COVID-19 Vaccination in Maine

Page last updated 09-13-2021.

Health Care Worker Vaccination FAQs

On August 12, 2021, the Mills Administration announced that health care workers in Maine must be fully vaccinated against COVID-19 by October 1. While the rule takes effect on October 1, the Mills Administration announced on September 2, that it will 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 the $146 million in forthcoming funds to address workforce needs. 

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 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 mandatory COVID-19 vaccination of health care workers in Maine. The emergency rule issued on August 12, 2021, can be found here.

Organizations Subject to the Immunization Rule

1. Which health care facilities are subject to the requirements for employee immunization?

This 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 is unchanged from the previous rule requiring certain vaccinations for Health Care Workers at Designated Healthcare Facilities with two exceptions: the updated rule now also includes Emergency Medical Service (EMS) Organizations and Dental Practices.

The following table indicates whether certain types of facilities are included. Providers should review their issued license(s) to determine whether each of their sites qualifies as a Designated Healthcare Facility.
 

Healthcare Facility Designated in Amended Vaccination Rule?
Hospital Yes
Nursing Facility Yes
Residential Care Facility- Adult Yes
Residential Care Facility- Children No
Transitional Youth Shelters No
Private Non-Medical Institution (PNMI)

Depends on Licensure:

  • If PNMI Adult Residential Care facility: Yes
  • If PNMI Child Residential Care facility: No
  • If Assisted Living: No
Waiver Group Home

Depends on Licensure:

  • If Residential Care facility: Yes
  • If Assisted Living: No
Multi-level Facility Yes, if any part of the facility is subject to the rule.
Assisted Living Facility No, unless part of a multi-level facility.
Shared Living Home No
Community/Work Support Center No
Adult Day Health Center No, unless part of a multi-level facility.
Senior Center No
School Based Health Clinic No
Home Health Agencies Yes
Personal Care Agencies No
Hospice Facility No, unless part of a multi-level facility.
Ambulatory Surgical Center No, unless operated under hospital license.
Dental Practices Yes
Emergency Medical Service (EMS) organizations Yes
2. What is a “multi-level facility”?

A facility with one license issued by the Division of Licensing and Certification for an assisted housing program that is located on the same contiguous grounds with a licensed nursing facility.

3. Are self-directed personal care workers included in this policy?

No. These are the equivalent of Personal Care Agency staff and are not considered health care workers under this rule.

4. Does this rule apply only to licensed residential facilities, or does it also include licensed outpatient behavioral health facilities, MaineCare Behavioral Health Homes (BHHs), Opioid Health Homes (OHHs), Targeted Case Management (TCM) programs, etc.?

The rule applies to licensed residential facilities and would apply to any outpatient behavioral health facilities that are part of a hospital’s license or operating/billing through the hospital as part of the hospital’s CMS Certification number (CCN).  

5. If a licensed home health agency also provides behavioral health services, are the behavioral health workers required to be vaccinated?  

Yes, the behavioral health workers are employees of the licensed home health agency and thus would be required to comply with this rule.

6. Does this rule apply to physicians’ offices or health care clinics?

It does not include physicians’ offices, health care clinics, or any other health care organizations to which the immunization rule has not previously applied (with the two noted exceptions). It would apply to any physicians’ offices, health care clinics, or any other health care organizations which are functioning or billing under a hospital’s license, the hospital’s CMS Certification number (CCN), or a similar multi-level facility. 

7.  Are there plans to use this or other authorities to extend a COVID-19 vaccine requirement to other sectors?

This change was limited to amending existing vaccination requirements for Designated Healthcare Facilities, EMS Organizations and Dental Practices to include the COVID-19 vaccine. There are no additional changes at this time.

8. Will additional health care providers be added to this rule? 

The Department will accept comments on potential changes to a forthcoming proposed final rule, such as which health care providers should be subject to the immunization requirements, which will be issued after the 90-day emergency period ends.  

9. Does the rule apply to a nonprofit outpatient dialysis facility?

No, dialysis facilities do not fall within the definition of Designated Health Care Facility.

10. Why are adult Private Non-Medical Institutions (PNMI) facilities subject to the immunization requirements while children/youth PNMI are not?

Children's Residential Care Facilities (children/youth PNMI) do not fall within the definition of Designated Health Care Facility.

11. Do Direct Services Professionals (DSPs) providing support to people in their own homes have to get the COVID-19 vaccine and all other required healthcare professional vaccines?

DSPs providing quarter-hour support to adults with intellectual disabilities in unlicensed private homes are not covered by the rule unless they also work in a licensed group home. Any DSP working in a licensed group home (waiver home) must be vaccinated under the rule.

