Logan Health announced to its more than 4,000 employees on Tuesday that by early December in order to continue to work on site they need to be fully vaccinated for COVID-19, or have their first vaccine shot, or have filed exemption paperwork.
The announcement from the Flathead County hospital was spurred by a nearing deadline for a federal final interim rule issued by the Biden administration in early November through the Centers for Medicare and Medicaid Services (CMS). That rule requires staff be fully vaccinated at healthcare facilities receiving payments through Medicare and Medicaid by Jan. 4, or those facilities will lose out on Medicare and Medicaid payments. The White House said at the time it expected the CMS vaccination requirement to apply to more than 17 million workers at 76,000 health care facilities.
Though the rule went into effect in November, CMS had announced in early September the Biden administration intended to move forward with a COVID-19 vaccination requirement for staff at Medicare and Medicaid-certified facilities. That announcement came after the FDA granted the Pfizer COVID-19 vaccine full approval in late August. The vaccine had been granted emergency use authorization in December 2020.
The window at Logan Health for submitting paperwork for a medical or religious vaccine exemption runs from Nov. 29 through Dec. 5, health officials said. Employees need to have a first COVID-19 vaccine dose or proof of vaccination by Dec. 11.
For Logan Health, Medicare and Medicaid recipients make up more than 400,000 visits every year, and include some of its “most vulnerable patients,” the hospital said in an emailed statement on Nov. 23.
“Failure to comply means that CMS could terminate our participation in the program, which will threaten our ability to care for those in our services,” the hospital’s statement said.
In Montana more than a half-million people are covered under Medicare and Medicaid and 67% of hospital revenue in the state, or about $2.1 billion, comes from Medicare and Medicaid reimbursements, according to the Montana Hospital Association.
According to Logan, and several other hospitals in the state, the final interim rule supersedes the authority of Montana House Bill 702, which forbids businesses and government entities from treating people differently because of their vaccination status.
Logan Health acknowledged that states have challenged the CMS rule, but notes in its statement that the deadline for Logan to be in compliance is approaching.
Officials in more than 10 states, including Montana Attorney General Austin Knudsen, have sued to try and prevent the CMS COVID-19 vaccine requirement. The results so far have been mixed.
A Florida judge recently denied a request for a preliminary injunction to stop the CMS mandate from going forward in Florida.
On Monday, Nov. 29, a judge in the Eastern District of Missouri granted plaintiffs a preliminary injunction pending a trial to stop the CMS vaccine mandate from going forward in certain states. States affected by that judge’s ruling include Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota and New Hampshire.
Montana is part of a suit filed in Louisiana district court which also seeks to stop the CMS COVID-19 vaccine requirement for healthcare workers. Other states in that suit include Louisiana, Arizona, Alabama, Idaho, Georgia, Indiana, Mississippi, Oklahoma, South Carolina, Utah and West Virginia.
Speaking Monday, Knudsen said his office is cautiously optimistic in light of Monday’s ruling and an earlier ruling in an OSHA case over vaccine requirements.
“Hopefully it’s a sign of things to come. Obviously we’re filed in a different district court. I think this is indicative of how courts are going to be looking at these broad, sweeping mandates,” Knudsen said.
The attorney general said he expects an order on the injunction motion will likely come this week, but noted that ultimately the judge on the case sets his own timeline. The attorney general said he thinks “a large group of people” will either choose to be fired or resign rather than go along with the vaccine requirement.
“I just think it’s wrongheaded to start with,” Knudsen said of the CMS COVID-19 vaccine requirement. “We’re a rural state. We’re already having a healthcare worker shortage, especially on the eastern side of the state where I’m from. This is just going to make it exponentially worse.”
The Biden administration, through the Occupational Safety and Health Administration (OSHA), issued a similar COVID-19 vaccine requirement earlier this month for businesses employing more than 100 people. That rule would allow for employees who chose not to get vaccinated to submit to weekly testing instead. A testing option is not included in the CMS vaccination rule for healthcare workers.
The OHSA requirement was expected by the White House to apply to more than 84 million people, and lawsuits challenging the rule quickly followed. Plaintiffs were granted a temporary block on the rule by a panel of judges on the Court of Appeals for the Fifth Circuit Court in New Orleans.
