vaccine mandate for healthcare workers
valentinrussanov/Getty Images Plus

With every state but Texas now covered by a federal COVID-19 vaccine mandate with specific deadlines, providers are facing increased urgency around ongoing vaccination campaigns.

The Centers for Medicare & Medicaid Services late Friday announced requirements for 24 states where a federal mandate was allowed to move forward by a Jan. 13 Supreme Court decision.

Those states must ensure workers have one shot by Feb. 13, the agency said in a memo to surveyors. It added that employees in the newly covered states must be fully vaccinated by March 15.

The memo largely mirrors COVID-19 vaccine mandate guidance issued Dec. 28. That version covered 25 other states, Washington, D.C, and territories. It was issued after the removal of an earlier injunction by a lower federal court. Workers in those states must have at least one shot by Jan. 27, with full vaccination required by Feb. 28.

Together, the enforcement memos cover anyone in a patient-facing position in about 15,000 nursing homes accepting either Medicare or Medicaid funding. An injunction remains in effect in Texas, so providers there are currently exempt from the CMS mandate. On Friday, however, the administration filed an appeal to have that injunction lifted.

Numbers remain below vaccine mandate threshold

CMS has said that facilities with vaccination rates under 100% will have a failsafe as enforcement begins. Those with more than 80% of workers vaccinated after 30 days and a plan to achieve a 100% staff vaccination rate within 60 days would not be subject to additional enforcement action, the agency said.

The vaccination rate among nursing home workers had crept up to 80.3% nationally per recent CMS data. But 27 states had averages below that. Missouri had the lowest at 66.4%, according to data reported to CMS by Dec. 26.

Some states reported far lower numbers in pockets before the COVID-19 vaccine mandate was allowed to proceed.

New vaccine mandate deadlines leads to high anxiety

Many are concerned about losing workers as the newly established deadline for first shots draws near.

Among them is Betsy Johnson, president of the Kentucky Association of Health Care Facilities. The organization represents about 85% of the state’s roughly 300 nursing homes. Kentucky facilities had 76.2% of workers fully vaccinated as of late last month.

KAHCF found in a November poll that the state had about 3,000 job vacancies across the skilled nursing sector. About 57% of respondents said they could be forced to close without some workforce solutions.

One of the main reasons workers have given for leaving the field? Vaccinations.

“KAHCF/KCAL stands strong with our long-term care facilities throughout Kentucky dealing with crippling staffing shortages while still battling a dangerous virus,” Johnson told McKnight’s Saturday. She added that vaccines are “the best way to prevent and fight this deadly pandemic.”

The association is working closely with state government leaders and medical experts. The goal is to ensure providers “are equipped and ready for any issues, including any workforce shortages that are occurring and will continue due to the vaccine mandate,” Johnson added.

Vaccine mandate winners and losers

A CMS official told McKnight’s Friday that the agency is moving “full speed ahead” to implement the mandate.

Also Friday, CMS acknowledged it had refined its estimate of workers covered by its rule. When the rule was first announced in November, federal officials estimated some 17 million, or 80% of 22 million U.S. healthcare workers, would be required to get vaccinated. In its regulatory impact analysis, the agency lowered that estimate to 10.4 million employees.

The new guidance came on the heels of the Supreme Court’s split rulings over vaccine mandates for U.S. workers. The High Court voted 5-4 to lift two injunctions and allow the CMS healthcare worker mandate to move forward. Appeals continue to play out in lower courts. Justices also blocked a broader Occupational Safety and Health Administration mandate aimed at companies with 100 or more employees.

Harvard health policy researcher David Grabowski, Ph.D., at the time bemoaned the split. He Tweeted that nursing homes “will lose workers to businesses w/out mandates.”

AMDA, the Society for Post-Acute and Long-Term Care Medicine, echoed those concerns Monday.

“The stay also provides a path for vaccine-hesitant nursing home staff to move to assisted living or another work venue that does not require vaccination,” Executive Director Christopher E. Laxton said in a statement.

Medical exemptions in face of vaccine mandate

AMDA also encouraged nursing homes nationwide to adopt its standardized medical exemption request form as more staff members are expected to pursue that option in coming weeks. The organization’s list of acceptable medical reasons not to complete a COVID-19 vaccine includes severe adverse reaction after a previous dose of or component of the vaccine, and active myocarditis or COVID-19 infection. 

While staff providing telemedicine or support services outside of the facility are not subject to the healthcare worker mandate, CMS reminded Friday that most other personnel are.

“Regardless of clinical responsibility or resident contact, the policies and procedures must apply to …. facility staff, who provide any care, treatment, or other services for the facility and/or its residents,” the CMS memo said. It listed applicable individuals as: facility employees, licensed practitioners, students, trainees, volunteers, and “individuals who provide care, treatment, or other services for the facility and/or its residents, under contract or by other arrangement.”