12. Are independent private duty nurses working in home care that bill the state directly subject to the rule?

No, unless the nurse contracts to work on the premises of a licensed Home Health Agency, other designated healthcare facility, EMS organization or dental health practice.

13. Is the Department’s definition in this emergency rule of an “Emergency Medical Services (EMS) Organization” different than that in the emergency rule issued by the Board of Emergency Medical Services?

To the extent that there is any inconsistency, DHHS will use its enforcement discretion to align its emergency rule’s EMS definitions with the Board of Emergency Medical Services’ emergency rule’s definitions.

Employees Subject to the Immunization Rule

14. How are “employees” defined under this rule?

Employees are defined in the rule as “any person who performs any service for wages or other remuneration for a Designated Healthcare Facility, EMS Organization and Dental Practice.” For the purpose of this rule, DHHS interprets employee to mean those physically present at a Designated HealthCare Facility, EMS Organization or Dental Practice.

15. Does the rule include contract staff hired by covered agencies?

Yes.

16. Will there be a grace period for COVID-19 vaccination after September 17 so as not to delay a new employees’ first day on the job?

New staff should be fully vaccinated upon employment as of October 1 in order to fully comply with the rule, however the enforcement by the State will not begin until October 29, 2021. This applies to both regular and contract staff. 

17. Do outside contractors have to be vaccinated to perform work on equipment in organizations covered by the rule?

Yes. Independent contractors or employees of independent contractors working on the premises of a designated healthcare facility, EMS organization, or dental health practice must be vaccinated for COVID-19.

18. Do volunteers need to be vaccinated?

No, not pursuant to this rule. This rule only applies to employees.

19. Are people who work in another capacity remotely but who help fill in empty shifts in group homes required to get the COVID vaccine?

Yes.

20. Are students enrolled in training programs (e.g., certified nursing assistant programs) required to be fully vaccinated for COVID-19 to obtain their clinical hours in healthcare facilities?

Only if they also meet the definition of “employee”.

21. Does the emergency immunization rule apply to construction, repair, ground maintenance, and other similarly situated contractors and vendors? 

DHHS issued the emergency rule pursuant its statutory authority to establish procedures for the control and prevention of communicable diseases. The purpose of the rule is to stop the spread of COVID-19 within covered facilities amongst patients and / or residents and staff in order to protect patients and / or residents and staff from COVID-19 and also protect Maine’s health care system. COVID-19 spreads when an infected person breathes out droplets and very small particles that contain the virus, and individuals within 6 feet of the infected person are most likely to get infected, particularly in indoor environments. DHHS intends to enforce the rule consistent with the purpose of the rule, prioritizing violations within those settings that present significant threats to public health and safety of patients and or residents and healthcare workers from the spread of COVID-19.  DHHS doesn’t intend to use its enforcement resources to address contractors and vendors whose activities do not present a significant threat to the transmission of COVID-19 in light of the nature, duration, and location of their work. 

Exceptions or Exemptions for Certain Employees

22. What exceptions or exemptions are allowed under this rule?

Section 3 of the rule provides as follows: “An employee who does not provide proof of immunization or immunity for a vaccine required under this rule may be permitted to attend work if that employee is exempt in accordance with 22 MRS § 802 (4-B).”  

23. Can an exception be made for an employee who has been tested and found to have antibodies for COVID-19?

No. The U.S. CDC current clinical recommendations state: “Antibody testing is not currently recommended to assess for immunity to SARS-CoV-2 following COVID-19 vaccination, because the clinical utility of post-vaccination testing has not been established.”

24. Is there additional guidance on who qualifies for a medical exemption?
No. The requirements for medical exemptions are provided in statute at 22 M.R.S. § 802(4-B).
25. Can individuals who have a valid medical exemption maintain their employment?
Organizations subject to this rule may make their own specific enforcement policies within the framework of the rule.
26. Do staff without medical exemptions have the option of wearing N-95 masks and being tested weekly as opposed to being vaccinated?
No.
27. Is there a religious exemption in the rule?
No. Effective September 19, 2019, the Maine Legislature eliminated religious exemptions to vaccination requirements for health care workers and mandated the removal of religious exemptions from all Department vaccination requirements. To comply with that statutory change, the Department removed religious exemptions from this rule in April 2021.
28. Does this rule prohibit Designated Health Care Facilities, Dental Health Practices, and Emergency Medical Services Organizations from making accommodations for unvaccinated employees who object to receiving the COVID-19 vaccine because of sincerely held religious beliefs, as may be required by the Maine Human Rights Act and/or Title VII of the Civil Rights Act?
This rule does not prohibit employers from providing accommodations for employees’ sincerely held religious beliefs or practices that may otherwise be required by law. For example, this rule does not prohibit employers from allowing employees to work remotely or reassigning employees to positions outside of a Designated Health Care Facility, Dental Health Practice, or Emergency Medical Services Organization. However, if accommodations provided by a Designated Health Care Facility, Dental Health Practice, or Emergency Medical Services Organization are not in compliance with this rule, then the Designated Health Care Facility, Dental Health Practice, or Emergency Medical Services Organization may be subject to enforcement action.
29. What types of clinicians are authorized to provide a medical exemption to COVID-19 vaccination for Health Care Workers?

