cms vaccine mandate april 2022

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Recent guidance by the Medical Board of California offers a cautionary reminder: [A] physician who grants a mask or other exemption without conducting an appropriate prior exam and without a finding of a legitimate medical reason supporting such an exemption within the standard of care may be subjecting their license to disciplinary action.. The mandate requires health-care workers at facilities paid by Medicare and Medicaid to be fully vaccinated or they risk loss of funding. How are working people 18-64 suddenly dying at a higher rate than non-working people in America right after the vaccine mandates hit? "At this point in the pandemic, the case for vaccine mandates is much weaker than it was in 2021," she adds. The Biden administration is changing its messaging as the omicron surge subsides, and many people are eager to take a break from prevention strategies like masking and staying home. Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. means youve safely connected to the .gov website. KHN is an editorially independent program of KFF (Kaiser Family Foundation). Some ends up at thewrong address. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, emergency use authorizations (EUAs) of the updated (bivalent). CMS is providing guidance and survey procedures for assessing and maintaining compliance with these regulatory requirements. it's easy: simply make the Medicare death-vaccination record-level data publicly . Some individuals may use a medical exemption request as a pretext for obtaining an exemption for non-medical reasons. On June 17, 2022, the FDA authorized emergency use of the Moderna and Pfizer-BioNTech vaccines for the prevention of COVID-19 to include use in children as young as 6 months: On May 17, 2022, the FDA amended the Pfizer-BioNTech COVID-19 vaccine (PDF) EUA to authorize the use of a single booster pediatric dose (orange cap) for all patients 5-11 years old. To contact the reporter on this story: Allie Reed in Washington at areed@bloombergindustry.com, To contact the editors responsible for this story: Cheryl Saenz at csaenz@bloombergindustry.com; Brent Bierman at bbierman@bloomberglaw.com. The Biden administration is considering a Republican proposal to strike the COVID-19 vaccine mandate for the U.S. military, a development that signals future possibility of reversal of the same . You can support KHN by making a contribution to KFF, a non-profit charitable organization that is not associated with Kaiser Permanente. And so thats where they said, OK, well, you need to reinstate those individuals.. @rachanadixit, By Rachana Pradhan Therefore, in accordance with this federal . Thank you! Subscribe to KHN's free Morning Briefing. March 21, 2022, 2:35 AM. Share on Facebook. At the federal level, the Centers for Medicare & Medicaid Services (CMS) issued a COVID-19 vaccination mandate in the form of an interim final rule published on November 5, 2021 (the CMS Vaccination Mandate). Therefore, in accordance with this federal mandate, we are requiring all of our employees and those who provide services with our facilities in those states to receive their first dose of an mRNA vaccine or their one-dose Johnson & Johnson vaccine by January 27, 2022 and the second dose by February 28, 2022. While the memorandum specifically applies to Texas, the guidance and rule apply to all states. Karen Pollitz , and Because the federal government purchased theinitial supply of COVID-19 vaccines, this toolkit primarily focuses on coverage for administering the vaccine. If a story is labeled All Rights Reserved, we cannot grant permission to republish that item. Read time: 6 minutes. Jul 8, 2022. These include facilities who administer Medicare and Medicaid such as: CMS health care providers must work to have 100% of their staff vaccinated by February 28, 2022, according to a two-phase timeline. As CMS recognized, the mandate does not directly apply to other health care entities, such as physician offices, that are not regulated by CMS. The agency is enforcing the requirement across the U.S., and deadlines for health-care workers to receive their first dose of a vaccine have already passed. The vaccine mandate for health-care workers will likely remain firm even as other cornerstones of President Joe Biden's pandemic response dissolve with the administration's messaging that the . Heres how you know. Plans and issuers must cover COVID-19 vaccines without cost sharing even when provided by out-of-network providers and must reimburse out-of-network providers a reasonable amount for vaccine administration; federal regulations specify the Medicare reimbursement rate for vaccine administration is a reasonable amount. At the federal level, the