After the Supreme Court ruled on Thursday that CMS could require most health care workers to be vaccinated against Covid-19, many health systems have started implementing vaccine mandates—but some now find themselves torn between conflicting state and federal rules.

The Covid-19 vaccine mandate: Here's what's in CMS' new rule

Background

On Thursday, the Supreme Court rejected a legal challenge against CMS' mandate, which would require health care facilities participating in Medicare or Medicaid to implement a vaccine requirement for their workers.

In new guidance released after the ruling, the agency said that health care workers will be required to get their first shot of a Covid-19 vaccine by Feb. 14 and their last primary vaccine shot by March 15.

Health care facilities also must demonstrate they have developed policies and procedures to ensure all employees have received at least one shot of a Covid-19 vaccine by Feb. 14, according to the guidance.

The guidance applies to health care facilities in 24 states, but it does not apply to facilities in Texas, as the state is involved in a separate lawsuit against the mandate.

Hospital and health system response to Supreme Court ruling

Following the Supreme Court's ruling on CMS' mandate, many hospitals and health systems that had previously suspended vaccine mandates have implemented them once again.

The Cleveland Clinic said in a statement that it will require employees and those who provide services within Cleveland Clinic facilities to get their first shot of a Covid-19 vaccine by Jan. 27 and their second by Feb. 28.

"Those who do not receive their vaccinations and do not have an approved exemption will be placed on an unpaid leave of absence," the Clinic said.

Similarly, University Hospitals said it intends to comply with CMS' mandate. It noted in a statement that "[t]he overwhelming majority of [its] caregivers are vaccinated" and said it would be "reviewing the most recent ruling to ensure compliance with federal requirements."

However, the next steps are less clear for some hospitals and health systems located in states that previously passed laws banning vaccine mandates.

Florida, for example, has passed such a law. Gov. Ron DeSantis (R) on Thursday called CMS' mandate "insane" and on Friday indicated that Florida will not follow federal mandates that he argued " are rooted in political, not medical science."

"Hospitals don't want to be caught between the federal government and the state government," Mary Mayhew, president and CEO of the Florida Hospital Association, said. "The Supreme Court ruling makes clear the authority that CMS has to implement and enforce its vaccine mandate."

Smaller hospitals and nursing homes have also expressed concerns that implementing a vaccine mandate could exacerbate staffing shortages.

"Even the loss of one nurse can have a negative impact on the number of patients for whom we are able to deliver care," Lee Bond, CEO of the Singing River Health System in Mississippi, said.

These concerns have led some health care facilities to urge the Biden administration to allow health care workers to be regularly tested for Covid-19, rather than requiring them to get vaccinated.

According to Mark Parkinson, CEO of the American Health Care Association, which represents nursing homes, "When we are in the midst of another [Covid-19] surge, caregivers in vaccine hesitant communities may walk off the job because of this policy, further threatening access to care for thousands of our nation's seniors." (Burch/Abelson, New York Times, 1/15; Gooch, Becker's Hospital Review, 1/18; Goldman, Modern Healthcare, 1/14)