Providers in limbo after COVID-19 vaccine mandate paused

Hospitals and health systems are in a holding pattern after a federal judge in Louisiana temporarily blocked a COVID-19 vaccine mandate for healthcare workers, bringing both relief and uncertainty to some providers.

The mandate, subject to a preliminary injunction under a ruling Tuesday, could still be reinstated. The federal government has appealed the decision, and even if the court ultimately were to rule for the Republican officials who sought to invalidate President Joe Biden’s policy, the government likely would appeal. Other courts are considering similar lawsuits filed by other GOP officeholders. The issue could go all the way to the Supreme Court, said Laurel Cornell, a partner at the law firm Fisher Phillips.

Judge Terry Doughty of the U.S. District Court for the Western District of Louisiana issued the injunction just weeks before the Centers for Medicare and Medicaid Services was set to enforce the rule. Healthcare companies that receive Medicare and Medicaid reimbursements were required to have their workforces fully vaccinated by Jan. 4, after a Dec. 4 deadline for workers to have received at least one dose. Under the regulation, employers that don’t comply could lose their Medicare and Medicaid certifications.

For some hospitals and systems that didn’t require worker vaccinations on their own, the block relieves tension. At East Tennessee Children’s Hospital in Knoxville, employee vaccination increased roughly 15% after CMS announced its mandate. But about 20 workers intended to resign rather than be inoculated. The 152-bed, not-for-profit hospital is reaching out to let them know they can keep their jobs and are expected back at work, President and CEO Matt Schaefer said.

Uncertainty about the vaccination rule is typical of the pandemic response in many ways, Schaefer said. Employees will continue to “roll with the changes despite the confusion, and despite the emotion,” he said.

Montana hospitals are relieved that the injunction may alleviate staffing shortages, said Montana Hospital Association President and CEO Rich Rasmussen. COVID-19 vaccine mandates haven’t led to a mass exodus from the healthcare workforce to date, but have disrupted operations at a few locations around the country at a time when staffing shortages abound.

“Hopefully, this is going to give everyone a little bit more time to reevaluate where they are personally with the vaccine, and certainly now with the omicron variant being out there, I think people are going to take another look at the vaccine,” Rasmussen said.

Montana is one of twelve states with new laws that directly conflict with the CMS rule. Although federal policy generally preempts state and local laws, the mandate pause eliminates some confusion over how to comply with dueling policies.

Many Texas hospitals are carrying on as though the rule is still in force for the time being, Texas Hospital Association spokesperson Carrie Williams said.

“Our hospitals don’t want to be out of compliance with either the federal government or the state government,” Florida Hospital Association President and CEO Mary Mayhew said. Florida adopted a law allowing exemptions for workers subject to vaccine mandates beyond what CMS allows.

Still, the injunction is temporary and the Biden administration could prevail in the courts, leaving providers unsure of what comes next.

At Scotland County Hospital in Memphis, Missouri, CEO Dr. Randy Tobler is frustrated at the time and effort his team spent to get into compliance with a regulation that may be tossed out. The hospital also has to consider how to handle employees who are partially vaccinated, he said. About a dozen Scotland County Hospital employees who hadn’t yet been vaccinated when the federal mandate took effect received their first shots or exemptions before Tuesday, he said. Tobler will encourage them to complete the vaccine series in the meantime but doesn’t know how to address what will happen if the mandate is reinstated.

Healthcare employers should continue to act as though the vaccine rule is in force because the legal situation could rapidly change, Cornell said. If the policy were reinstituted, the deadlines would probably shift, but companies should be prepared to act quickly. she said. Companies also need to be mindful of state and local laws mandating healthcare worker vaccines, which aren’t affected by the federal lawsuits, she said.

University of Iowa Hospitals and Clinics of Iowa City will continue its internal vaccination efforts but won’t require immunizations unless the CMS regulation resumes or if local competitors jointly establish a uniform policy, CEO Suresh Gunasekaran said.

“We’re not interested in creating our own standard. I think that will lead to a lot of confusion and I don’t think that accomplishes the goal,” Gunasekaran said. Given the high use of temporary employees at healthcare sites during the pandemic, varying policies among healthcare employers in a market would cause confusion, he said.

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