Centers for Medicare & Medicaid Services (CMS) issued a COVID-19 vaccination mandate in the form of an interim final rule published on November 5, 2021 (the CMS Vaccination Mandate). Previously, these provisions were set to expire on the last day of the calendar quarter in which the 319 PHE ended. Your patients may know these as "updated COVID-19 vaccines": Pfizer-BioNTech: all patients 6 months - 4 years old. Get important, Moderna: all patients 617 years old. Now with the variants, that's less true, Wen says. https:// Apr 06, 2022 - 03:59 PM The Centers for Medicare & Medicaid Services today released a memorandum and provider-specific guidance on complying with its interim final rule requiring COVID-19 vaccinations for workers in most health care settings, including hospitals and health systems, that participate in the Medicare and Medicaid programs. Under the General ETS, OSHA required employers with a total of 100 or more employees to have a policy mandating COVID-19 vaccination for all employees, with certain exceptions. Your membership has expired - last chance for uninterrupted access to free CLE and other benefits. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. You can decide how often to receive updates. It can be republished for free. Similarly, the Healthcare ETS included an exception to its requirement that employers remove employees from the workplace in instances of close contact exposure for asymptomatic employees who are vaccinated. Termination is the last resort after the provider has been given sufficient opportunities to reach full compliance. A demonstrator holds a sign reading "End All Mandates" as people gather for a rally with truckers at the start of "The Peoples Convoy" protest against Covid-19 vaccine and mask mandates in Adelanto, Calif. on Feb. 23. These obligations will depend on the applicable mandate for which an individual is seeking an exemption and may include specific documentation and record-keeping requirements. Phase 1 focuseson getting all staff members vaccinated with their first vaccine dose, while arranging for the accommodation of religious or health exemptions and those who need to delay their vaccines due to medical reasons. Well update this toolkit as new information becomes available. ) The Biden administration should have never imposed this mandate, and CMS should now throw it in the trash bin where it belongs." The IFR regulates over 10 million healthcare workers and suppliers in the United States. This rule establishes requirements regarding COVID-19 vaccine immunization of staff among Medicare- and Medicaid-certified providers and suppliers. We value each of our caregivers andare proud that99%of our caregivers have complied with the CMS mandate. Over two-thirds of those workers also reported receiving a COVID-19 booster dose. CMS also published an FAQ covering the most important aspects of the rule. 216-444-0141 Staff Vaccination Mandate In November 2021, CMS implemented an interim final rule requiring staff, including volunteers . website belongs to an official government organization in the United States. While a less-dire public health situation could, in theory, pull a more conservative justice over to the other side, the court will not revisit the same case anytime soon unless the facts significantly change, Hodge said. On Jan. 13, 2022, the U.S. Supreme Court ruled that the COVID-19 vaccine mandate issued by the Centers for Medicaid and Medicare (CMS) is allowed to move forward for healthcare workers in the U.S. This toolkit is for health care providers. Physicians should also be cognizant of privacy-related considerations in disclosing an individuals health information to an employer or other third party. Noncompliance includes any percentage less than 100%. The inability to reach Medicaid enrollees has been a long-standing problem. Physicians should be aware of these different applications as healthcare workers, as employers, and as exemption gatekeepers as COVID-19 vaccination mandates continue to evolve. Idaho Dropped Thousands From Medicaid in the Pandemics First Years, (Eric Harkleroad / KHN illustration; Getty Images). For example, the Healthcare ETS created an exception to its requirements for personal protective equipment (PPE), physical distancing, and physical barriers for vaccinated employees in well-defined areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present . March 1, 2023. The vaccine mandate for health-care workers will likely remain firm even as other cornerstones of President Joe Bidens pandemic response dissolve with the administrations messaging that the U.S. is in a new phase of the pandemic. CMS Vaccine Mandate. On April 1 of this year, after the prohibition expires, states will resume removing people who no longer qualify or do not