Public Policy

Nov. 8 Federal Update: Vaccine Mandate Rules Released

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November 8, 2021

Late last week, various federal agencies released more details about new vaccine mandates. The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued a new federal rule last week mandating COVID-19 vaccinations or at least weekly testing for workers at U.S. companies with 100 or more employees. The OSHA rules are a key part of President Biden’s push to use employer mandates to increase vaccination rates. OSHA is holding webinars to detail these new rules this Tuesday and next Monday. The administration also released a new rule through the Centers for Medicare and Medicaid Services (CMS) that requires workers at health care facilities participating in Medicare or Medicaid to be fully vaccinated by Jan. 4, however, most community-based organizations are excluded from the definition of a “covered entity.” This FAQ from CMS provides more details. This summary of the OSHA rule from the National Council of Nonprofits is a helpful guide to the regulations. For more details, check out our article brief below.

Meanwhile, Congress continues negotiations around the Build Back Better bill. On Friday night, the House passed the physical infrastructure bill and conducted a procedural vote to pass the Build Back Better Act no later than the week of Nov. 15, putting pressure on the Senate to speed up negotiations. Several weeks ago, President Biden released a new framework for the social spending and climate bill based on negotiations. However, he is still seeking the support of Senator Joe Manchin (D-W.V.) to move forward. That version of the bill removed a new paid leave program. However, progressives have negotiated the paid leave provisions back into the bill, creating additional challenges for Manchin to get on board. Independent Sector recently released a helpful summary of current provisions in the bill, which are subject to change as negotiations continue. Some highlights include a one-year extension of the new Child Tax Credit provision from the American Rescue Plan; $300 million for broadband affordability and access; $20 billion for workforce development programs; $150 billion for affordable housing; $100 billion to support child care costs, universal preschool, and more. Congressional leaders seem hopeful that they will pass a bill by Thanksgiving at the very latest.

New Toolkits for Building Your Advocacy Muscle

Social Current offers two newly updated advocacy toolkits, one with general public policy and advocacy how-tos and another with tips for media relations and social media to support advocacy. Inside, you’ll find sections on creating impact stories, engaging with legislators, developing media relations, hosting special events, and conducting social media outreach. They also contain brand new sections on virtual advocacy, constituent engagement and coalition building. Read about how COVID-19 has changed the rules for meeting with legislators and download the toolkits from the Policy Action Center.

New Vaccine Rules for Employers

Late last week, various federal agencies released more details about new vaccine mandates. The U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued a new federal rule mandating COVID-19 vaccinations or at least weekly testing for workers at U.S. companies with 100 or more employees. The OSHA rules are a key part of President Biden’s push to use employer mandates to increase vaccination rates. The first compliance deadline for employers—providing time off for workers to get vaccinated and ensuring those who aren’t vaccinated are wearing masks, is Dec. 5. Workers must be fully vaccinated by Jan. 4 or submit to testing requirements. Some exceptions apply for the vaccine, but otherwise will still require testing and masks. The number of employees is based on all employees (part and full-time combined). Employees working remotely or outdoors are counted for employer coverage purposes, but they may not necessarily be required to comply with the requirements if they don’t come into contact with clients or coworkers. Employers may require employees to pay for the cost of testing, except where other legal or collective bargaining obligations require otherwise. Employers not in compliance could face a fine of up to $13,653 for each violation. A willful violation is an employer deliberately disregarding the mandate, which could result in a fine as high as $136,532. For states with their own standards, implementation could be delayed as governments decide whether to accept the standard as written, modify it, or draft equivalent or more protective rules. Each state has 30 days to implement a standard.

This summary from the National Council of Nonprofits is a helpful guide to the regulations. Additional information from OSHA is also available.

The administration also released a new rule through the Centers for Medicare and Medicaid Services (CMS) that requires workers at health care facilities participating in Medicare or Medicaid to be fully vaccinated by Jan. 4. CMS is requiring that workers at health care facilities participating in Medicare or Medicaid have necessary shots and be fully vaccinated by Jan. 4. It covers approximately 76,000 health care facilities and more than 17 million health care workers. It applies to employees regardless of whether their positions are clinical or non-clinical, essentially any employee, student, trainee, or volunteer who works at a covered facility. It also covers individuals who provide treatment and other services for the covered facility under contract or other arrangements. Covered facility types include hospitals, ambulatory surgery centers, home health agencies, psychiatric residential treatment facilities, rural health clinics, federally qualified health centers, and long-term care facilities. However, it does provide an exemption for certain home- and community-based services.

