COVID-19 Vaccination in Maine

Page last updated 11-10-2021.

Health Care Worker Vaccination FAQs

On August 12, 2021, the Mills Administration announced an emergency rule requiring that certain workers at health facilities in Maine be fully vaccinated against COVID-19 by October 29, 2021.

While the rule’s deadline for full vaccination was October 1, 2021, the Mills Administration announced on September 2, 2021 that it would begin enforcement of its COVID-19 vaccination requirement for health care workers on October 29, 2021, providing an additional month for health care workers to complete their vaccination protocol and for health care organizations to use $146 million in forthcoming funds to address workforce needs. During the same time period, the Maine Department of Health and Human Services (DHHS) issued a proposed rule for comment to take effect with the expiration of the emergency rule. The final rule, effective as of November 10, 2021, can be found here. 

The State of Maine has long required the immunization of employees of designated health care facilities to reduce the risk of exposure to, and possible transmission of, vaccine-preventable diseases. Maine DHHS, at the recommendation of Maine Center for Disease Control and Prevention (CDC), amended the existing rule to include the COVID-19 vaccine to protect the health and lives of Maine people, safeguard Maine’s health care capacity, and limit the spread of the virus.

These FAQs address COVID-19 vaccination of health care workers in Maine under the final Maine DHHS rule, including changes from the emergency rule, and how this rule may relate to similar Federal rules, with the caveat that Federal agencies are the authorities on their rules. These FAQs supersede the FAQs on the emergency rule for immunization requirements for Maine health care workers.

Organizations Subject to the Immunization Rule

1. Which health care facilities are subject to Maine DHHS health care worker immunization requirements rule compared to other State and Federal rules?

This final Maine Department of Health and Human Services (DHHS) rule applies to “Designated Healthcare Facilities” as outlined in 22 MRS § 802 (4-B) and licensed by the DHHS Division of Licensing and Certification.  The list of facilities in the final rule is unchanged from the previous permanent rule requiring certain vaccinations for health care workers at Designated Healthcare Facilities.

Since the Maine DHHS emergency rule was issued, Maine’s Bureau of Emergency Medical Services (EMS) issued its own emergency (PDF) and proposed rules that applies to EMS Organizations that generally requires COVID-19 vaccination for certain types of EMS workers. 

The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) issued an interim final rule for comment (PDF) on November 5, 2021, that “establish[es] COVID-19 vaccination requirements for staff at the included Medicare- and Medicaid-certified providers and suppliers.” 

The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued an Emergency Temporary Standard (PDF) on November 5, 2021, “to protect unvaccinated employees of large employers (100 or more employees) from the risk of contracting COVID–19 by strongly encouraging vaccination. Covered employers must develop, implement, and enforce a mandatory COVID–19 vaccination policy, with an exception for employers that instead adopt a policy requiring employees to either get vaccinated or elect to undergo regular COVID–19 testing and wear a face covering at work in lieu of vaccination.”

The following table identifies what healthcare facilities are affected by the Maine DHHS rule and offers a general understanding of which federal COVID-19 rule, if any, may apply to those health care facilities. This table is not definitive regarding the Federal rules because the Maine DHHS is not the authority on Federal rules. Providers should review their issued license(s), their corporate/business structure, and, as needed, consult with Federal officials to make final determination on the CMS rule or OSHA ETS applicability to their organization.   

Health Care Facility  Required to Comply with Maine Vaccination Rule?  May be Required to Comply w/CMS Vaccination Rule **  May be required to Comply w/OSHA Vaccination or Mask-Testing Rule  
Hospital  Yes  Yes  No 
Nursing Facility  Yes  Yes  No 
Intermediate Care Facility for Individuals with IDD  Yes  Yes  No 
Residential Care Facility or Private Non-Medical Institution (PNMI): Adult *  Yes  No  No 
Residential Care Facility or Private Non-Medical Institution (PNMI): Children  No  No  Yes if > 100 
Multi-level Facility  Yes, if any part of the facility is subject to the rule  Yes  No 
Assisted Living Facility  No  No  Yes if > 100 
Shared Living Home  No  No  No (Independent Contractors) 
Community/Work Support Center  No  No  Yes if > 100 
Adult Day Health Center  No  No  Yes if > 100 
Senior Center  No  No  Yes if > 100 
Hospice Facility  No  Yes  No 
Home Health Agency  Yes  Yes  No 
Personal Care Agency  No  No  Yes if > 100 
Ambulatory Surgical Centers  No  Yes  No 
End Stage Renal Disease Facility  No  Yes  No 
Nonhospital-based Physician Group Practice   No  No  Yes if > 100 
Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC)  No  Yes  No 
Outpatient Physical, Occupational, Speech Facility   No  Yes  No 
Emergency Medical Service (EMS) Organization  Yes: Maine EMS Bureau Rule  No  Yes: Other Workers if > 100 
Dental Practice  No  No  Yes if > 100 

* If a waiver group home is a licensed residential care facility or PNMI, then it is subject to Maine DHHS rule.

**If facility is CMS certified or subject to CMS Conditions of Participation; if not, subject to Maine DHHS rule if applicable or OSHA rule.

2. Do the CMS rule’s Phase 1 (December 6, 2021) and Phase 2 (January 4, 2022) effective dates delay Maine DHHS final rule’s effective date?  

No. The Maine DHHS final rule’s effective date of November 10, 2021, remains unchanged.

3. Why does the final Maine DHHS rule eliminate EMS Organizations?

The Bureau of Emergency Medical Services adopted an emergency rule on August 23, 2021, requiring that certain personnel be vaccinated against COVID-19. On November 3, 2021, the Bureau proposed a non-emergency rule requiring that certain personnel be vaccinated against COVID-19.  The Maine DHHS removed EMS Organizations from this rule to avoid any conflict or confusion with the Bureau’s rules that require certain workers to be vaccinated. 

4. Why does the final Maine DHHS rule eliminate Dental Practices?

Upon review of the data and comments that were submitted on jurisdiction, the Maine DHHS removed dental health practices from this rule. 

5. Are there other changes to the types of organizations that are subject to the Maine DHHS health care worker vaccination rule?

No. The definition of Designated Healthcare Facilities subject to this long-standing immunization rule is unchanged. 

Employees Subject to the Immunization Rule

6. Has the definition of “employee” changed between the emergency and final Maine DHHS rule?

Yes. The Maine DHHS final rule includes clarifications to the definition of “employee” to make that definition consistent with the proposed rule and guidance on the emergency rule. 

7. Is Maine DHHS rule’s definition of “employee” as broad as that of the CMS rule which, for example, includes some volunteers? 

We do not believe so, but organizations subject to both rules should consult the CMS rule and CMS FAQs (PDF) for an understanding of that rule’s application. 

Exceptions or Exemptions for Certain Employees

8. Must health care facilities subject to the Maine DHHS rule as well as the CMS rule offer the exemptions in the CMS rule?

Maine DHHS is reviewing the CMS rule and will provide further guidance in November 2021.

Reporting and Enforcement

9. How and why has reporting under the immunization rule for health care workers changed?

The reporting requirements remain the same. Designated Healthcare Facilities are required to have in place a uniform health record for maintaining information regarding the health status of each employee, which by definition includes independent contractors. The CDC will send an annual survey to all Designated Healthcare Facilities who are required to respond by December 15.

Maine CDC will coordinate with the Division of Licensing and Certification (DLC) on enforcement measures. Enforcement may include an array of actions, including a written warning of noncompliance, a determination of a State of Deficiency and a Plan of Correction, or DLC pursuing a licensing action.