[UPDATED] CMS, OSHA Issue Vaccine Mandate for All Health Care Workers

The U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S. Occupational Safety & Health Administration (OSHA) have issued emergency regulations requiring COVID-19 vaccination for eligible staff at health care organizations that participate in Medicare or Medicaid.

Health care employers must implement a policy requiring staff to receive the first vaccine dose prior to providing care, treatment or services by Dec. 5. All eligible staff must have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna or one dose of Johnson & Johnson – by Jan. 4, 2022. The OSHA rule applies to companies with 100 employees or more. The CMS rule applies to all, regardless of company size.

The CMS rule takes priority over all other federal vaccine requirements, a CMS spokesperson told Hospice News.

“Ensuring patient safety and protection from COVID-19 has been the focus of our efforts in combatting the pandemic and the constantly evolving challenges we’re seeing,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s action addresses the risk of unvaccinated health care staff to patient safety and provides stability and uniformity across the nation’s health care system to strengthen the health of people and the providers who care for them.”

Citing the strain that the pandemic has placed on the health care system, the White House indicated that the mandate will apply to nearly 76,000 providers and 17 million of their employees. Employees can be exempt based on recognized medical conditions or religious objections.

The CMS mandate applies to any staff who provide any care, treatment or services for the health care organization or its patients, including new and current employees as well as those under contract or other arrangement, regardless of clinical responsibility or patient contact. The rule is also applicable to staff that primarily provide services remotely that occasionally encounter fellow staff or enter a care setting.

The rule states that hospices must have a “contingency plan” to address workers who do not become vaccinated as required under the emergency regulation. Those who provide services 100% remotely are not subject to the requirement.

Some in the hospice community expressed concern that some gaps remain in terms of ensuring the mandate covers all providers.

“We appreciate that [the Department of Labor and CMS] took thoughtful steps in setting compliance standards, deadlines, and exemptions,” said William A. Dombi, president of the National Association for Home Care & Hospice. “Still, we remain concerned that the rules divide home care providers into two categories, those subject to the mandate and those that are not because of size or relationship to Medicare and Medicaid. This may lead to staff separations and some access to care limitations.”

CMS presumes that implementation by providers would require labor by a registered nurse and an administrator. The agency estimates that a nurse would spend eight hours on this work at a cost of $632, using the rate of $79-per-hour. For administrators, CMS estimated two hours of work as a total cost of $244, or $122-per-hour. This does not include the costs associated with tracking and documenting employee’s vaccination status.

Hospice providers that to date have not issued staff mandates have been strongly encouraging employees to receive the vaccine, a process that has accelerated since the White House indicated that a federal requirement would be coming.

“Over the past few months, we have implemented a number of initiatives designed to increase the vaccination rate of our employees. These include a stipend for getting vaccinated, and an ongoing communication program and now a program that provides prize opportunities for vaccinated employees,” Addus HomeCare (NASDAQ: ADUS) CEO Dirk Allison said in a third quarter earnings call. “These efforts have been effective as we have seen our vaccination rates continue to increase.”

LHC Group (NASDAQ: LHCG) President Joshua Proffitt said during a third quarter earnings call that 100% of the company’s clinicians are vaccinated, with the exception of those that have a qualifying exemption.

The new emergency regulations expands a prior federal vaccine mandate for nursing home workers. Since that mandate was introduced the vaccination rate among those employees has risen to 71%, up from 62%, though the rule did prompt some backlash from those employees over fears they would lose already scarce staff who refused to the shots. Stakeholders in the hospice space have echoed these concerns, though acknowledging the value of vaccines in protecting patients, families and staff.

“For hospice patients that are receiving non-curative but supportive care, we are concerned that contracting COVID-19 could increase their
discomfort, decrease their quality of life, or perhaps even hasten their death,” CMS indicated in the rule language. “In addition, the patients’ homes may have poor ventilation or members of the household may not be complying with recommended safety precautions.”

The unvaccinated account for nearly 99% of recent COVID-19-associated deaths, according to an Associated Press analysis of CDC data. More than 750,000 people in the United States are known to have died as a result of the virus to date, according to the U.S. Centers for Disease Control and Prevention.

The most common fear related to the mandate is that providers will lose staff amid worsening industry-wide workforce shortages exacerbated by the pandemic.

“The country and the health care community must do everything we can to reduce the impacts of this deadly disease on the public and on the health care workforce,” National Hospice & Palliative Care Organization President and CEO Edo Banach said. “Because it applies uniformly across all segments of health care, it will help stabilize staffing across the fragmented health care sector that has experienced workforce upheaval over nearly two years.”