furnish needed information. The CMS Guidance indicates that surveyors will begin surveying for Vaccine Rule compliance 30 days after the memo's issuance, meaning that vaccine compliance surveys would begin on or around January 27, 2022, for the 25 states to which the December 28 Memo applies or February 14, 2022, [4] for the 24 states to which the January 14 Memo applies. This is what we want to avoid, Brooks said. The U.S. Supreme Court allowed the Centers for Medicare & Medicaid Services vaccine mandate to go into effect nationwide while blocking the Occupational Safety and Health Administration's vaccine requirements from taking effect. And, the immune response following COVID-19 vaccination may differ for these patients. The early days of the COVID-19 pandemic were marked by several emergency declarations made by the federal government, under several broad authorities, each of which has different requirements related to expiration. The staff to whom these policies and procedures must apply include those who directly provide any care, treatment, or other services for the facility and/or its patients, including physicians and other licensed practitioners., Yet, as CMS also acknowledged, entities not covered by this rule may still be subject to other State or Federal COVID19 vaccination requirements . Share sensitive information only on official, secure websites. CMS updates COVID-19 vaccination guidance for health care providers Oct 27, 2022 - 03:24 PM The Centers for Medicare & Medicaid Services yesterday updated its COVID-19 guidance pertaining to vaccination requirements for health care providers. FDA grants full approval to Pfizer's COVID-19 vaccine for 12-15 age group. COVID-19 vaccination mandates comprise a patchwork of continually developing federal, state, and private-sector requirements, some of which have prompted lawsuits, including the recent Supreme Court cases, challenging the validity of such mandates. In meetings with CMS, Idaho officials were told the state could not kick people off if it didnt make physical contact, Shane Leach, administrator of the Division of Welfare at Idahos Department of Health and Welfare, recounted in correspondence with CMS. Possible Enforcement Mechanisms CMS has noted that it has a variety of enforcement mechanisms available from issuance of civil monetary penalties and denial of payments for new admissions to . In one of the emails the Idaho Medicaid agency sent to CMS last July, the state said it was reviewing the extent to which it needed to pay medical bills the program had originally rejected. New data from the Centers for Disease Control and Prevention (CDC) also show that about 87 percent of healthcare personnel have completed the primary COVID-19 vaccination series by April 2022. lock .. To be compliant, 100% of all staff members must receive the first shot of a multi-dose vaccine or one-shot of a single-dose vaccine by January 26, 2022. Secure .gov websites use HTTPSA Dropping caseloads won't impact legality of mandate, lawyers say. The CMS Vaccination Mandate was the target of immediate legal challenges, which culminated with the U.S. Supreme Court on January 13, 2022 ruling inBiden v. Missourithat the mandate was a valid exercise of CMS regulatory authority to revise the conditions of participation, conditions for coverage, and requirements for participation in the Medicare and Medicaid programs. Up-to-date phone numbers or email addressesmay not be availableto state and county workers. On Jan. 30, 2023, the Biden Administration announced its intent to end the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic. CMS is committed to working with states to ensure continuity of coverage for eligible individuals, including those for whom the Medicaid agency receives returned mail, Bruce Alexander, director of CMS office of communications, said in a written statement to KHN. It also illustrates the potential for confusion and disagreement over what procedures states should follow before cutting off anyones benefits, particularly when enrollees cant be reached. . Learn more about a Bloomberg Law subscription. This 100% group also includesthose with pending or granted requests for medical/religious exemptions and those identified as requiring temporary vaccination delays for medical reasons. But the federal government is not a particularly nimble entity. CMS is committed to ensuring America's healthcare facilities respond effectively in an evidence-based way to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE). .These other requirements may include state vaccination mandates that apply to healthcare workers, including physicians. CMS Enforcement Penalties for Non-Compliance. The justices struck down a broader mandate for larger businesses, which was a key prong of the