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. The medical exemption policies in the CMS rule and the Maine DHHS rule have different operational details (e.g., reporting). Which medical exemption policy should be used by Maine health care organizations subject to both rules? (Updated November 30, 2021)
For Maine health care organizations that are subject to both the CMS rule and the Maine DHHS rule, compliance with the CMS rule’s medical exemption policies and procedures will satisfy the requirements of the Maine DHHS rule with respect to medical exemptions.
Note that the CMS rule applies only to COVID-19 vaccination effective December 6, 2021, for Phase 1. The Maine DHHS final rule applies to a range of immunizations, including COVID-19, effective November 10, 2021. The rules’ scope (e.g., covered entities and individuals) and other elements also differ.
- 9. Unlike the Maine DHHS rule, the CMS rule expressly acknowledges that religious exemptions to COVID-19 vaccination may exist under federal law. What does this mean for health care organizations in Maine subject to both rules? (Updated November 30, 2021)
The CMS rule is consistent with the Maine DHHS rule’s treatment of religious accommodations. A 2019 Maine law eliminated religious exemptions from Maine DHHS immunization rules, including the health care worker immunization rule. However, Federal civil rights laws, such as Title VII of the Civil Rights Act, continue to apply to some employers. The Maine DHHS rule does not prohibit employers from providing accommodations for employees’ sincerely held religious beliefs, observances, or practices that may otherwise be required by Title VII and other federal civil rights laws. The CMS rule similarly states that “employers must comply with applicable Federal anti-discrimination laws and civil rights protections,” including Title VII of the Civil Rights Act. Neither the Maine DHHS rule nor the CMS rule expand the scope of the federal civil rights laws or otherwise require employers to provide religious exemptions. However, implementation, if such accommodations are provided by a Designated Health Care Facility, must comply with the Maine DHHS rule.
Reporting and Enforcement
- 10. 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.