January 13, 2022
Update (Aug. 28, 2022): Eleventh Circuit Narrows Scope of Contractor Vaccine Mandate Injunction
Update (Jan. 15, 2022): After the Jan. 14, 2022, publication of this alert, the Centers for Medicare & Medicaid Services issued updated guidance to State Survey Agency directors providing 30 days (by Feb. 13) for facilities to demonstrate that staff had their first vaccine doses and 60 days (by March 15) for facilities to demonstrate that staff are fully vaccinated in the 24 states subject to the injunctions lifted in the Supreme Court opinion. This extension applies only to surveyors in the following states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming. Texas remains subject to an injunction, while all other U.S. states retain their current timelines (including fully vaccinated staff by Feb. 28, 2022).
On Jan. 13, 2022, the U.S. Supreme Court granted an emergency request for relief, staying the federal Occupational Safety and Health Administration’s (OSHA) emergency temporary standard (ETS), which requires employers with 100 or more employees to mandate COVID-19 vaccines or weekly testing for covered employees.
On the same day, the Court allowed the federal Centers for Medicare & Medicaid Services’ (CMS) interim final rule to be enforced, which requires mandatory COVID-19 vaccines for healthcare workers at certain CMS-covered facilities (i.e., with no testing option, except for approved medical or religious accommodations).
What Do the Court’s Decisions Say?
The Supreme Court’s decisions turn on whether the scope of OSHA’s and CMS’ authority is broad enough to allow them to issue their respective rules.
OSHA ETS Decision
The Court’s OSHA opinion in National Federation of Independent Business v. Department of Labor relies in large part on the so-called major-questions doctrine. The Court explains that it expects Congress to “speak clearly when authorizing an agency to exercise powers of vast economic and political significance.” Because there “can be little doubt” that the ETS involves the exercise of such power, the Court states that the question at issue is whether the Occupational Safety and Health (OSH) Act “plainly authorizes” the vaccine-or-test mandate. According to the Court, “It does not. The Act empowers the Secretary [of Labor] to set workplace safety standards, not broad public health measures.”
“As the agency itself explained to a federal court less than two years ago, the statute does ‘not authorize OSHA to issue sweeping health standards’ that affect workers’ lives outside the workplace . . . . Yet that is precisely what the agency seeks to do now — regulate not just what happens inside the workplace but induce individuals to undertake a medical procedure that affects their lives outside the workplace. Historically, such matters have been regulated at the state level by authorities who enjoy broader and more general governmental powers. Meanwhile, at the federal level, OSHA arguably is not even the agency most associated with public health regulation. And in the rare instances when Congress has sought to mandate vaccinations, it has done so expressly. . . . We have nothing like that here.”
CMS Interim Final Rule Decision
By contrast, in allowing the CMS interim final rule to be enforced, the Supreme Court’s CMS opinion in Biden v. Missouri states that “[t]he [CMS] rule . . . fits neatly within the language of the statute[,]” which “authorized the Secretary [of Health and Human Services] to impose conditions on the receipt of Medicaid and Medicare funds that ‘the Secretary finds necessary in the interest of the health and safety of individuals who are furnished services.’” Per the Court, “[a]fter all, ensuring that providers take steps to avoid transmitting a dangerous virus to their patients is consistent with the fundamental principle of the medical profession: first, do no harm.”
The Court further notes:
Practical Considerations Going Forward
Further, employers should continue to monitor other federal COVID-19 workplace requirements as well, including the federal contractor vaccine rule under Executive Order 14042 (which has been paused for now and has yet to reach the Supreme Court).
Thus, the Biden administration could decide to push ahead with litigation over the current ETS, put down its sword, or develop a new, more targeted rule or set of rules – or some combination thereof. Indeed, U.S. Secretary of Labor Marty Walsh issued a press statement on Jan. 13, 2022, admonishing employers:
“We urge all employers to require workers to get vaccinated or tested weekly to most effectively fight this deadly virus in the workplace. Employers are responsible for the safety of their workers on the job, and OSHA has comprehensive COVID-19 guidance to help them uphold their obligation. Regardless of the ultimate outcome of these proceedings, OSHA will do everything in its existing authority to hold businesses accountable for protecting workers, including under the COVID-19 National Emphasis Program and General Duty Clause.”
Indeed, in states with anti-vaccination limits, the federal “preemption” legal cover provided by the ETS no longer applies. The same is true with respect to whether adoption of the ETS requirements is a “mandatory subject of bargaining” under collective bargaining agreements. Thus, employers should evaluate any workplace policies that they have adopted in anticipation of the ETS and determine whether to continue, modify or withdraw them.
Further, if the CMS rule applies, each covered healthcare employer needs to determine what employees and other “staff” are required to have vaccinations. CMS does not limit vaccination to common-law employees. Instead, the rule includes those who provide care to patients on a regular basis through various arrangements — e.g., students, trainees, volunteers and contractors. CMS also requires vaccines for certain remote staff members, as they may occasionally encounter fellow staff who enter a covered facility to provide patient care.
As to how that enforcement will be applied across the 50 U.S. states and territories (some of whom were covered by a legal stay, and others of whom were not), CMS Administrator Chiquita Brooks-LaSure stated in a press statement issued Jan. 13, 2022:
“As a result of today’s decision, health care providers subject to the Omnibus Health Care Staff Vaccination rule in the 24 states (Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia, and Wyoming) covered by this decision will now need to establish plans and procedures to ensure their staff are vaccinated and to have their employees receive at least the first dose of a COVID-19 vaccine.
Today’s decision does not affect compliance timelines for providers in the District of Columbia, the territories, and the 25 states where the preliminary injunction was previously lifted.”
Thus, for the 24 states for which the CMS interim rule was just reinstated by the Supreme Court, there appears a possibility that CMS will issue further guidance, allowing more time for policy implementation. But that remains, for now, unclear.
For questions about the OSHA ETS, CMS interim rule, the import of the Supreme Court’s decisions or the requirements of other COVID-19 mandates, or for assistance in developing and tailoring policies for the patchwork of federal and state vaccination rules that may apply, please contact the authors of this article, your McGuireWoods contact, or a member of the firm’s labor and employment, healthcare, affirmative action, federal contracting, appeals and issues or COVID-19 response teams.