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CMS COVID-19 Vaccine Mandate Frequently Asked Questions

On November 4, the Centers for Medicare & Medicaid Services, or CMS, issued an emergency regulation that requires COVID-19 vaccines for healthcare workers. As a facility covered by the CMS regulation, Community HealthCare System is required to abide by the new rule. The vaccination requirement includes all CHCS associates, specialty clinic staff, vendors, volunteers, trainees, and students.

If you are already vaccinated and have not provided documentation to Employee Health, please do so immediately by emailing a copy of photo of your vaccine card to [email protected]. If you would like to get your vaccine right away, please call your clinic to schedule.

The new regulation requires the following.

  • By December 5, we must have a process and plan in place for vaccinating all eligible staff, and all staff must have received the first dose of COVID-19 vaccine or the single-dose J&J vaccine. We also must have a process in place for documenting staff vaccinations AND a process in place for providing medical and religious exemptions by December 5.
  • By January 4, 2022, all staff must be fully vaccinated. (Note that booster shots are NOT required; individuals are considered fully vaccinated upon completion of a two-dose series or upon receiving the single dose of J&J vaccine.)

Below is a list of frequently asked questions. We will add to the list as more questions are received, and we will update answers as information changes. If you have additional questions, please email them to [email protected]

 

1. What does it mean that the CMS regulation has a “comment period?” Will CHCS submit comments?

CMS is giving stakeholders 60 days to submit formal comment, Because the rule is an emergency regulation, though, it takes effect immediately, so we have to assume the deadlines are real. The comment period officially closes on January 4, 2022. The CMS FAQ says that at that point, CMS “will consider and respond to comments as a part of potential future rulemaking, if needed.”

Many efforts to provide comments are underway. CHCS is working with the Kansas Hospital Association to provide comments on behalf of Kansas Hospitals. We may submit our own comments, too.

CHCS has written letters expressing our displeasure to Kansas Senators and our Representative. We also plan to write a letter to Kansas Governor Laura Kelly.

2. Are we even considering a weekly testing option?

This option is not available to healthcare facilities. The OSHA emergency temporary standard for private employers with 100 or more employees allows employers to require vaccination or weekly testing and masking for unvaccinated employees, but the CMS rule does not allow this option for Medicare- or Medicaid-certified providers or suppliers. CHCS is regulated by both CMS and OSHA, but the CMS rules take precedence.

3. Will lawsuits or Congressional action stop the vaccine mandate from CMS and/or OSHA?

The CMS and OSHA vaccine mandates could be struck down in two ways. (Note: CHCS is regulated by both CMS and OSHA, but CMS rules take precedence. Because the CMS rule took effect immediately upon the announcement last week and we are operating under a December 5 deadline, and because both of these processes take time and seem unlikely, we have to move forward.)

  1. Congressional Review Act, or CRA. This act allows Congress to reject a new regulation with a simple majority vote in each house. Senator Mike Braun of Indiana has initiated the CRA process in the Senate for the OSHA regulation. The House Energy & Commerce Committee is reportedly considering doing the same for the CMS mandate, and Senator Roger Marshall seems to be exploring this option in the Senate. If all the stars aligned and both houses vote to repeal the regulation, it would go to the President, who would be likely to veto it. Congress could seek to override through a super-majority vote. Given the divisions in Congress, that seems highly unlikely.
  2. Court challenges
  • CMS: Attorneys General in Kansas and Missouri are suing to stop the federal government from mandating COVID-19 vaccinations for healthcare workers. This will take a long time to play out, and we don't know what the results will be. Read a news story about the lawsuit.
  • OSHA ETS: As you’ve probably heard, the Fifth Circuit Court of Appeals stayed the OSHA ETS. Kansas is in the Tenth Circuit, and Kansas Attorney General Derek Schmidt joined a lawsuit in the Sixth Circuit. When there are multiple Circuit Court lawsuits, suits can be consolidated, and the Chief Justice of the Supreme Court could literally have to draw a circuit number out of a hat to determine which case goes forward for review (and a Judicial Panel on Multidistrict Litigation involved). These processes are fairly complicated and will take some time to play out.

4. What criteria must be met for an associate to receive a medical exemption?

The medical exemption form asks for associates to check one of four boxes. All require medical documentation and a medical provider’s signature. Options are:

  • Severe allergic reaction after a previous dose of any COVID-19 vaccine or to a COVID-19 vaccine component
  • Treated for COVID-19 with monoclonal antibodies or convalescent plasma within the last 90 days (must comply when eligible)
  • History of Guillain-Barre Syndrome within 6 weeks of previous vaccination
  • Other

5. What criteria must be met for an associate to receive a religious exemption?

Associates need to convey a sincere and meaningful religious belief or practice. Note that a religious belief or practice is not something that is based on grounds of political, social, or personal philosophy, preference, or convenience under applicable law. View the form.

6. Why can CHCS ask me about my religious preferences and sincerity on this form?

We ask this question merely for purposes of gathering information about your religious objection. This information will not be used to discriminate against you or for any purpose other than to determine if you are entitled to a legally required accommodation. Please note that CHCS is not making any judgments about your religion, but is only seeking information to determine whether the requested accommodation is based on religious grounds.

Neither CHCS nor anybody at CHCS is determining the validity of your beliefs or whether your religious is “good enough” or “strong enough.” Rather, this information is requested to enable CHCS to determine if your request for an accommodation is based on religious grounds.

