CMS may now enforce its COVID-19 vaccination policy for healthcare workers in all 50 states

All 50 states are now subject to the Centers for Medicare & Medicaid Services’ (CMS’) healthcare workforce mandate after a federal court tossed Texas’ lawsuit and preliminary injunction contesting the requirement.

Today's dismissal comes less than a week after the Supreme Court removed a stay of the federal government’s industry-wide vaccine requirement in 24 states that opposed the policy. The Biden administration filed an appeal of Texas’ injunction the following day.

Although CMS’ requirement may now be enforced across the country, the agency has set varying compliance deadlines reflecting whether its initial interim final rule was enjoined in a particular state.

In 25 states and territories that were unaffected by legal stays, CMS said in December that eligible healthcare providers must have a COVID-19 vaccination policy in place with all staff having received at least one dose of a vaccine, a pending or approved qualifying exemption, or a temporary delay as recommended by the Centers for Disease Control and Prevention (CDC) by Jan. 27.

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By Feb. 28, those same facilities must also have the entirety of their staffs fully vaccinated, approved for an exemption or recognized as having a CDC-recommended delay. CMS defined a completed vaccine series as one dose of a single-dose vaccine or all doses of a multiple-dose vaccine series, with no mention of booster shots.

States subject to those deadlines include California, Colorado, Connecticut, Delaware, Florida, Hawaii, Maine, Maryland, Massachusetts, Michigan, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, Washington and Wisconsin.

Following the top court’s decision, CMS issued an updated guidance on Jan. 14 for 24 states that fought the policy, outlining the same workforce vaccination requirements with compliance deadlines of Feb. 14 and March 15.

The later enforcement dates apply to Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming.

“Federal, state, Accreditation Organization and CMS-contracted surveyors will begin surveying for compliance with these requirements as part of initial certification, standard recertification or reaccreditation, and complaint surveys 30 days following the issuance of this memorandum,” CMS wrote in its guidances.

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CMS’ updated guidance excluded Texas due to a preliminary injunction that was not immediately lifted by the Supreme Court’s decision.

The agency at the time instructed surveyors in the state not to “undertake any efforts to implement or enforce the [interim final rule].” CMS has not issued an update following the district court’s dismissal.

CMS’ COVID-19 vaccine requirement applies to roughly 10.4 million healthcare workers at 76,000 medical facilities, according to the Biden administration.

The policy was broadly welcomed by the medical community and hospital industry as a “common-sense” measure to limit COVID-19 transmission, although some individual facilities and the nursing home/assisted living industries worried the requirement would worsen an ongoing labor shortage.

Staffing concerns were also cited by each of the states that moved to obtain the preliminary injunctions alongside arguments that the federal government and its health agencies had overstepped their bounds.