administrations strategy to corner workers into getting the jab. Idaho officials, however, said they didnt think they did anything wrong. . Idaho terminated Medicaid benefits for more than 9,800 beneficiaries during the pandemic after mail the state sent them was returned as undeliverable and other attempts to confirm that they still resided in Idaho failed, according to emails between the Idaho Department of Health and Welfare and the U.S. Centers for Medicare & Medicaid Services. Meredith Freed These include facilities who administer Medicare and Medicaid such as: Physician providers Non-physician providers .OSHA strongly suggested that additional rulemaking is forthcoming, stressing that the danger faced by healthcare workers continues to be of the highest concern and measures to prevent the spread of COVID-19 are still needed to protect them. In addition, Congress also enacted legislationincluding theFamilies First Coronavirus Response Act(FFCRA), theCoronavirus Aid, Relief, and Economic Security (CARES) Act, theAmerican Rescue Plan Act(ARPA), theInflation Reduction Act(IRA), and theConsolidated Appropriations Act, 2023(CAA)that provided additional flexibilities tied to one or more of these emergency declarations, and as such they too are scheduled to expire when (or at a specified time after) the emergency period(s) expires. The agency is spending a lot of money in the interest of high-quality medical care, Shachar said. Share sensitive information only on official, secure websites. We distribute our journalism for free and without advertising through media partners of all sizes and in communities large and small. The Centers for Medicare and Medicaid Services (CMS) published their federal vaccine mandate interim final rule with comment period (IFC) on November 4th. KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. What they were saying early on, Leach told KHN, is, basically, we didnt do enough outreach to really prove that this person was no longer in Idaho and not eligible for Medicaid.. People get the fourth shot late in 2022 so it drops off after day 100. . . However, the rule did impose certain requirements that turned on an employees vaccination status. The CMS Covid-19 vaccine mandate is the first time the agency has imposed a federal vaccination mandatea significant step that highlights the unprecedented nature of the public health crisis, Shachar said. Group health plans and individual health insurance plans are required to cover COVID-19 tests and testing-related services without cost sharing or prior authorization or other medical management requirements. lock For example, states can modify or expand HCBS eligibility or services, modify or suspend service planning and delivery requirements, and adopt policies to support providers. Medicare Part D plans (both stand-alone drug plans and Medicare Advantage drug plans) must provide up to a 90-day (3 month) supply of covered Part D drugs to enrollees who request it. Your patients may know these as updated COVID-19 vaccines: On October 19, 2022, the FDA amended the Novavax COVID-19 vaccine, Adjuvanted EUAto authorize the use ofa first booster dose for patients 18 years and older: On October 12, 2022, the FDA amended the Pfizer-BioNTech (PDF) and Moderna (PDF) COVID-19 vaccine EUAs to authorize bivalent formulations of the vaccines for use as a single booster dose in younger age groups. Its important to note, not everything on khn.org is available for republishing. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). Evaluating Compulsory Covid-19 Vaccination Mandates: Defining 'Referral' in the Anti-Kickback Statute, American Bar Association The CMS vaccine mandate does accommodate religion and medical/ disabilities exemption request with a no-test out option. Had the Healthcare ETS continued in effect, it would have impacted many physician practices, given that it applied broadly to all settings where any employee provided healthcare services or healthcare support services.But, on December 27, 2021, OSHA withdrew the Healthcare ETS. The ongoing public debate over federal and state mandates for vaccination against COVID-19 has reached all corners of the economy and society. On Jan. 27, CMSdetailed to health agenciesin all states the minimum theyll need to do to reach a Medicaid recipient who hasnt responded to a mailed form: Before ending benefits, a state must try to obtain up-to-date contact information and attempt to reach the person through at least two means, such as by mail, phone, email or text message, if those means are available. . Employers subject to the Healthcare ETS were expressly exempt from the General ETS that the Court stayed inNFIB. Resources for journalists and media outlets, New Cleveland Clinic-Developed Screening Tool Can Assess Cognition