7. Can an associate ask for both a religious and a medical exemption? 

Yes. If you choose to do this, please turn in both at the same time. 

8. How should I get a provider to sign my medical exemption form? 

Your primary care provider (PCP) must sign your medical exemption request. If your PCP is from CHCS, please fill our your form and take it to the appropriate clinic Registration, and Registration will get it to the PCP for review and signature. If your PCP is outside CHCS, you must have that person sign not. Please do not approach CHCS providers in person or by email to get them to sign your form just because you know them personally or professionally. 

9. Who will review the medical and religious exemptions?

Medical exemptions will be reviewed by the following committee:

  • Dr. Nicholas Cahoj, Employee Health Physician
  • Cindy Flentie, Human Resources
  • Christina Hasenkamp, Employee Health Nurse

Religious exemptions will be reviewed by the following committee:

  • Hali Brown, PharmD
  • Dr. Nicholas Cahoj, Employee Health Physician
  • Cindy Flentie, Human Resources
  • Lorraine Meyer, Chief Operating Officer and Risk Management Officer
  • Mindy Olberding, Chief Nursing Officer

10. When are exemptions due, and when will they be approved or denied?

Medical and religious exemptions are due to Human Resources by 5:00 p.m. Monday, November 15.

Exemptions will be reviewed as soon as possible, but if HR receives a large number of requests, it could take a few days.

11. What happens if I want to submit a medical or religious exemption but can’t see my provider or consult with a religious leader before the deadline?

If you are in this situation, please let Human Resources know in writing by the deadline that you intend to submit an exemption and when you anticipate being able to submit it. Please submit your form as soon as possible.

12. If associates are approved for medical or religious exemptions, will they have to be tested weekly or daily or at some other interval? If so, who will pay for that? What else will these associates have to do?

This has not yet been determined, but a team is evaluating the accommodations that will be required. A testing requirement is likely. 

13. If a testing requirement is put in place for unvaccinated associates with approved exemptions, will the associates have to pay for testing? 

No, associates would not have to pay for testing. 

14. Can those who have received monoclonal antibodies be allowed to wait 90 days before getting the vaccine as recommended by CDC?

Yes. Associates who have been treated for COVID-19 or convalescent plasma may delay their vaccination until they have completed the 90-day period following treatment.

15. Will someone who recently recovered from COVID-19 be allowed a 90-day exemption?

No. A recent recovery from COVID-19 does NOT result in an automatic 90-day exemption. If you are out of quarantine, afebrile, and have recovered from all major symptoms, it is recommended for you to receive the vaccine. If you feel you need more time to recover before receiving the vaccine, you need to file a medical exemption request by November 15. 

A 90-day exemption applies for those who received monoclonal antibodies.

16. Will women who are pregnant or trying to conceive be considered as a medical exemption?

If you are pregnant or trying to conceive and you are concerned about receiving the COVID-19 vaccine, talk to your doctor. If your doctor recommends that you not get vaccinated, get a note from your doctor and apply for a medical exemption.

17. Will associates be offered an incentive to get the vaccine such as money or additional PTO?

Financial incentives for associates have not been discussed, but associates are provided paid time to receive the vaccine and recover from any side effects.

18. What happens if an associate refuses to get the vaccine and does not request an exemption? Does the associate’s last day have to be December 5, or can they work until January 4?

Unless an associate is exempt, they must have received their first vaccine or the one-dose J&J vaccine by December 5, so an associate who does not meet those criteria will be considered a voluntary resignation. Associates who plan to resign voluntarily should give adequate notice.

19. Do we need parental consent forms for associates under 18 to receive the vaccine?

Parental consent is required for those under 18 to receive any vaccine.

20. Do parents need to sign medical/religious exemption forms for associates who are under age 18?

Yes

21. Will clinics be held for associates to receive the COVID-19 vaccine?

We are assessing the number of associates who wish to receive the vaccine and will offer a clinic if needed. In the meantime, any associate who wishes to receive the vaccine can call any CHCS clinic to schedule an appointment.

22. If an associate gives adequate notice, will s/he receive a payout of PTO? 

Associates who give proper notice according to the CHCS Resignation/Termination of Employment policy are eligible to receive payment for accrued PTO hours. Read the policy.

Appropriate notice is as follows:

  • PRN: no notice required
  • Probationary associates: 14 days preferred
  • Non-management staff: 14 calendar days
  • Management staff: 30 calendar days

23. What if my exemption is not reviewed in time for me to give a 14-day notice if the exemption is declined?

We are operating under a tight timeline. The committee’s intent is to review exemption requests and respond as soon as possible.

24. Are associates who resign because of the vaccine mandate eligible for unemployment?

Any associate who resigns is eligible to apply for unemployment, but they are not guaranteed to receive it. Traditionally, associates who resign their positions have difficulty obtaining unemployment compensation.

25. What will happen if CHCS loses a large number of staff because of the vaccine requirement? 

Losing staff could mean that CHCS has to limit services, which will limit our ability to treat patients in our communities. 

More information on how the rule will be enforced by surveyors, how CMS defines terms, facilities that are affected, and much more is available in an FAQ from CMS. Find it here: https://www.cms.gov/files/document/cms-omnibus-staff-vax-requirements-2021.pdf