Family practice physician Christina Tuomi, D.O., (right) gets Homer's first dose of Pfizer's COVID-19 vaccine from Emergency Department nurse Steve Hughes (left) on Thursday, Dec. 17, 2020 at South Peninsula Hospital in Homer, Alaska. Tuomi has been the hospital's medical lead throughout the pandemic. (Photo courtesy Derotha Ferraro/South Peninsula Hospital)

Feds issue vaccine mandate to health care workers; Dunleavy joins lawsuit against the rule

Rule by CMS applies to hospitals, rural health clinics, community mental health centers.

Local health care providers have begun to comply with a mandate by the Centers for Medicare & Medicaid Services that requires staff to receive COVID-19 vaccinations or get religious or medical exemptions. On the southern Kenai Peninsula, CMS certified facilities that fall under the mandate include South Peninsula Hospital, Kachemak Bay Family Planning Clinic, SVT Health & Wellness, and South Peninsula Behavioral Health Services, also known as The Center.

Under an interim final rule published Nov. 5, health care providers listed in the rule have until Dec. 5 to develop policies that establish religious or medical exemption rules and track COVID-19 vaccinations for staff who don’t get exemptions. Non-exempt staff should get the first dose of a two-dose series or the only dose of single-dose vaccination by Dec. 5. The second dose must be taken by Jan. 5, 2021. Facilities also should develop policies for mitigating the transmission and spread of COVID-19 among those who have exemptions.

The CMS rule revises requirements that most Medicare- and Medicaid-certified providers must meet to participate in Medicare and Medicaid programs.

At Homer’s largest health care provider, South Peninsula Hospital, those policies have already been enacted, said Derotha Ferraro, SPH Public Information Officer. Physician offices like Homer Medical Clinic are exempt from the rule, but CMS rules advised that because staff there visit the hospital, clinic staff also should get vaccinated or apply for exemptions.

“The rule said that if you have employees who work out of the hospital, but on occasion come into the hospital or work with hospital staff, you should have everybody,” Ferraro said.

Telecommuting workers also will have to get vaccinated or get exemptions, she said. Those workers periodically visit the hospital for staff meetings. Working from home is a temporary COVID-19 pandemic arrangement, Ferraro said, because physical offices aren’t big enough to allow large groups to work together safely.

“We’re doing our entire organization,” Ferraro said. “… Anyone who works for South Peninsula Hospital Inc.”

SPH also entered into a letter of agreement with Teamsters Local 959 — the union representing some hospital workers — regarding the implementation of the CMS vaccine mandate, Ferraro said. The hospital used guidelines for religious exemptions set out by the U.S. Equal Employment Opportunity Commission. Exemption forms and an explanation of the policy were sent out Nov. 12 to all SPH employees.

The hospital already has put in place COVID-19 mitigation measures — the measures it’s been following throughout the pandemic, Ferraro said.

Kachemak Bay Family Planning Clinic also falls under the mandate, said Executive Director Claudia Haines, as it participates in Medicaid programs. The clinic provides reproductive health services. Haines said that the clinic is working on its policy so as to comply with the CMS mandate, including medical and religious exemptions. She also said the clinic practices “evidence-based health care.”

“The science tells us getting vaccinated reduces the threat of COVID-19, not just on our staff, our clients … but really the whole community,” Haines said. “That’s also our motivation.”

The clinic also provides youth programs and peer education through the REC Room. The vaccine mandate and exemption policy also will apply to adult staff there, Haines said. Because minors require parental consent, the mandate will not apply to peer educators under age 18. The clinic and the REC Room also practice COVID-19 safe practices like required face mask wearing and social distancing.

South Peninsula Behavioral Health Services, The Center, also falls under the CMS vaccine mandate, Executive Director Jay Bechtol wrote in an email. It is certified by CMS and is reimbursed for Medicare and Medicaid services. Initially, Bechtol wrote that he didn’t think the mandate would apply to community mental health centers.

“When the CMS Interim Final Rule came out on Nov. 4th, we like many other agencies were surprised to be included,” he wrote.

The Center connected with South Peninsula Hospital and other state partners and began drafting a policy as required. Staff were notified of the policy on Nov. 5 and the leadership team and board of directors wrote a final policy on Nov. 18. As at SPH, The Center has begun collecting vaccination records and medical and religious exemptions.

“SPBHS is committed to providing a safe space where individuals and families can access services they need,” Bechtol wrote. “Following the CMS guidelines will allow us to continue providing that service to the community.”

The CMS vaccine mandate does not apply to The Terrace, the assisted living home operated by Homer Senior Citizens Inc., Executive Director Keren Kelley wrote in an email. However, Kelley said they do take vaccinations seriously. She said earlier this month that all residents are 100% vaccinated against COVID-19. Many staff are vaccinated, and those with religious or medical mandates test every week for COVID-19.

Since the CMS mandate rules went out to South Peninsula Hospital employees, Ferraro said reaction has been mixed.

“We have some employees who are getting vaccinated,” she said. “We have some who are applying for religious exemptions, some who are applying for medical exemptions and some taking no action.”

Of SPH’s 524 employees, 363 or 69% are vaccinated, not including travelers or contractors, Ferraro said.

Unlike when the health care workers were part of the first group authorized to receive COVID-19 vaccinations in December 2020 and the hospital held in-house clinics, no big mass vaccination clinics will be held, she said. Employees can get vaccinations are the hospital’s testing and vaccination clinic.

Laurel Hilts, Marketing and Public Relations Director for Seldovia Village Tribe and SVT Health & Wellness, said she did not have any comment on their response to the CMS vaccine mandates.

After CMS announced the vaccine mandate, on Nov. 10 Gov. Mike Dunleavy responded in a press release that Alaska had joined nine other states challenging the CMS rule in a lawsuit filed in U.S. District Court for the Eastern District of Missouri. The plaintiffs seek an injunction to prohibit CMS from enforcing the mandate.

“This new rule is an insult to the personal freedoms of the health-care heroes who have been critical to Alaska’s response to the COVID-19 pandemic,” Dunleavy said in the press release.

In its rule, CMS said it “has broad statutory authority to establish health and safety regulations, which includes authority to establish vaccination requirements.”

Florida’s attorney general filed a similar challenge to the CMS vaccine mandate, but on Monday, U.S. District Judge M. Casey Rodgers issued an order denying a request for a preliminary injunction against the mandate, the Orlando Weekly reported.

Ferraro said this is the first time CMS has required any vaccine for health care workers at South Peninsula Hospital.

Reach Michael Armstrong at marmstrong@homernews.com.

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