Pursuant to 22 M.R.S. 802(4-B)(A), licensed physicians, nurse practitioners, and physician assistants are eligible to provide a medical exemption.

Reporting and Enforcement

30. What needs to happen by October 1? Do all workers need to be fully vaccinated?  

In order to comply with the new rule, all employees subject to the rule should have their final dose of a COVID-19 vaccine by September 17, 2021. This allows these employees to be fully vaccinated by October 1, 2021, two weeks following their final dose. Enforcement of this rule will begin on October 29, 2021.

31. Is there enough time for a two-dose vaccine, or does everyone need to get the one-dose Janssen/Johnson and Johnson vaccine?

To meet the rule’s timeline, individuals should receive one of the authorized COVID-19 vaccines by the following dates: 

•    First dose of the Moderna vaccine on or before August 20, 2021, in order to complete the two-dose series four weeks later (by September 17, 2021). 
•    First dose of the Pfizer vaccine on or before August 27, 2021, in order to complete the two-dose series three weeks later (by September 17, 2021). 
•    One dose of the Johnson & Johnson / Janssen vaccine before or on September 17, 2021. 

There is time for health care facility employees to receive their choice of vaccine and comply with the rule’s timeline.

32. What do providers need to report to Maine CDC, and how do they do that?

Please see 7.D.1 of the rule for the information Designated Healthcare Facilities, EMS Organizations and Dental Practices must file with the Maine CDC on an annual basis. 

33. How will the Department enforce this rule?

In light of support from the Maine Hospital Association, Maine Health Care Association, and others, it is our hope that designated health care facilities and employees will recognize the important public health reasons for this requirement -- the prevention and mitigation of COVID-19 transmission -- and will be vaccinated.

If needed, the Division of Licensing and Certification will issue citations to facilities deemed non-compliant and may take additional enforcement action as outlined in rule for the specific facility type. 

34. Do employees who are discharged or quit for failing to comply with an employer’s policy to get vaccinated for COVID-19 qualify for unemployment benefits?

In general, no.  Refusing to comply with an employer’s policies, including a health or safety policy, typically disqualifies a person from being eligible to receive unemployment benefits.

35. Will the Department provide any extensions, waivers, or employer-based exceptions to the requirement that covered employees be fully vaccinated for COVID-19 by October 1, 2021?
While employees should be fully vaccinated by October 1 to be considered fully compliant with the rule, the State will not begin enforcement for the rule until October 29, 2021. 
36. Are there different rules for Emergency Medical Services (EMS) organizations?
The Department’s immunization rule’s deadline for EMS organization employees remains October 1st. Maine EMS, consistent with direction from its Board, filed an emergency rule that largely parallels the Department’s rule in its COVID-19 vaccination requirement for certain EMS employees. EMS organizations and employees with questions should contact Maine EMS about implementation.
37. Will compliance include an employee getting a booster shot?
No, this rule does not require booster shots.
38. Will health care facilities be able to access Johnson & Johnson / Janssen vaccine doses to facilitate compliance?
Yes. The Maine Immunization Program continues to secure vaccine doses for providers authorized to administer the COVID-19 vaccine. Information on procuring vaccines can be found at the MIP COVID-19 Provider Site.
39. Will the Department align its requirement for vaccination of nursing facility staff with the one announced by the Federal government on August 18, 2021?
No. Throughout the COVID-19 pandemic, with support from the Federal government, states have taken the lead on public health interventions. The new Federal rule will extend vaccination for nursing facility employees to all states.
40. If an employee of an organization is not vaccinated and doesn’t plan on getting the vaccine, should they be dismissed from the organization covered by the rule on September 17 or can the employee continue to work until October 1?
Organizations subject to this rule may make their own specific enforcement policies within the framework of the rule.
41. Since EMS organizations and dental practices have not previously submitted the annual reports like hospitals and other facilities, will Maine CDC provide assistance on how to report their information?
The Maine Immunization Program will send annual surveys to all healthcare settings included in this rule, and the results of those surveys constitute the annual report. If there are any questions about the survey, the Maine Immunization Program is available to answer questions by emailing immunizeme.dhhs@maine.gov.
42. The emergency rule expires after 90 days, on November 10. Will there be a permanent rule?

Yes. A proposed rule was issued on September 8, 2021 and can be found here. The Department will take public comment on the rule.