Emergency Regulation Requiring COVID-19 Vaccination for Healthcare Workers


On Thursday, November 4, 2021, CMS and OSHA released complimentary concurrent regulations mandating COVID-19 vaccinations for employees. While the OSHA standard targets facilities with 100+ employees, CMS takes primacy in the majority of healthcare settings and requires all eligible staff (including staff that is not patient facing) who are employed by facilities that participate in Medicare and Medicaid programs be fully vaccinated against COVID-19 by January 4, 2021.

Facilities covered by the CMS regulation can be found in the Federal Register.

The regulation requirements are split into two phases. The first phase states that these facilities must develop and implement policies and procedures to ensure that all staff are fully vaccinated against COVID-19 by December 5, 2021. These must include:

  • A process for ensuring staff receive at least one dose of the vaccine prior to providing care, treatment, or other services
  • A process for additional precautions to prevent the spread of COVID-19 for staff that are not fully vaccinated (i.e. have an approved and documented exemption)
  • A process for tracking and documenting vaccination status as well as additional booster vaccines as recommended by the CDC
  • A process for staff members to request an exemption from the vaccine to include exemption due to medical contraindications or religious beliefs
  • A plan for staff who are not fully vaccinated

The second phase states all eligible staff employed by these facilities must be fully vaccinated by January 4, 2022. Fully vaccinated is defined as two weeks or more since they completed either a single-dose vaccine or the second dose of a two-dose primary vaccination series for COVID-19. The CMS regulation does allow for medical and religious exemptions. It also requires documented proof of the exemption necessity.

If not governed by the CMS standard, the OSHA standard, if adopted by SC OSHA, will apply to all organizations that have 100+ employees and is in force until May 5, 2022. SC OSHA must adopt the new vaccine standard within 30 days of its publication in the Federal Register. The OSHA standard allows for religious and medical exemptions as well as a testing alternative for those who choose not to take the vaccine.  Employees are responsible for paying for their weekly testing. Additional elements to the alternative testing allowance in the OSHA standard will be discussed in a later post. As a standard part of the rulemaking process, you may submit comments and attachments for the next 30 days at www.regulations.gov. Be sure to include the “Docket No. OSHA-2021-0007” in your submissions. Please note SC OSHA adopted the previous portion of 1910 Subpart U COVID-19 Emergency Temporary Standard on October 29, 2021, and it is now enforceable. SC OSHA now has 30 days to adopt this new portion of Subpart U.

Additional information will be featured in upcoming blog posts and can be found through OSHA and CMS FAQ pages.

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Sarah Carter, BSN, RN

Sarah is responsible for providing risk management consulting services to the members of Palmetto Healthcare Liability Insurance Program (PHLIP) in order to assess, identify, and reduce risks in the areas of professional and general liability. She provides assessments, education, and resources to address specific areas of concern identified by members. After graduating with her BSN, Sarah started her nursing career in a local ICU caring for medically complex patients. She quickly advanced her career and became an Assistant Nurse Manager in the same unit while also becoming certified in critical care. She enjoyed being involved with harm reviews and finding ways to improve patient care. This led her into a Clinical Nurse Educator role where she helped develop several system-wide programs to help reduce patient harm, improve quality care, and increase patient satisfaction.