CMS Issues Proposed Interim Final Rule on President’s COVID Vaccine Mandate

By Beth Clay

November 4, 2021 (Falls Church). Today the Center for Medicare and Medicaid (CMS) pre-published on the Federal Register the Interim Final Rule with public comment available. It will be formally published tomorrow morning with a 60 day comment period. ICA will be preparing comments and share them with our members.

CMS is clear – this interim final rule does not apply to other health care entities such as ‘physician’ office, only to the providers and suppliers listed below.

This is an extensive document (over 200 pages). You can read it here in its unofficial posting

The ICA will be reviewing and providing comments to CMS. We had previously notified membership through a press release of September 13 which provided:

Updated September 13 at 3:30 pm: CMS provided the following information on background regarding clarification on the mandate rule:

“This regulation does not directly apply to physician’s offices as these are not regulated under the provider-specific Medicare health and safety regulatory provisions, generally referred to as “Conditions of Participation.”

Given that Doctors of Chiropractic are ‘physicians’ in Medicare, this mandate as currently issued, will not apply to chiropractors in private practice. ICA will keep you posted if this changes.

Updated September 13 at 1:10 pm: Official Statement from CMS Spokesperson on background, “

On background and attributable to CMS spokesperson:

CMS anticipates that the staff vaccination requirement would apply to Medicare and Medicaid-certified provider and supplier types that comply with the Medicare health and safety regulatory provisions, known as the Conditions of Participation, which includes, but is not limited to, hospitals, dialysis facilities, ambulatory surgical centers, and home health agencies.”

It would appear the spokesperson was accurate on September 13.

The List of providers and Suppliers included in this interim final rule.

● Ambulatory Surgical Centers (ASCs) (§ 416.51)

● Hospices (§ 418.60)

● Psychiatric residential treatment facilities (PRTFs) (§ 441.151)

● Programs of All-Inclusive Care for the Elderly (PACE) (§ 460.74)

● Hospitals (acute care hospitals, psychiatric hospitals, hospital swing beds, long term

care hospitals, children’s hospitals, transplant centers, cancer hospitals, and rehabilitation

hospitals/inpatient rehabilitation facilities) (§ 482.42)

● Long Term Care (LTC) Facilities, including Skilled Nursing Facilities (SNFs) and

Nursing Facilities (NFs), generally referred to as nursing homes (§ 483.80)

● Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID) (§ 483.430)

● Home Health Agencies (HHAs) (§ 484.70)

● Comprehensive Outpatient Rehabilitation Facilities (CORFs) (§§ 485.58 and 485.70)

● Critical Access Hospitals (CAHs) (§ 485.640)

● Clinics, rehabilitation agencies, and public health agencies as providers of outpatient

physical therapy and speech-language pathology services (§ 485.725)

● Community Mental Health Centers (CMHCs) (§ 485.904)

● Home Infusion Therapy (HIT) suppliers (§ 486.525)

● Rural Health Clinics (RHCs)/Federally Qualified Health Centers (FQHCs) (§ 491.8)

● End-Stage Renal Disease (ESRD) Facilities (§ 494.30)

If you are not employed in one of these facilities and thus you are not effected.


Updated Friday morning 8:00 am – Overnight CMS issued the formal announcement with a press release. The link is available here:

FAQ link:

Midway through the FAQ page it again reiterates this rule – this vaccine mandate- does not apply to “physician officers” (Doctors of Chiropractic are categorized as physicians in Medicare) – so you and your staff if not in one of the named facilities are not subject to this mandate.


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