CMS now says hospitals in half the country must abide by the COVID-19 vaccine mandate starting in late January

A new memo provides additional insight on circumstances in which state survey agencies can delay penalties for violations of the mandate.

The status of the COVID-19 vaccine mandate for healthcare workers took another twist Dec. 28, with CMS stating it will look to enforce the mandate within a month in half the country.

At hospitals and many other healthcare settings in 25 states and Washington, D.C., (see below for a complete list), staff must have received the first shot in a two-dose series or completed a single-dose series by Jan. 27. Hospitals also must ensure they have processes in place by that date for tracking vaccinations and permissible exemptions.

By Feb. 28, staff must be fully vaccinated as defined by the CDC, meaning both shots in a two-dose series. A booster shot currently is not required for staff to be considered vaccinated as defined by the regulations.

CMS will not look to enforce the mandate in the 25 states (see below) for which three courts have issued injunctions. The Supreme Court is scheduled to review the injunctions during a hearing Jan. 7, with its decision determining whether half the country or the entire country will be subject to the mandate while the cases make their way through the federal court system.

If the injunctions are allowed to remain, health systems with hospitals in multiple states could face the prospect of deciding whether to implement the mandate across the board or only where required.

More on enforcement of the mandate

CMS issued a memo to quality safety and oversight (QSO) agencies regarding enforcement of the mandate. Hospitals won’t be subject to penalties at the Jan. 27 deadline if at least 80% of nonexempt staff have received the required vaccination and the hospital can demonstrate a plan to ensure full compliance within 60 days.

A similar allowance will apply at the Feb. 28 deadline if 90% of nonexempt staff are vaccinated and the hospital can show a plan to get everyone else vaccinated within 30 days.

In instances of substantial and prolonged noncompliance, healthcare organizations could be disqualified from the Medicare and Medicaid programs.

Where the mandate will be enforced

Hospitals and various other types of healthcare organizations — but not physician practices, which aren’t required to adhere to Medicare conditions of participation — will be subject to the mandate in the following states:

California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, Washington, Wisconsin.

Around half of those states already had mandates in place for healthcare workers, although some included an option to undergo regular COVID-19 testing in lieu of vaccination. In addition, a number of the nation’s largest health systems already required staff to be vaccinated in the absence of a valid exemption.

Where the mandate won’t be enforced

Unless the Supreme Court lifts the various injunctions, the mandate currently is barred from being implemented in the following states:

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, Texas, Utah, West Virginia, Wyoming.