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CMS Releases COVID-19 Vaccine Mandates

Posted Nov 4, 20213 min Read

Regulatory & Clinical
CMS released an interim final rule (IFR), with comment period, that revises the requirements that most Medicare- and Medicaid-certified providers must meet to participate in the Medicare and Medicaid programs.   CMS also released this FAQ about the health care staff vaccination mandate.  The Biden Administration is requiring covered​ health care workers to be vaccinated through this IFR released by CMS.
Please note that due to court action the CMS IFR is not applicable in Indiana.  A Supreme Court hearing is currently set for January 7, 2022.
The CMS regulations are in a phased-in approach. Phase I implementation must be done by December 5, 2021. Phase II implementation must be done by January 5, 2022. Details of each phase are provided below.

Phase I – Effective December 5, 2021

Skilled Nursing Facilities, Nursing Facilities, and ICF-IIDs must establish a policy ensuring that all eligible staff have received by December 5, 2021 the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services, or have requested or been granted exemption.

  • Exemptions based on recognized medical conditions or religious beliefs, observances, or practices are included in the rule.
  • Included staff are individuals who provide care, treatment, or other services for the facility and/or its patients:
    • ​​facility employees
    • licensed practitioners
    • students
    • trainees
    • volunteers
    • anyone under contract or other arrangement.
  • ​​Contractual or arranged workers may include hospice, dialysis, physical therapy, occupational therapy, mental health professionals, social workers, portable x-ray suppliers, etc., and are included in “staff” for whom COVID-19 vaccination is now required as a condition for continued provision of those services for the facility and/or its residents regardless of the frequency for which they enter the facility.
    • An exception is made for 100% teleworkers as they are not included in the required staff vaccination. However, if they come into the facility at all, they are then included in the staff vaccination requirement.
    • When determining whether to require COVID-19 vaccination of an individual who does not fall into the categories established by the IFR, facilities should consider frequency of presence, services provided, and proximity to patients and staff

​Facilities are required to track and securely document the vaccination status of each staff member, including those for whom there is a temporary delay in vaccination, such as recent receipt of monoclonal antibodies or convalescent plasma. Vaccine exemption requests and outcomes must also be documented. Documentation will be an ongoing process as new staff are onboarded. Examples of acceptable forms of proof of vaccination include:

  • ​​CDC COVID-19 vaccination record card (or legible photo of the card)
  • Documentation of vaccination from health care provider or electronic health record
  • State immunization information system record
  • If vaccinated outside of the U.S., an equivalent to previous examples is acceptable

Phase II – Effective January 5, 2022

  • Requires that primary vaccination series has been completed and that staff are fully vaccinated, except staff who have been granted exemptions, or those whom COVID-19 vaccination must be temporarily delayed as recommended by the CDC due to clinical precautions and considerations. Staff who have completed the primary series for the vaccine by January 5, 2022, are considered to have met the requirements, even if they have not yet completed the 14-day waiting period required for full vaccination.
CMS makes clear that the IFR issued does not apply to assisted living.