Employee COVID-19 Vaccine Mandate: Technical Assistance Resources for Health Centers

Updated 3/14/2022

This page shares resources to assist Community Health Centers with implementing employee vaccine mandates. Scroll down for the latest updates, an FAQ, operational guide and webinar recordings.

NACHC Vaccine Mandate Office Hours

Did you miss the February 24 office hours? February’s COVID-19 vaccine mandate office hours featured health center leaders from states involved with the Supreme Courtโ€™s vaccine mandate lawsuit and navigating related challenges to exemptions and employee compliance.

Watch the recording.

Guidance for Mandate Compliance

On January 13, 2022, in a 5-4 decision, the Supreme Court upheld the  CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule (CMS IFR) and struck down the  OSHA COVID-19 Vaccination and Testing ETS (OSHA ETS). The CMS Staff Vaccination Requirement is enforceable in all States and US Territories.  

There are two compliance time frames for states under the IFR, known as Group 1 and Group 2. The compliance requirements under the IFR and FQHC guidance are the same. Please review the applicable groups to determine the appropriate compliance dates.  

Group 1

California                   Massachusetts                         Pennsylvania 

Colorado                     Michigan                                Rhode Island

Connecticut                Minnesota                               Tennessee

Delaware                     Nevada                                    Vermont

Florida                        New Jersey                             Virginia

Hawaii                        New Mexico                           Washington

Illinois                        New York                               Wisconsin                  

Maine                          North Carolina

Maryland                    Oregon

On December 28, 2021, CMS released new guidance on the implementation of their IFR and guidelines to assess and maintain compliance with the COVID-19 vaccination requirements. This Guidance applies to Group 1 states.

CMS Surveyors will begin surveying for compliance at FQHCs starting January 27, 2022.

By January 27, 2022, facilities are required to:

  • Develop and implement policies and procedures ensuring all facility staff are vaccinated for COVID-19, including tracking staff vaccinations and documenting exemptions; and
  • Have 100% of staff receive at least one dose of COVID-19 vaccine or have a pending requests for, or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the CDC.
    •  A facility that is above 80% and has a plan to achieve a 100% staff vaccination rate within 60 days (by February 28, 2022) would not be subject to additional enforcement action. 

By February 28, 2022, facilities are required to: 

  • Develop and implement policies and procedures ensuring all facility staff are vaccinated for COVID-19, including tracking staff vaccinations and documenting exemptions; and
  • Have 100% of staff receive the necessary doses to complete the vaccine series (one dose of a single-dose vaccine or all doses of a multiple vaccine series) or have been granted a

qualifying exemption, or are identified as having a temporary delay as recommended by the CDC.

o A facility that is above 90% and has a plan to achieve a 100% staff vaccination rate within 30 days (March 30, 2022) would not be subject to additional enforcement action.

By March 30, 2022, facilities failing to maintain compliance with the 100% standard may be subject to enforcement action. 

Group 2

Alabama                           Kentucky                                New Hampshire      West Virginia

Alaska                               Kansas                                    North Dakota        Wyoming

Arizona                             Kentucky                                Ohio

Arkansas                           Louisiana                                Oklahoma

Georgia                             Mississippi                             South Carolina

Idaho                                 Missouri                                 South Dakota

Indiana                              Montana                                  Texas

Iowa                                  Nebraska                                 Utah

On January 14, 2022, CMS  released new guidance on the implementation of their IFR and guidelines to assess and maintain compliance with the COVID-19 vaccination requirements. This guidance applies to states in Group 2.

CMS Surveyors will begin surveying for compliance at FQHCs starting February 14, 2022.

By February 14, 2022, facilities are required to:

  • Develop and implement policies and procedures ensuring all facility staff are vaccinated for COVID-19, including tracking staff vaccinations and documenting exemptions; and
  • Have 100% of staff receive at least one dose of COVID-19 vaccine or have a pending requests for, or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the CDC.
    •  A facility that is above 80% and has a plan to achieve a 100% staff vaccination rate within 60 days (by March 15, 2022) would not be subject to additional enforcement action. 

By March 15, 2022, facilities are required to: 

  • Develop and implement policies and procedures ensuring all facility staff are vaccinated for COVID-19, including tracking staff vaccinations and documenting exemptions; and
  • Have 100% of staff receive the necessary doses to complete the vaccine series (one dose of a single-dose vaccine or all doses of a multiple vaccine series) or have been granted a
  • qualifying exemption, or are identified as having a temporary delay as recommended by the CDC.
    •  A facility that is above 90% and has a plan to achieve a 100% staff vaccination rate within 30 days (April 14, 2022) would not be subject to additional enforcement action. 

By April 14, 2022, facilities failing to maintain compliance with the 100% standard may be subject to enforcement action. 

What is my state already implemented a vaccine mandate for health care workers?

We strongly encourage all health centers to review the CMS Staff Vaccination Interim Final Rule requirements. The CMS compliance guidelines could have different requirements than your stateโ€™s vaccine mandate. For instance, the CMS rule requires all employers to permit staff to apply for religious and medical exemptions. Additionally, the CMS rule has a very broad definition of staff that could include more employees than your stateโ€™s vaccine mandate.

NACHC FAQ: CMS COVID-19 Staff Vaccination Interim Final Rule

On November 4, 2021, the CMS issued the Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule requiring health care workers at Medicare and Medicaid-certified facilities to be vaccinated unless they have approved religious or medical exemptions. The responses in NACHCโ€™s Vaccination Interim Final Rule FAQ document below (updated 1/19/22) are based on the Interim Final Rule and CMS FAQ. We encourage health centers to review the information and periodically check for updates.

Questions? Please contact Vacheria Tutson at regulatoryaffairs@nachc.org

Operational Resource Guide: COVID-19 Vaccine Mandate

NACHC prepared this resource to provide tips to implement employee vaccine mandates at Community Health Centers.

November 2021 Issue: Operational Considerations and Sample Policies & Procedures

February 2021 Issue: Policies and Procedures Checklist

Questions? Contact Vacheria Tutson at Regulatoryaffairs@nachc.org or Brandon Jones at trainings@nachc.org.

CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule Resources

Questions? Contact Vacheria Tutson at Regulatoryaffairs@nachc.org


Webinar Recordings: CMS Vaccine Mandate –Compliance Requirements and Operational Resources for Health Centers

January 21st COVID-19 Mandate Office Hours: Litigation Update and Compliance Overview. View recording.

December 6 webinar: On December 6, NACHC held a webinar, “Building Trust: A Relational Approach to talking about staff COVID-19 Vaccination Mandates.”  View webinar recording.

November 22 webinar: On November 22, NACHC held a webinar about the vaccine mandate, “CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule: Health Center Compliance and Equitable Implementation.” View webinar.

November 1 webinar: On November 1, NACHC held a webinar about the โ€œCMS Omnibus COVID-19 Health Care Staff Vaccinationโ€ compliance requirements and the impact on FQHCs. 


Health Center Board Resources

Ten FAQs About Health Center Boards & the CMS Omnibus COVID-19 Staff Vaccination Interim Final Rule

NACHC created this resource to address Frequently Asked Questions (FAQs) about the implications of the CMS Omnibus COVID-19 Staff Vaccination Interim Final Rule (CMS IFR) for health center boards and board members. View the FAQs. (2/23/22)

Find more COVID-19 resources for health centers

Visit NACHC’s COVID-19 Information and Resources for Community Health Centers to find materials addressing a range of health center concerns related to COVID-19.