Several state attorneys general are planning to sue the federal government to block the initiative.

New Ratings in the Family First Prevention Services Clearinghouse

The Title IV-E Family First Prevention Services Clearinghouse recently announced ratings for 13 new programs. One was found to be “well-supported” by research, two were found to be “supported,” three were found to be “promising,” and the rest didn’t meet criteria to be rated. A new comparison between ratings from the IV-E federal Prevention Services Clearinghouse and the California Evidence-Based Clearinghouse is now available.

This brings the total number of programs meeting criteria in the clearinghouse to:

  • Mental Health: 6 “well-supported,” 8 “supported,” and 12 “promising”
  • Substance Use: 4 “well-supported,” 3 “supported,” and 3 “promising”
  • In-Home Parent Skill-Based: 7 “well-supported,” 7 “supported,” and 3 “promising”
  • Kinship Navigator: 1 “promising” and 0 “well-supported” or “supported”

New ratings are as follows:

Source: Child Welfare & Mental Health Coalition

Centers for Medicare and Medicaid Services Publish New Q&A on QRTPs and the IMD Exclusion

The Centers for Medicare & Medicaid Services (CMS) published a Q&A guide to inform states that they can seek to modify the terms of an existing Medicaid section 1115 demonstration opportunity to allow Title IV-E beneficiaries to receive coverage in a Qualified Residential Treatment Program (QRTP) that is an Institute for Mental Disorder (IMD) for longer than that demonstration model currently allows. States with an existing, approved severe mental illness/severe emotional disturbance (SMI/SED) 1115 demonstration would need to submit an amendment to take advantage of this opportunity. For those states that do not currently have the demonstration, approval of new demonstrations will depend on the details of state applications submitted and whether they can meet the current requirements of the SMI/SED 1115 demonstration. As a condition of approval, states will be required to provide CMS with a plan, including key milestones and timeframes, for transitioning children out of QRTPs that are IMDs.

This Q&A clarifies that placement in a QRTP that is an IMD does not impact Medicaid eligibility. It details that the IMD exclusion only prohibits states from receiving federal reimbursement for services delivered. It does not affect a child’s eligibility for Medicaid.

Source: Child Welfare and Mental Health Coalition

Congressional Research Service Releases Report on Chafee Funds

The Congressional Research Service released a new report on the status of funding for youth who have or are about to age out of care. Major provisions in the John H. Chafee Foster Care Program for Successful Transition to Adulthood Act expired Sept. 30, 2021, the end of the 2021 fiscal year. These funds included Education and Training vouchers, which allow states to assist youth with room and board payments and postsecondary school or training until age 27. The report states that a large majority of states pulled down less than 50% of Chafee funds available to them last year, meaning that critical funds are in limbo. Reps. Danny Davis (D-Ill.) and Jackie Walorski (R-Ind.) co-sponsored H.R. 5661, which passed the House of Representatives in October, extending funding flexibilities for another year; however, the Senate has yet to take up the companion bill (S. 3078).

Social Determinants of Health Caucus Holds First Congressional Briefing

The Congressional Social Determinants of Health Caucus hosted its first briefing focusing on transportation as a critical component of population health and well-being. Reps. Cheri Bustos (D-Ill.), Markwayne Mullin (R-Okla.), G. K. Butterfield (D-N.C.) and Salud Carbajal (D-Calif.), members of the Social Determinants of Health Caucus, highlighted transportation barriers as a key challenge to individuals and families having access to pharmacies, hospitals, and other health care centers. Especially in rural areas, lack of transportation options severely impacts one’s ability not only to receive care, but also to access employment, education and other social services that are central to well-being. In July, the caucus was formed to raise awareness about health disparities and come up with solutions that increase long-term health and well-being.

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