November 18th, 2021
Categories: CMS Updates, Practice Management

Covid-19 Vaccine Vial On Coronavirus Vaccination Record Card

11/30/21 Update:

A federal Judge (U.S. District Judge Matthew Schelp in St. Louis)  has blocked the CMS COVID-19 vaccination requirement for healthcare workers in the following 10 states, meaning the vaccination requirement is not currently enforceable for the below states pending further legal action. It’s possible for similar action in other states, so healthcare professionals should monitor for ongoing changes and litigation.

  • Missouri
  • Nebraska
  • Arkansas
  • Kansas
  • Iowa
  • Wyoming
  • Alaska
  • South Dakota
  • North Dakota
  • New Hampshire

Reference: U.S News

Date: 11/17|2021   Approx. 3 min. read
Author: Brianna Plencner, CPC, CPMA  Senior Consultant & Manager, Practice Development, HCCI

There are two current policies finalized regarding the requirements of healthcare providers and facilities requiring COVID-19 vaccination status for employees. This should not come as a surprise as vaccinations for healthcare professionals have been a priority for the Centers for Medicare & Medicaid Services (CMS) and the current administration.

Let’s first outline the CMS rule. On November 4-5, 2021, CMS published a press release and the Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule.

The CMS rule applies to Medicare and Medicaid-certified providers and suppliers regulated under the Medicare health and safety standards (or Conditions of Participation (COP’s). Impacted facilities and organizations include:

  • Long term care facilities
  • Hospices and Home Health agencies
  • Clinics
  • Programs for All-Inclusive Care for the Elderly (PACE) programs
  • Rehabilitation Agencies
  • Ambulatory Surgical Centers
  • Psychiatric Residential Treatment Facilities
  • Hospitals
  • Intermediate Care Facilities for individuals with intellectual disabilities
  • Comprehensive Outpatient Rehabilitation Facilities
  • Critical Access Hospitals
  • Providers of outpatient physical therapy and speech-language pathology services
  • Community Mental Health Centers
  • Home Infusion Therapy Suppliers
  • Rural health clinical (RHC’s) and Federally Qualified Health Centers (FQHC’s)
  • End-Stage Renal Disease (ESRD) facilities

What staff does the CMS rule apply to: (See below from the CMS FAQ)

“This vaccination requirement applies to eligible staff working at a facility that participates in the 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, and volunteers. Additionally, this also includes individuals who provide care, treatment, or other services for the facility and/or its patients under contract or other arrangements.” The only exception to this rule is full-time teleworkers who provide services 100% remotely.


  • By December 5, 2021, all staff must have received, at a minimum, the first dose of the primary series or a single dose vaccine or requested and/or been granted a lawful exemption prior to staff providing any care, treatment, or other services for the facility and/or its patients. CMS requires providers and suppliers to establish and implement a process that staff may request an exemption from COVID-19 vaccination requirements based on applicable Federal law. Certain allergies recognized medical conditions or religious beliefs, observances, or practices, may provide grounds for exemption.  
  • By January 4, 2022, all applicable staff must be fully vaccinated, except for those who have been granted exemptions or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by CDC, due to clinical precautions and considerations

2nd Policy-OSHA Regulation: 

The Occupational Health and Safety Administration (OSHA) released an Emergency Temporary Standard (ETS) published on November 5, 2021.  

Who it applies to: 

The OSHA regulation applies to all employers with 100 or more employees. 


  • Either workers must be fully vaccinated against COVID-19 by January 4, 2022 or test negative for COVID-19 at least once a week. 
  • Employers must provide paid time off for employees to get vaccinated as well as sick leave to recover from side effects. However, employers are not required to pay for testing.  
  • Unvaccinated workers are required to wear masks.

The OSHA regulation became effective on November 5, 2021. However, the U.S Court of Appeals granted a motion to stay until further court order. Per OSHA’s website, the court ordered that OSHA “take no steps to implement or enforce” the ETS “until further court order.” 

Healthcare providers and practices should prepare now and strategize their response to these standards.