Memorial Regional Health in Craig will have to require all employees, direct contractors and support staff to be vaccinated for COVID-19, with the first dose by the end of the month and the second dose by Oct. 31.
Religious and medical exemptions will be closely monitored and reviewed by the Colorado Department of Public Health and Environment. The Colorado Hospital Association writes that “Colorado hospitals avoiding the COVID-19 Vaccination Regulations would be exposed to severe legal and financial repercussions.”
In a letter to the community, MRH states that they have explored all avenues to not make the vaccinations mandatory so as not to affect rural care in the Moffat County community.
Here is the full letter from Memorial Regional Health, on Sept. 15, 2021.
Dear Community,
MRH has received several questions from the public and through our elected officials asking us how the recent COVID-19 vaccines mandates impact MRH and our employees.
Thank You and Some Challenges
First, our staff has shown strength, resilience, and commitment to our patients and community throughout this pandemic. As a hospital, we have seen first-hand how destructive the COVID-19 virus can be. Despite countless challenges to our mission to improve the quality of life for the communities we serve through patient-centered healthcare and service excellence over the last year, we persevered together. We now face potential unintended consequences of decisions being made through the state legislative and federal administrative process.
Colorado Policy Changes
On August 30th, the Colorado State Board of Health (CDPHE) voted 6-1 to legally require COVID-19 vaccines for all licensed healthcare facilities in Colorado (6 CCR 1011-1 Chapter 2, General Licensure Standards and the COVID-19 Vaccine.)(COVID-19 Vaccination Regulations). The rule requires licensed health care facilities like MRH to comply by directing their employees, direct contractors, and support staff to receive the COVID-19 vaccine by a certain date. Employees not in compliance with the vaccination requirements are no longer eligible to
maintain their employment with defined healthcare facilities. However, employees are eligible to apply for certain limited exemptions. The COVID-19 Vaccination Regulation is summarized below:
- 100% of all health care workers, support staff, and direct contractors must have their first COVID-19 dose by Sept. 30, 2021, a second dose no later than Oct. 31st ;
- COVID-19 boosters will be required if recommended by the Advisory Committee on Immunization Practices (ACIP); and
- Exceptions may be granted for valid medical and religious exemptions.
The process to determine medical and religious exemptions is determined under both state and federal antidiscrimination laws and generally outlined by the Equal Opportunity Commission (EEOC) and the Americans with Disabilities Act (ADA), even if that was not specifically outlined in the state law. Behind the scenes, MRH has been working with the Colorado Hospital Association and Senator Bob Rankin to request that the COVID-19 Vaccination Regulations be modified based on the burden placed on rural healthcare hiring, staffing and retention
at our facilities. We know that passage with a 6-1 majority, the COVID-19 Vaccination Regulations were unlikely to be overturned. At the request of MRH, and many of our peer hospitals on the western slope, Senator Rankin appealed to the CDPHE on our behalf. In relevant part, he stated,
“Our rural health care delivery system in rural Colorado is fragile. My constituents simply don’t have the option to simply go to another location. And hiring and retention of staff is already severely stressed. Please consider a very flexible waiver process that allows these vital local hospitals to continue to operate while respecting the individual choices of their employees. Perhaps it can be based on access to critical services. I suggest that the mandate allow for a threshold of 90% vaccinated in line with the current flu vaccine requirement. And please relax the time requirement. Don’t react to the current COVID surge and damage our health care system for a long time into the future.”
Federal Policy Changes
Any hope for altering the CDPHE COVID-19 Vaccination Regulations changed on September 13, 2021 when the Biden administration announced a new policy to be set by the federal Occupational Safety and Health Administration (OSHA), which focuses on much of the news and controversy. The proposed rule will require all businesses with 100 or more employees to either achieve 100% vaccination rates or require weekly testing of unvaccinated employees.
Within the same directives, the President has instructed the Centers for Medicare and Medicaid Services (CMS) to require that all healthcare facilities that receive Medicare and Medicaid payments to comply with the same rules as a condition of participation to receive any federal monies. The CMS rule would cover the overwhelming majority of healthcare facilities operating in the U.S.
The CMS rule will require COVID-19 vaccinations for workers in most health care settings that receive Medicare or Medicaid reimbursement, including, but not limited to, hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies. This CMS policy will also apply to nursing home staff and certain staff in hospitals and other CMS regulated settings.
MRH is not technically subject to OSHA in Colorado, because Colorado has not adopted OSHA standards for governmental entities. For example, the Moffat County Government is not subject to federal OSHA standards and therefore is not required by law to comply. Nonetheless, even if the federal OSHA rule is challenged in court by other entities, court challenges regarding the authority of CMS to regulate the conditions of participation for healthcare facilities as part of the Medicare and Medicaid reimbursement rules would be unsuccessful. CMS rules are fully within the administrative authority of that federal agency.
The COVID-19 Vaccination Regulations and any federal policy changes will not override the antidiscrimination laws (e.g., ADA and EEOC). In fact, federal rules are even more subject to the ADA and EEOC provisions. Approved medical or religious exemption requirements will therefore remain in place. However, since Federal law always supersedes state law where Federal law is more restrictive than state law, those healthcare employees with approved medical or religious exemptions will face weekly testing requirements for as long as a
rule exists as a condition of participation at CMS. Approximately sixty-six percent of our revenue is based on payments from CMS. MRH cannot ignore these changes and will be surveyed in person by our accreditation body to demonstrate compliance.
MRH leadership met with representatives from the Colorado Hospital Association (CHA) on September 13, 2021. During that meeting it was emphasized to MRH that the Colorado Department of Public Health and Environment (CDPHE) will be carefully reviewing facilities that try to avoid COVID-19 Vaccination Regulations by simply looking the other way or by approving unsubstantiated and/or disingenuous medical or religious exemptions. CHA specifically expressed that Colorado hospitals avoiding the COVID-19 Vaccination Regulations
would be exposed to severe legal and financial repercussions.
MRH Internal Compliance Procedures
Any religious or medical requests for an exemption will be resolved through an internal process that follows applicable regulatory and statutory requirements. CDPHE has indicated that any exemptions granted by healthcare facilities will be reviewed for compliance purposes at a later date for both process and outcomes. Those granted medical or religious exemptions will need to comply with ongoing CDPHE testing requirements. Appropriate workplace accommodations will be considered, as we balance the safety of staff and our community with this
mandate.
Our Family Caring for Yours
As healthcare providers, we understand that our top priority is to do everything we can to provide high quality care to our patients in a safe environment. This mandate is exasperating short staffing levels all over the State of Colorado and is specifically troublesome in rural America. MRH will continue to work hard to offer high quality health care for all of Moffat County and the surrounding communities that it serves while it complies with these new regulations and challenges.