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Healthcare CMS Vaccine Mandate Update – November 17, 2021

This article is from SESCO Management Consultants, ASA's Human Resource partner.  To learn more about this and all of the benefits of your ASA membership, click here.

As we have reported on previously, the Centers for Medicare & Medicaid Services (CMS) has released a rule (“CMS Rule”) requiring Medicare – and Medicaid – certified healthcare providers and suppliers to have all employees fully vaccinated.


  • The CMS Rule applies to employees regardless of whether their positions are clinical or non-clinical and includes employees, students, trainees, and volunteers who work at a covered facility.
  • The CMS Rule applies only to virtually all healthcare entities regardless of the number of employees that receive Medicare or Medicaid funding or reimbursement. This includes, but is not limited to, hospitals, long-term care facilities, home health agencies, and community mental health centers. Importantly, the CMS Rule does not apply to other healthcare entities, such as physician offices, that are not subject to certification health and safety standards.

Vaccine Requirements

  • The CMS Rule does not allow for testing in lieu of vaccination (unless considered as an accommodation to an approved medical or religious request for exemption).
  • Covered employers must establish a policy ensuring all eligible staff have, by December 5, 2021, received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine.
  • Covered employers must require that, by January 4, 2022, all affected staff be fully vaccinated, except for staff granted medical and religious exemptions. For purposes of compliance with the CMS Rule, individuals who received the second dose by January 4, 2022, will meet the vaccination requirement.
  • Covered employers must require documentation from employees to prove vaccination, even if an employee has previously attested to their vaccination status.

Religious and Medical Exemptions

  • Staff who claim a religious exemption must be required to provide a written statement that they have a sincerely held religious belief that prevents them from receiving the vaccine. No additional verification of the religious belief can or should be required.
  • Staff who claim a medical exemption must be required to provide a written statement that is supported by medical documentation that they have a medical or mental health condition that prevents them from receiving the vaccine.
  • Religious and Medical Exemption forms are available at no charge to retainer clients.

The CMS Rule expressly states that it preempts any inconsistent state or local laws, including laws that ban or limit an employer’s authority to require vaccination or proof of vaccination status.

Several states and entities have filed suit in federal appellate courts seeking to have those courts stop the CMS Rule from being enforced. As of November 17, 2021, the CMS Rule has not been blocked from enforcement. SESCO will continually monitor developments as to the progress of legal challenges; however, it is not anticipated that the CMS Rule will be blocked from enforcement.

SESCO Management Consultants will continue to monitor and report on developments with respect to the COVID-19 pandemic and will post updates in the firm’s COVID-19 Resource Center as additional information becomes available.

SESCO retainer clients and members of select associations can call or email SESCO to discuss specific industry, state and/or company questions and concerns. Those receiving these alerts that are not SESCO clients can contact SESCO by phone, fax or email to explore support options.