COVID-19 Vaccine Mandate Resources

CHA is working diligently to keep members apprised of the most up-to-date information and resources available on state and federal COVID-19 vaccine requirements. For questions or more information, contact Joshua Ewing, CHA vice president of legislative affairs, at joshua.ewing@cha.com or 720.330.6061.

State Vaccine Mandate

Sept. 30 Update

On Aug. 30, the State Board of Health convened an emergency rulemaking hearing to discuss the Colorado Department of Public Health and Environment (CDPHE)’s proposed rule – 6 CCR 1011-1 Chapter 2, General Licensure Standards and the COVID-19 Vaccine. The emergency rule requires licensed health care facilities to mandate their personnel (i.e., employees, direct contractors, and support staff) who interact with individuals seeking medical are to receive the COVID-19 vaccine.

After more than an hour of testimony in favor and opposed, the Board voted 6-1 to approve the proposed rule. It is effective immediately. In summary:

  • All health care workers, support staff and direct contractors must have their first COVID-19 dose by Sept. 30, second dose no later than Oct. 31.
  • COVID-19 boosters will be required if recommended by the Advisory Committee on Immunization Practices (ACIP).
  • This applies to all CDPHE-regulated health care facilities.
  • Facilities must maintain documentation of proof of vaccination or medical/religious exemption for each required health care worker.
  • Beginning Oct. 1, facilities must report COVID-19 vaccination rate to CDPHE on the 1st and 15th of every month, in addition to the following list of additional data points:
    • The total number of employees, direct contractors, and support staff, whether or not the individual is subject to the requirements of this part 12.
    • Total number of vaccinated employees, direct contractors, and support staff and the total number of employees, direct contractors, and support staff.
    • Number of medical exemptions claimed by employees, direct contractors, and support staff.
    • Number of religious exemptions claimed by employees, direct contractors, and support staff.
    • Number of employees, direct contractors, and support staff identified by the facility as exempt from the requirements of this part 12.
    • Number of employees, direct contractors, and support staff who have left employment with the facility or agency due to the requirements of this part 12, since the last reporting date.
  • All reported information will be publicly available.

CDPHE also noted that this rule is an emergency rule and that the final rule will look different (including the reporting requirements). CHA testified to ask CDPHE to work with the Association and member hospitals and health systems to ensure flexibility and alignment with similar federal reporting requirements, especially given the short time period in which facilities must come into compliance.

CDPHE also emphasized that the rule applies to facilities, not individuals. It does not determine how facilities implement this mandate – health care facilities are allowed to determine their own policies and procedures needed in order to achieve this mandate. Facilities that cannot meet the 100% vaccination mandate can apply for a waiver.

The new Mandatory Vaccination Waiver Application Form is now available. This can be found under the “Waivers” section of the following webpage – https://cdphe.colorado.gov/health-facilities-policies-guidelines-and-publications

  • Once completed this specific waiver should be submitted to covid_waivers@state.co.us
  • A facility should submit for this waiver when it determines that the 100% vaccination rate cannot be met. This is the case when a facility has 1 or more religious exemptions.
  • Medical exemptions are included in the facility’s 100% vaccination status. If a facility only has staff with medical exemptions, a waiver is not required.
  • Waivers may not be granted for up to 90 days. Once submitted, facilities may operate as if their waiver has been approved. The facility’s mitigation measures described in the waiver application must be used for staff that remains unvaccinated during this time.
  • When reviewing waivers CDPHE may take into consideration the number of staff that are unvaccinated. It is important for facilities to develop comprehensive mitigation plans for all staff that remain unvaccinated.
  • For additional information, feel free to reference the Mandatory Staff Vaccination Guidance

Questions about the implementation of the rule should be directed to the Residential Care Strike Team (residentialcarestriketeam@state.co.us). Questions about the rule language can be directed to the Health Facilities Policy Team (cdphe.hfregs@state.co.us).

Hospitals should be working to prepare for the Oct. 1 and 15 data reporting requirement right now, as it will both provide the state with clarity about the situation on the ground at Colorado hospitals and allow CHA to more effectively advocate for the right flexibilities in the final rule. On Sept. 24, CDPHE announced the release of the COVID-19 Vaccination Reporting function in the Colorado Health Facilities Interactive (COHFI) application. The application is similar to the Flu Vaccination Reporting function.

  • The application will load on Wednesday, Sept. 29, during a regularly scheduled maintenance window.
  • Only COHFI Account Managers will be able to access the COVID Vaccination Reporting application. If you do not have the Manage Users button next the facility name, you will not be able to submit the report. The state is working to add the functionality of being able to assign that role to facility users, but it will not be ready at release.
  • The Vaccination Reporting option will be available for all facilities at launch. If you are not a licensed facility but would still like to report, you will have that option. Only licensed facilities are required to submit reports.
  • Residential care facilities that currently report vaccination rates in EMResource will transition to COHFI reporting by Oct. 1 with other health facility types.

On Sept. 28, CDPHE staff announced their intention to recommend several changes for consideration by the Board of Health on Oct. 21 based on feedback provided by CHA and its member hospitals and health systems, as well as other providers. Changes are outlined in this presentation, and include important changes advocated for by CHA in our verbal and written comments, such as:

  • Decreasing the facility compliance threshold from 100 percent vaccination rate among staff and director contractors to 90 percent to match the current flu vaccine mandate;
    • Please note: All health care workers will still be required to be vaccinated, this only changes the threshold at which hospitals and other health care facilities may face civil penalties imposed by the Department
  • Including religious exemptions in the same category as vaccinated individuals and medical exemptions, thus removing the requirement for a waiver to accommodate religious exemptions
  • Removing testing as a mandatory mitigation requirement for facilities, specifically:
    • Those who are above 90 percent vaccination rate would have no mandatory testing requirement
    • Those below 90 percent will be required to submit a waiver, and the testing of unvaccinated employees will be a condition of waiver approval
  • Pushing final rulemaking back to Dec. 15 and using the Oct. 21 Board of Health meeting to make the above changes to the emergency rule and provide CDPHE staff with greater flexibility to align rulemaking with the forthcoming Centers for Medicare and Medicaid Services (CMS) mandate and timing so that hospitals are not subject to conflicting mandates

Given the significance of these potential changes and the urgency with which health care facilities are working to comply with this proposed mandate, CHA has requested that CDPHE issue formal guidance to guide facilities’ efforts in the interim between now and the Oct. 21 hearing.

CDPHE staff have indicated that they anticipate updated language for the emergency rule to be finalized and made available for public feedback within two weeks.

Federal Vaccine Mandate

Oct. 6 Update

  • Centers for Medicare & Medicaid Services (CMS), expanding emergency regulations requiring vaccinations for nursing home workers to include hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies, among others, as a condition for participating in the Medicare and Medicaid programs.
  • CMS is developing an Interim Final Rule with Comment Period that will be issued in October.
  • How will vaccination data be reported?
  • How will requests for religious and medical exemptions be handled?
  • What, if any alternatives to vaccination will be permitted, such as increased testing, masking and physical distancing?
  • What obligations will employers have to provide paid time off to individuals who must undergo increased testing or receive vaccines?