Last Tuesday the Biden administration asked a federal appeals court to let the government proceed with the OSHA mandate, the New York Times reported.
The vaccine requirements at hospitals in the state come as Montana hospitals are already facing worker shortages and burnout in the face of an ongoing pandemic that has killed 2,612 Montanans and caused 9,863 hospitalizations.
Citing CDC data, Bloomberg Law reported on Monday that one CDC analysis found about 30% of healthcare workers in over 2,000 hospitals were not vaccinated as of mid-September.
There are 30,000 hospital employees in Montana, according to Montana Hospital Association President and CEO Rich Rasmussen, who said he did not know how many were currently vaccinated. Rasmussen said Monday that to the best of his knowledge all hospitals in the state are moving toward compliance with the CMS mandate.
“If a hospital chose to defy the rule, and CMS were to follow through on its directive to withhold funding from those programs, those hospitals would find it extremely difficult, if not impossible to remain financially viable,” Rasmussen said.
Billings Clinic CEO Dr. Scott Ellner told NPR in late October that of the hospital’s roughly 5,000 employees about two-thirds had been vaccinated. In Yellowstone County the overall vaccination rate is 50%.
In late October, Bozeman Health told Lee Enterprises’ Montana State News Bureau that the hospital had an 80% vaccination rate among staff. Gallatin County has 57% of its eligible population fully vaccinated.
Chris Leopold, a communications specialist with Logan Health, said he did not have the information available when asked what percentage of employees are fully vaccinated. In Flathead County 48%, or 47,868 people, have received one COVID-19 vaccine dose. Among its eligible population 42% of people are fully vaccinated in the county.
Some hospitals in the state, like the Billings Clinic, have hosted informational meetings about the vaccine with staff.
Riley Polumbus, a marketing and community relations manager for Logan Health Whitefish said that for the week of Nov. 29 the hospital was planning on having a staff meeting, and drop-in Q&A meetings for staff to meet with administrators about the mandate.
“We are encouraging all staff to come to these sessions with their questions,” she said. The hospital is also planning on hosting three vaccine clinics for staff that same week.
The announcement from Logan about the vaccine requirement came a day after a Montana Department of Public Health and Human Services (DPHHS) snapshot report showed Logan with more than 90% of its beds occupied, and eight out of 10 large hospitals in the state having either limited bed availability or approaching capacity. From Sept. 6 through Nov. 22, Logan began nine out of 11 weeks with more than 90% of its hospital beds filled. That report includes in its total bed count things like NICU and pediatric beds, which aren’t for adult patients.
In a social media post Wednesday, Logan Health reported it was treating 27 people hospitalized for COVID-19, including 10 people receiving intensive care unit treatment and four people on ventilators. Of those hospitalized Wednesday, all but five were not vaccinated.
From April 1 through Nov. 19 unvaccinated people have accounted for 83% of COVID-19 hospitalizations in the state, which comes out to 4,107 hospitalizations, according to DPHHS data. A total of 722 unvaccinated people have died in the state over that same span, which accounts for 77% of COVID-19 deaths in Montana over that period.
According to the Centers for Disease Control and Prevention more than 196 million people, or 59% of the U.S. population, is fully vaccinated, and 69.7% of the population has received at least one vaccine dose. More than a half-million Montanans, representing about 50% of the eligible population in the state, were fully vaccinated as of a Monday update from DPHHS.
The percentage had been higher, but the recent addition of 90,769 children ages 5 to 11 to the eligible population caused the total percentage of people vaccinated in the state to fall.
Counties with a lower percentage of fully vaccinated people include Broadwater (29%), Carter (29%), Chouteau (35%), Dawson (38%), Fallon (34%), Garfield (24%), Golden Valley (41%), Granite (37%), Judith Basin (37%), Liberty (35%), Lincoln (40%), McCone (26%), Musselshell (33%), Petroleum (29%), Powder River (27%), Prairie (41%), Richland (38%), Sanders (36%), Stillwater (40%), Sweet Grass (41%), Wheatland 34%) and Wibaux (31%).
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