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CMS COVID vaccination mandate faces legal challenge

By Shari Harris, Publisher

The Centers for Medicare & Medicaid Services (CMS) announced on November 4 that the Biden-Harris Administration is requiring COVID vaccinations of eligible staff at health care facilities that participate in the Medicare and Medicaid programs, via an emergency regulation issued by CMS. On November 10, Missouri Attorney General Eric Schmitt and Nebraska Attorney General Doug Peterson led a coalition of 10 states that challenged the CMS emergency regulation.

Over 17 million health care workers at approximately 76,000 providers of Medicare/Medicaid services are covered under the CMS emergency regulation nationwide. They must receive the first dose of a two-dose vaccine or a one-dose vaccine by December 6, 2021, unless they qualify for an exemption based on “certain allergies, recognized medical conditions or religious beliefs, observances, or practices.” If a two-shot vaccine is taken, the second dose must be administered by January 4, 2022.

Providers who are non-compliant will be cited and allowed an opportunity to become compliant before “additional actions” are taken by CMS.

Agencies included in the regulation include hospitals, hospices, long term care facilities, home health agencies, clinics, Rural Health Clinics/Federally Qualified Health Centers, and End-Stage Renal Disease Facilities (dialysis).

CMS states, “Unvaccinated staff pose both a direct and indirect threat to the very patients that they serve. Vaccines are a crucial scientific tool in preserving and restoring efficient operations across the nation’s health care system while protecting individuals. This new requirement presents an opportunity to continue driving down COVID-19 infections, stabilize the nation’s health care system, and ensure safety for anyone seeking care.”

CMS reports 40 percent of all U.S. hospitals have announced COVID vaccination requirements for their staff, and that these requirements have not led to widespread resignations. However, local health care providers are already reporting unfilled openings, and area long term care facilities (nursing homes) faced pre-pandemic staffing challenges.

CMS reports nursing home staff vaccination rates nationally have increased from 62 to 71 percent. Hickory Manor in Licking recently reported a staff vaccination rate of 47 percent, nearly equal to the rate of Texas County Memorial Hospital, which has 50 percent of staff vaccinated. Furthermore, long term care facilities are also required to meet minimal state staffing requirements, which regulate the minimum ratio of skilled staff per resident.

A significant loss of staff is catastrophic to any business, but a loss of health care providers is potentially catastrophic for every resident, patient, family member and co-worker who depend on that provider for a home, for health care, for care of a loved one, or for employment.

Attorney generals from Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota and New Hampshire joined Missouri and Nebraska in the lawsuit filed against the CMS emergency regulation.

The lawsuit states: “The CMS vaccine mandate also threatens to exacerbate an alarming shortage of healthcare workers, particularly in rural communities, that has already reached a boiling point. Indeed, the circumstances in the Plaintiff States – facts that CMS, which skipped notice-and-comment rulemaking, did not fully consider – foreshadow an impending disaster in the healthcare industry. By ignoring the facts on the ground and unreasonably dismissing concerns about workforce shortages, the CMS vaccine mandate jeopardizes the healthcare interests of rural Americans.”

“Requiring healthcare workers to get a vaccination or face termination is unconstitutional and unlawful, and could exacerbate healthcare staffing shortages to the point of collapse, especially in Missouri’s rural areas,” said Attorney General Schmitt.

Healthcare providers, their employees, and many rural Missourians anxiously await the legal process as the deadline for the first vaccination looms near.


  1. Emily on November 19, 2021 at 6:34 pm

    Sure would be nice if a judge could find the time to look at this…deadline is closing in fast. Or is this intentional? Kicking the can long enough for deadlines to lapse? This is the most blatant violation of our constitution I’ve personally ever witnessed, and that’s after 8 years of Clinton, Bush, & Obama.

  2. Teresa Swiger on November 19, 2021 at 10:06 pm

    Im a nurse and I submitted a religious exemption today to save my job. Waiting for the results, but word is most are rejected. I cant believe we are losing our jobs because of this illegal government overreach. Biden did this.

  3. Rhonda Karl on November 19, 2021 at 10:06 pm

    I am a respiratory therapist and an Rn. The CMS COVID 19 mandate is a major concern for me and many others working in the healthcare field. This mandate directly impacts me and many others who have decided not to take the vaccine due to medical or religious exemptions. Myself, and many others are going to lose our jobs because of this unfair coercion of a mandate. I have safely been performing my job for the last 20 months, while also complying with the hospital’s COVID-19 protocols. I have safely and competently performed my job duties without a vaccine up to this point- including during the PEAK of the COVID pandemic. I realize this may not fully represent your viewpoint. Therefore, I will look forward to your reply expressing your current stance on the issue. Thank you for your consideration of my viewpoint on this matter. I believe that this is a very important issue, and I would like to see the legislation stop this mandate. Sincerely, Rhonda Karl, RRT, RN.

    • Editor on November 22, 2021 at 8:03 am

      We have tried to remain balanced in our approach to reporting. Despite how any one of us may feel about the vaccine itself, we do agree that people should have the right to choose. The effects of understaffing at hospitals, clinics and nursing homes has the potential to affect us all. Furthermore, for the residents of nursing homes that are otherwise homeless, the impact of a decrease in nursing home beds due to staffing issues could be catastrophic. We are anxiously awaiting the results of the lawsuit.

  4. Sami on November 22, 2021 at 11:05 am

    I’m a mental health therapist working in a stand alone psychiatric hospital. My hospital is only requiring the vaccine because of the CMS mandate. We do not provide care or treat individuals with COVID, as they are redirected to a medical hospital. I’ve complied with all COVID protocols and am one of the few employees who has never had to be put on COVID precautions. There is much still to be learned about this vaccine, and the fact that the government is trying to force me to take something I’m opposed to or lose my job and livelihood terrifies me.

    We are running out of time.

    • Jill Patterson on November 27, 2021 at 2:31 pm

      I have worked nonstop since the pandemic..I follow the guidelines and so far have not had the virus. WE ARE IN DESPERATE NEED to have this mandate stopped as it is CRIPPILING our health care system – we can’t find staff ANYWHERE! many are leaving health care all together -if something isn’t done about this soon – we are going to have a complete collapse of our hospitals, nursing homes, private group homes etc. PLS HELP OUR COUNTY!!

  5. Lori Davis on November 23, 2021 at 10:13 am

    Thank you for this unbiased article. They are few and far between nowadays. I am xray/ct/mammo tech. I just lost my job of 9 years because of refusing the jab. I started a travel tech job because there was no mandate in WY. As soon as I got here, literally the day I started, they mandated it. So now i am so stressed out. I will have to pack up and move again. But where to? We are not the land of the free anymore. DC could give 2 #$@!% about the brave (frontline) workers. Florida sounds good, but even they don’t know what’s gonna happen in Jan.

  6. Allison on November 29, 2021 at 2:59 pm

    I’m a registered nurse in a rural hospital. We have been minimally staffed since before the pandemic. This mandate will be devastating to my hospital.

    No one in the national government batted an eye at the fact that Medical staffers wore the same N-95 mask for months on end in 2020. No one was bothered that I stood next to, and cared for covid patients day in and day out while pregnant with my son. I was told, “you signed up for this.” I had people give me dirty looks if I pumped gas in scrubs. There were local writers writing disparaging op Eds about nurses who were working on the front lines. No government official was concerned when I got sick with Covid-19 and was hospitalized just 3 weeks before my son was born.

    Now, however, suddenly the government is concerned about health and safety? Not likely. I will not comply.

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