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Skilled Nursing Facilities Vaccine Mandate

Last week there were two new rules issued by the Biden administration regarding vaccine mandates. The Center for Medicare and Medicaid Services (CMS) released an interim final rule (IFR), along with the Emergency Temporary Standards released by the Occupational Safety and Health Administration (OSHA).

Providers Involved:

  • Ambulatory Surgical Centers
  • Hospice Agencies
  • Psychiatric Resident Treatment Facilities
  • Programs of All-Inclusive Care for the Elderly
  • Acute-Care Hospitals
  • Long-Term Care Facilities
  • Intermediate Care Facilities
  • Home Health Agencies
  • Comprehensive Outpatient Rehabilitation Facilities
  • Critical Access Hospitals
  • Outpatient Rehab Facilities
  • Community Mental Health Centers
  • Home Infusion Therapy Suppliers
  • Rural Health Clinics
  • End Stage Renal Disease Facilities

Neither CMS nor the OSHA mandate appears to apply to assisted living facilities at this time. But the American Health Care Association (AHCA) stated that this was an oversight and should be corrected soon.

CMS vs OSHA Rule

CMS’s rule is more stringent stating that all providers listed above must vaccinate all employees, regardless of employer size, and does not provide an option for weekly testing. This interim rule is likely to go into effect as proposed with a shorter comment period and no formal response needed to commenters.

The OSHA rule included most employers with 100 or more employees and includes a weekly testing exemption for unvaccinated employees with the same deadline as the CMS rule. These weekly tests can require the employee to pay for the test.

Both rules include exemptions for medical contraindication and religious beliefs.

CMS Rule Implementation 

CMS’s interim rule went into effect November 5, 2021, and will be implemented in two phases.

  • Phase I – Deadline is December 5, 2021, is for all eligible staff to have at least one dose of the vaccine.
  • Phase II – Deadline is January 4, 2022, at this point you should have all your staff fully vaccinated.

Define Fully Vaccinated

CMS defines fully vaccinated as one dose of the Johnson & Johnson vaccination, or both doses of Moderna or Pfizer vaccinations. At this point, the boosters are not included in fully vaccinated status.


The CMS will issue explanatory guidelines this will include citations and additional actions for facilities who do not comply with the vaccine mandate.

Policies and Procedures 

Providers must also develop policies and procedures that include, how they are ensuring staff are vaccinated, paid leave for vaccination and recovery, documentation and tracking, establishing an exemption process and a contingency plan for dealing with unvaccinated staff.

Employees Covered/ Not Covered

Employees covered in this rule are any staff who provided any care, treatment of services for other staff, or patients.

This includes:

  • Housekeeping
  • Activities
  • Licensed Practitioners
  • Students
  • Trainees
  • Volunteers
  • Corporate Consultants that come to your building

This does not include:

  • Staff working 100% remote
  • Staff that work exclusively outside the facility and do not come into contact with staff or patients
  • Staff with the following exceptions
    • Medically recognized contraindicated conditions
    • Religious beliefs and practices

Skilled Nursing Facilities Vaccine Mandate: What You Can Do

AHCA is encouraging providers to submit comments pertaining to a testing option for the CMS rule. The deadline for submission is January 4, 2022. You can submit your comments here.

Contact Us

Blue & Co. understands that these are difficult times for Skilled Nursing Facilities and we want you to know we are here to help. Our Post-Acute Care team offers the following services:

  • Interim administrative assistance by a registered nurse with developing and implementing the policies and procedures that are required by the new rule to help prevent deficiencies.
  • Interim MDS assistance for staffing crisis either on site or remotely from an experienced registered nurse with a RAC-CTA and numerous years of MDS experience.

Reach out to a member of our Post-Acute Care team or contact your local advisor to learn how we can help your organization navigate these new changes.

Landon Hackett, Director

Stephanie Fey, Manager

Kayla Shelton, Senior Accountant

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