Coronavirus

Maine delays enforcement of healthcare worker vaccine mandate but offers no testing alternative

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According to Department of Health and Human Service (DHHS) Commissioner Jeanne Lambrew, Maine healthcare workers will not be able to opt out of the COVID-19 vaccine mandate by routinely submitting negative tests.

At a September 2 press conference, Lambrew was asked whether concern that the mandate might result in healthcare workers leaving the workforce would lead the state to consider a testing alternative.

“I think we believe that the number one best way to protect against COVID-19 is the vaccine. We have in the state of Maine had long-standing policy about the battery of vaccines and immunizations that help keep workers safe, so we maintain that our approach here in Maine is the more effective approach from a public health perspective,” Lambrew said. 

The September 2 press conference was jointly held by Lambrew and Maine Centers for Disease Control and Prevention (CDC) Director Dr. Nirav Shah to announce a delay in the enforcement date of the administration’s vaccine mandate for healthcare workers. Enforcement of the mandate is being moved from October 1 to October 29.

Shah distinguished between the date by which healthcare workers should be vaccinated, which he stated remains October 1, and the date DHHS will begin enforcing the mandate, which is now October 29. 

Lambrew characterized the delay as an attempt to “cut a little slack” for individuals and organizations that need extra time to come into compliance. Lambrew also explained the delay in enforcement was influenced by several recent events. One of these was the Pfizer vaccine being awarded full authorization by the Food and Drug Administration (FDA). Lambrew stated some healthcare workers were waiting for the vaccine to receive full approval before receiving it. 

Lambrew also stated that the delay in enforcement was influenced by a round of one-time funding Gov. Janet Mills recently announced is being awarded to healthcare facilities. Lambrew stated healthcare facilities can use that funding as incentive for their employees to receive the vaccine. 

According to Lambrew, enforcement of the COVID-19 vaccine mandate will be the same as for other vaccines mandated by DHHS. Healthcare facilities are required to report their vaccination numbers to DHHS, which will take noncompliance into account when it makes decisions about facility licensing and certification.

Unlike healthcare providers, dentists and emergency medical services (EMS) workers have not been subject to previous vaccine mandates. Healthcare workers are required to be vaccinated against measles, mumps, rubella, chicken pox, hepatitis B, and the flu.

Dentists and EMS workers are not required to have these vaccinations, but are required to receive the COVID-19 vaccine. DHHS did not return a request for comment about whether the vaccine enforcement process for dentists and EMS workers will be identical to the process used for healthcare workers.

Both Shah and Lambrew touted the effectiveness of the mandate, as well as the support the policy has received from healthcare groups, including Northern Light Health, the Maine Medical Association and the Maine Primary Care Association. 

DHHS currently posts the COVID-19 vaccination rates of staff at nursing homes, ambulatory surgical centers, and certain assisted living facilities on its website. It identifies staff whose vaccination status is required to be reported as all employees, temporary workers, contracted workers, volunteers and students. The data is updated monthly, no later than the seventh of each month. 

According to the most recent data, as of July 31, 85.9% of ambulatory surgical center staff, 74.7% of assisted housing staff, 80.3% of hospital staff, 68.2% of staff at intermediate care homes and 73% of nursing home staff in Maine are vaccinated. 

According to the Centers for Medicare and Medicaid Services (CMS), Maine’s nursing home employee vaccination rate is above the national average. As of August 22, CMS reports an average of 61.8% of nursing home staff per facility are vaccinated.

With a regular testing exemption unlikely to be embraced by the administration, most healthcare workers, dentists, and EMTs opposed to the vaccine mandate have few options if they want to keep their jobs in Maine. The state recently eliminated religious and philosophical exemptions to state vaccination requirements. Medical exemptions are still accepted, provided the individual has a statement from a physician. 

However, not all medical workers in the state are covered by the mandate, which applies to designated healthcare facilities, dental practices, and EMS organizations. The mandate does not cover independent physicians and private health care providers who practice under the license of an individual medical director. This means many private physician practices, urgent care clinics and healthcare providers who are not connected to a hospital or other medical facility, are not subject to the mandate.

The following table details what kinds of facilities are covered by the mandate:

As Lambrew discussed at the September 2 press conference, healthcare providers who exclusively use telehealth to provide their services are also not subject to the mandate. 

Maine has few rules that restrict the practice of telehealth, and during Maine’s COVID-19 state of emergency, Gov. Mills signed several executive orders that suspended and modified licensing requirements for the state’s healthcare workers. Both Executive Order 16 FY 19/20 and Executive Order 35 FY 19/20 made it easier for retired healthcare workers and out-of-state healthcare workers to obtain an emergency license to practice medicine in Maine during the state of emergency, while also allowing them to deliver services via telemedicine. 

Though those orders have now expired, some pandemic-changes expanding telemedicine coverage for MaineCare recipients were made permanent. In June of 2020, Maine DHHS adopted new permanent rules that removed a blanket prohibition against pharmacy services being provided via telehealth. Additionally, DHHS waived requirements that telehealth services covered under MaineCare be of comparable quality to in-person services and eliminated a rule stipulating a provider obtain written consent from a patient before providing telehealth services.

The rule changes also expanded the number of telehealth services provided under MaineCare to include store-and-forward, virtual check-ins, remote consultation and telephone evaluation and management. The expansion of coverage to store-and-forward and telephone evaluation allow medical providers to be reimbursed for communication about patients’ treatment and diagnosis. 

Expanding telehealth services may offer healthcare workers opposed to the COVID-19 vaccine mandate a way to continue working in Maine.

About Katherine Revello

Katherine Revello is a reporter for The Maine Wire. She has degrees in journalism and political science from the University of Maine. Her writing has appeared in Reason, The Washington Examiner, and various other publications. Got news tips? Contact Katherine at krevello@mainepolicy.org.

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