CMS Issues Vaccination Guidance for Behavioral Health Care Workers

The Centers for Medicare and Medicaid (CMS) issued guidance Tuesday on an interim final rule mandating COVID-19 vaccinations for workers at federally-funded health care facilities.

The vaccination guidance pertains to the final rule issued by the Biden administration in November, which mandated all workers at CMS-funded facilities to have the COVID jab by January 4, 2022.

The mandate applies to 76,000 providers and over 17 million workers nationwide, according to CMS data. A number of those facilities falling under the mandate include those providing behavioral health services, of which Medicaid is the nation’s largest payer. Among behavioral health staff that are required to get vaccinated are hospital workers, licensed practitioners, students, trainees, volunteers and others rendering care.


CMS said that federally-funded health care facilities are compliant with the mandate if all employees have at least one COVID vaccination within 30 days of the new guidance.

For facilities that have achieved an 80% vaccination rate among its workforce and demonstrate a plan within 60 days to raise the rate to 100%, they would not be subject to additional enforcement action.

Health care centers that have achieved a 90% vaccination rate within 30 days of the guidance, and who also demonstrate a plan for getting the number to 100%, will likewise not be subject to additional enforcement action.


Facilities might face enforcement action if they are not compliant with the rule within 90 days and thereafter from the issuance of the guidance. For hospitals and other facilities of acute and continuing care that ultimately do not comply with the mandate, the guidance stated that those providers would be subject to termination from the Medicare and Medicaid programs.

CMS indicated that termination would be a last resort, and that “it would generally occur only after providing a facility with an opportunity to make corrections and come into compliance,” according to a memorandum on the guidance.

Termination from the Medicare and Medicaid program is the sole enforcement action hospitals face for not complying with the mandate. Nursing homes, home health agencies and hospice care operators that are non-compliant face civil fines and reimbursement denials, along with CMS program termination as a final measure. Facilities, in some instances, can apply for a COVID vaccination exemption based on applicable federal law.

The final rule does not apply to those providing telehealth services outside of a hospital setting. Telehealth was used in 56% of behavioral health care services as recently as December 2020, according to the Commonwealth Fund. That number was the largest among 22 specialty health care areas measured.

The mandate also does not apply to any workers who provide other services outside of a hospital setting and who do not have any contact with patients and other staff. Additionally, the guidance does not apply to 25 states.

The CMS guidance has been issued as COVID cases related to the highly contagious omicron variant continue to rise across the country and abroad. Omicron currently makes up more than half of the COVID diagnoses nationwide, according to the Centers for Disease Control and Prevention (CDC).

The CDC downwardly revised its most recent data Tuesday related to new omicron cases. The agency reported a 50% drop of its previous estimates from December 18, when it was declared that 73% of new COVID cases were a result of the omicron variant.