions than provided for by federal law and that are inconsistent with the emergency rule, according to CMS.
Note: CMS also says that for covered facilities, the emergency rule generally takes precedence over OSHA’s emergency temporary standard for employers with 100 or more employees and vaccine requirements for federal contractors.
FAQs:
CMS has published FAQs to assist in understanding the emergency rule.
Compliance Recommendations:
Covered healthcare providers should review the emergency rule in full and ensure compliance by the applicable deadlines. Please contact your dedicated service professional with any questions.