In early September 2021, President Biden issued an executive order instructing OSHA to issue a standard requiring employers to require vaccination or weekly testing for Covid 19. There are exceptions including religious exemptions and also various disabilities (a physician’s statement that a person cannot receive the vaccination). The executive order applies to all Federal employees, contractors, healthcare workers, and employees of private sector employers with 100 or more employees. Various dates for implementation are mentioned in the order-- most of them are in November and/or December of 2021.

State laws can have more rigorous requirements, but they cannot be less rigorous. For instance, a state can mandate vaccines for employers with more than 50 employees rather than 100; but they can’t adjust the mandate to employers with more than 200 employees.

There are many unanswered questions with regards to these orders. Some of the most pertinent to our businesses and industry include:

• Are DME companies that provide service to Medicare and Medicaid recipients considered “government contractors”?
• Does the 100-employee threshold take into consideration per location employees or total employees in a corporation?
• Is an employer required to pay for testing for employees who do not receive the vaccine because of these listed exemptions?
• What constitutes a “religious exemption”?
• There is some ambiguous language regarding the definition of “healthcare worker”. For instance, in one document, it describes them as being either hospital or nursing home employees. In another document, it refers to employees who do clinical work of any kind in any setting.

States, private companies, and individuals are lining up to fight these requirements. Every day in the news we see examples of private sector companies and government entities furloughing workers who have not been vaccinated. The judicial system is responding quickly to address challenges to these mandates, but it will be at least months, if not years, before the overall issue is resolved. Expect to see lawsuits working their way through the state and Federal court systems in 2022. Don’t expect final rulings or stable guidelines anytime soon.

Our industry is clearly part of the healthcare delivery system in the United States and our employees come into contact with a wide range of infectious diseases. We already have requirements from OSHA to offer Hepatitis B vaccinations and provide staff education for subjects such as bloodborne pathogens training. Think of these new requirements as similar or related. Most stakeholders in this discussion feel that there will be requirements going forward. At a minimum, it is certainly time to begin to educate staff regarding these requirements and begin to set up a system to collect information about employee’s vaccination status and maintain it in the personnel file.

In the meantime, as these requirements and your organization’s response to them evolve, use the following checklist as a guideline:

• Educate staff on all aspects of Covid. This includes not only information on working in environments that might include exposure, but also the latest guidelines on vaccinations. Make it an ongoing process. The Covid in-service you conducted in April of 2020 is obviously not current.
• Maintain protocols such as masking and social distancing per your policies and with a mind toward your individual state’s guidelines and requirements.
• Provide personal protective equipment and supplies (PPE) to all staff.
• Monitor requirements as they change via the CDC, state and local health departments, and industry groups websites.
• Encourage employees to check with their healthcare provider (family physician) regarding questions about the vaccination.
• If you are a large enough company to have a medical director, include them in any discussions about your company’s policy regarding vaccinations.
• Going into some healthcare facilities requires showing vaccine cards. A handy tip for the vaccinated is to snap a picture of their vaccine card on their cell phone and have it available.
• Know resources in your community. When/if the mandate becomes reality for your organization, where will you send your staff to receive their vaccinations?

Expect turbulent times full of changes, updates, and revisions. Think of any policy or protocol as a “work in progress”. Monitor updates from the CDC, industry groups, and your healthcare attorney closely and often.

Finally, try to keep calm and carry on. The issue of Covid vaccinations, mask mandates, and community protocols has become polarizing and divisive. Organizations that want to survive and thrive in these difficult times will be the ones that stay focused on the law and regulation and leave the politics out of it. Remember your organization’s mission and work constantly on providing the best care possible around whatever requirements go into effect.