Final rule for healthcare worker vaccinations strikes dental practices and EMS organizations


The Maine Department of Health and Human Services (DHHS) on November 10 released its final rule updating the immunization requirements for healthcare workers at designated healthcare facilities to include the COVID-19 vaccine.

Unlike the emergency rule that went into effect in August, the final rule does not apply to dental health practices or emergency medical services (EMS) organizations.

At a press conference jointly held with Maine Centers for Disease Control and Prevention (CDC) Director Dr. Nirav Shah and DHHS Commissioner Jeanne Lambrew, the commissioner announced the publication of the final rule but did not immediately elaborate on the changes that had been made.

“After taking public comment, this final rule incorporates feedback, adopts some clarifying guidance and replaces the emergency rule, which has expired,” Lambrew said in her opening comments.

Later in the press conference, while responding to questions from reporters, Lambrew did clarify some of the changes made in the final rule. 

“Because the emergency medical services board did adopt its own rulemaking, the final Maine Department of Health and Human Services rule did remove EMS organizations to avoid any conflict or confusion with that bureau’s rule. And upon review of data and comments that were submitted on jurisdiction we did remove dental health practices from the rule as well.”

The definition of employee covered by the final rule has also been revised, as has a proposed definition of healthcare setting included in the emergency rule. 

The emergency rule included independent contractors for any of the healthcare facilities covered by the rule in its definition of an employee; that language has been removed from the final rule. While the final rule still includes some independent contractors under its definition of employee, it clarifies that “persons who provide ad hoc, non-health care services for a Designated Healthcare Facility and have no potential for direct contact (clinical, hands-on, or face-to-face interaction) with staff, patients, or visitors of a Designated Healthcare Facility” are not covered and subject to immunization requirements. 

DHHS also published a document summarizing comments it received in relation to the COVID-19 immunization rule and providing departmental responses.

In it, DHHS addressed the ongoing legal challenges to the rule, which no longer allows for religious and philosophical exemptions to vaccination.

The department noted that allegations about the lack of a religious exemption rendering the rule unconstitutional are “currently being litigated in both state and federal courts.” The department added that if the legal challenges are successful, it will “revise its rules and enforcement practices accordingly.”

The department also provided some data on the number of healthcare workers who have contracted COVID-19. According to the department’s response, 6,985 self-identified healthcare workers have contracted COVID-19 as of October 19. DHHS noted that this number only includes self-identified healthcare workers, which may mean the number of cases is underinclusive.

The department further noted that there have been at least 1,200 COVID-19 outbreaks in Maine since the pandemic began, including 209 outbreaks in long-term care facilities, 130 outbreaks in group home facilities and 28 in hospitals. 

According to DHHS’ comments, because many residential facilities have been closed to visitors, “it is likely that most health care facility outbreaks are the result of healthcare workers who bring COVID-19 into the facility.”

In its response, the department also said it has determined it has “insufficient data to support the claim that vaccine mandates significantly decrease Maine’s healthcare workforce.” According to data provided in its response, the agency stated that 0.3% of MaineHealth employees and 0.6% of Northern Light Health Employees had resigned in protest of the COVID-19 vaccination requirement as of mid-September.

During the November 10 press conference, Lambrew also announced that her agency had released updated data on the vaccination rates of healthcare workers for the month of October. Lambrew said the vaccination rate had risen to 97.7% of healthcare workers at designated facilities by the end of October. 

“This continues a significant increase in vaccination that we saw in September,” Lambrew said.

Lambrew claimed the near 100% vaccination rate for workers at designated healthcare facilities proves Maine’s policies are effective.

“The fact that nearly 100% of healthcare facility staff are vaccinated demonstrates that the policies that Maine has adopted have worked. They are protecting these critical workers, their patients, their residents, and their capacity to care for people with COVID-19, as well as other serious health problems.”

Lambrew also announced the number of unvaccinated workers reported by healthcare facilities “plummeted by 14,810, or 92%” between May, when the state first started reporting on healthcare worker vaccination, and October, the most recent month for which data is available.

In a press release also published on November 10, DHHS stated the number of staff reported by designated healthcare facilities fell by 516, or 1%, between May and October.

DHHS claimed the difference in the number of workers being reported is affected by “[f]acility expansion and contraction, reporting rate fluctuations, and seasonal changes in workforce affect these trends.”


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