President Joe Biden’s administration on Thursday expanded its federal COVID-19 vaccine mandate to all healthcare settings — instead of singling out nursing homes — and industry advocates immediately applauded the decision for its safety and workforce implications.

LeadingAge President and CEO Katie Smith Sloan

“This action not only shores up protection for older adults who move across care settings, but also levels the playing field among providers competing for in-demand healthcare workers,” LeadingAge President and CEO Katie Smith Sloan said in a statement. 

Biden and the Centers for Medicare & Medicaid Services late Thursday afternoon announced that staff in all Medicare- and Medicaid-certified facilities will now be required to be vaccinated against COVID-19. The regulation will cover hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies, among others, as a condition for participating in the funding programs.

The administration in mid-August announced a mandate solely for the nation’s 15,000-plus Medicare- and Medicaid-certified nursing homes. Both the American Health Care Association and LeadingAge had strongly criticized the move, arguing a skilled nursing-only vaccine rule would cause a “mass exodus of workers” from the profession and into other healthcare settings.

Image of Mark Parkinson, president and CEO, AHCA/NCAL
Mark Parkinson, president and CEO, AHCA/NCAL

“This will help prevent unvaccinated nursing home staff from looking for new lines of work, alleviating some of the staffing challenges too many long-term care facilities are currently facing,” AHCA President and CEO Mark Parkinson said in a Thursday evening statement regarding the expanded regulations. 

“Nearly 4,000 providers expressed their concerns about a federal mandate only for nursing home staff, and we appreciate the administration listening to those concerns and applying this policy more broadly,” Parkinson added. 

CMS is developing an interim final rule with a comment period that will be issued in October. Previously, it had said that nursing homes could expect an Interim Final Rule in September.

The expanded policy will encompass patients of 50,000 providers and over 17 million healthcare workers in Medicare- and Medicaid-certified facilities, according to CMS.

“There is no question that staff, across any healthcare setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health,” Xavier Becerra, secretary for the Department of Health and Human Services, said in a statement. “Ensuring safety and access to all patients, regardless of their entry point into the healthcare system, is essential.”

Mandates aren’t just for healthcare

Another element of a six-part “Path Out of the Pandemic” plan unveiled Thursday by the White House could also limit non-healthcare job options for those who wish to remain unvaccinated.

Biden announced he also would require vaccinations or weekly negative COVID-19 tests for all employers with 100 or more workers. The requirement could carry a $14,000 fine per violation and would affect two-thirds of the country’s workforce, according to officials.

And Biden is also broadening plans to require federal government employees to be vaccinated, with no test-out option.

Those measures turn the pressure that had been trained on sub-sectors such as nursing homes and select federal agencies onto tens of millions more Americans.

The American Medical Association also applauded Biden’s latest plans. AMA President Gerald E. Harmon, M.D., said aggressive measures will be needed to prevent further widespread transmission of COVID-19.

“Increased testing – more available and affordable – is a major step forward; a new push to vaccinate young people targets an important under-vaccinated group; increasing the supply of monoclonal antibody treatment provides much needed care; supporting schools that provide additional protections for their students and ensuring hospitals, dialysis, home health, and ambulatory surgical centers also require vaccinations – will help us reach vaccination thresholds necessary to defeat COVID-19,” Harmon said in a statement.