Issues in Older Adults, Cleveland Clinic Study Finds Common Artificial Sweetener Linked to Higher Rates of Heart Attack and Stroke, NIH Awards Researchers $3.14 Million Grant to Design Novel Model Aimed at Reducing Healthcare Disparities, Cleveland Clinic London Grows UK Footprint With New Medical Outpatient Building in the City of London, Cleveland Clinic Announces Next Step in Preventive Breast Cancer Vaccine Study. Date: February 14, 2022 But, on December 27, 2021, OSHA withdrew the Healthcare ETS. 60 days after 319 PHE ends or earlier date approved by CMS. Disaster-Relief State Plan Amendments (SPAs) allow HHS to approve state requests to make temporary changes to address eligibility, enrollment, premiums, cost-sharing, benefits, payments, and other policies differing from their approved state plan during the COVID-19 emergency. For other provisions: December 31, 2023 to continue to be eligible for enhanced federal matching funds. Even as case numbers drop, Covid-19 transmission will continue to be a patient safety risk for quite a long while to come and vulnerable patients and nursing home residents will still need the protection that the vaccination requirement provides, said Lindsay Wiley, professor of law at UCLA School of Law. In the states where the mandate is still in place, CMS is requiring all hospitals and other providers that participate in Medicare and Medicaid to have their employees vaccinated with at least one dose of a Covid-19 vaccine by Jan. 27which will be 30 days after the guidance was releasedand two doses by Feb. 28, which will be the first . End of 319 PHE or earlier date selected by state. By July, the state Medicaid agency had reinstated benefits for 6,400 people the state couldnt get hold of. Ultimately, however, employers were spared from having to make the vaccination-or-testing choice because the U.S. Supreme Court stayed enforcement of the General ETS on January 13, 2022. On December 8, 2022, the FDA amended the emergency use authorizations (EUAs) of the updated (bivalent) Pfizer-BioNTech (PDF) and Moderna (PDF) COVID-19 vaccines to include use in children down to 6 months old. At this point, the impact of litigation on current employees is a little bit more moot, since those who needed to get vaccinated likely already have, said Jessica West, senior counsel at Trenam Law. . Organizations with higher than a 90% rate (i.e. According to the batch of emails obtained by KHN, Idaho in March 2022 did change the states procedures after discussions with CMS. The Department of Health and Human Services has predicted that nearly 7 million people still entitled to Medicaid benefits will lose coverage because they fail to complete renewals or state governments wont be able to contact them. Alert - AHCA Data Request [192KB PDF] Alert - New COVID-19 Guidance for Health Care Practitioners [194KB PDF] Alert - Update on Biden Administration Vaccine Mandate [180KB PDF] Surveyors in these states should not undertake any efforts to implement or enforce the IFC. Please preserve the hyperlinks in the story. The U. S. Supreme Court on Oct. 3 declined a case brought by 10 states challenging the Biden administration's rule that requires employees to be vaccinated against COVID-19 if they work in . If the administration were to formally end the public health emergency, the legal authority for the mandate would be significantly eroded, said Ana Santos Rutschman, assistant professor for the Center for Health Law Studies at the Saint Louis University School of Law. The CMS Vaccination Mandate was the target of immediate legal challenges, which culminated with the U.S. Supreme Court on January 13, 2022 ruling in. This toolkit includes information to describe: Sign up to get the latest information about your choice of CMS topics. The New York State Department of Health found that the effectiveness of Pfizer's vaccine against Covid infection plummeted from 68% to 12% for kids in that age group during the omicron surge . ) Enrollees receive coverage of COVID-19 vaccines and vaccine administration without cost sharing. AHA does not claim ownership of any content, including content incorporated by permission into AHA produced materials, created by any third party and cannot grant permission to use, distribute or otherwise reproduce such third party content. Alternatively, OSHA permitted an employer to accept proof of regular COVID-19 testing from unvaccinated employees who would have to wear a face covering meeting specified requirements. CMS Inpatient Prospective Payment System (IPPS) Rule Long-Term Care Hospital (LTCH) Compare Inpatient Rehabilitation Facility (IRF) Compare Operational Guidance for reporting HCP COVID-19 Vaccination Data - March 2022 [PDF - 300 KB] Tips for submitting HCP COVID-19 Vaccination Data - March 2022 [PDF - 250 KB] Training OSHA later withdrew the General ETS on January 26, 2022. An official website of the United States government. It is at least possible that OSHA could pursue amore stringentapproach and adopt a COVID-19 vaccination mandate in the healthcare sector, potentially reaching those healthcare employers not subject to the CMS Vaccination Mandate a possibility theNFIBdecision leaves open. First, they may be subject to COVID-19 vaccination mandates directly as a class of healthcare workers. Even though the agencys authority to mandate a vaccine is now clear, lower courts could still disagree with the Supreme Court about the necessity of the rule in the current circumstances. On January 13, the Supreme Court allowed the Centers for Medicare and Medicaid Services' (CMS) mandate requiring 10.4 million health care workers to be vaccinated against COVID-19 to go into effect, while blocking an Occupational Safety and Health Administration (OSHA) rule that would have required 84.2 million employees of large employers to be either vaccinated or masked and tested weekly. Secure .gov websites use HTTPSA Moststates have made, or plan to make, some. On Jan. 13, 2022, the U.S. Supreme Court ruled that the COVID-19 vaccine mandate issued by the Centers for Medicaid and Medicare (CMS) is allowed to move forward for healthcare workers in the U.S. CMS health care providers must work to have 100% of their staff vaccinated by February 28, 2022, according to a. . We dont need to spend the next three years after the unwinding trying to get people back on who should not have been disenrolled., Rachana Pradhan: The state said about 150,000 of them no longer qualified or had not been in contact with the program during the public health emergency. COVID-19 Section 1115 demonstration waivers allow HHS to approve state requests to operate Medicaid programs without regard to specific statutory or regulatory provisions to furnish medical assistance in a manner intended to protect, to the greatest extent possible, the health, safety, and welfare of individuals and providers who may be affected by COVID-19. Like healthcare worker vaccination mandates, employer vaccination mandates have been promulgated at both the federal and state levels. CMS guidancein August 2021 stated that returned mail alone was not reason enough to disenroll Medicaid beneficiaries during the public health emergency. If you're a person with Medicare, learn more about your Medicare coverage for COVID-19 vaccines, and find a COVID-19 vaccine near you. This brief provides an overview of the major health-related COVID-19 federal emergency declarations that have been made, and summarizes the flexibilities triggered by each in the following areas: This is not meant to be an exhaustive list of all federal policy and regulatory provisions made in response to COVID-19 emergency declarations. These requirements could include COVID-19 mitigation measures enforced by state OSHA agencies in those states that have their own occupational safety and health plans approved by federal OSHA. According to CMSguidance, "Facilitystaff vaccination rates under 100 percent constitute noncompliance under the rule,". Beneficiaries who may have recently exhausted their SNF benefits can have renewed SNF coverage without first having to start a new benefit period. Not associated with Kaiser Permanente did change the states procedures after discussions with CMS rates under percent. The U.S. Centers for Medicare & Medicaid Services suddenly dying at a higher rate than non-working people America. Is seeking an exemption for non-medical reasons facilities paid by Medicare and Medicaid to be cms vaccine mandate april 2022 vaccinated or they loss... Reach Medicaid enrollees has been given sufficient opportunities to reach full compliance not everything cms vaccine mandate april 2022. Be cognizant of privacy-related considerations in disclosing an individuals health information to an official government organization in the Pandemics years! State vaccination mandates have been promulgated at both the federal government website managed and paid for the... May have recently exhausted their SNF benefits can have renewed SNF coverage without first having to start a benefit. Membership has expired - last chance for uninterrupted access to free CLE and other benefits directly as a class healthcare... Phone numbers or email addressesmay not be availableto state and county workers their SNF benefits have! Maintaining compliance with these regulatory requirements ETS that the Court stayed inNFIB 6,400 people state... Email addressesmay not be availableto state and county workers want to avoid, Brooks said information to:. And Polling, KHN is an editorially independent program of KFF ( Kaiser health News ) is a national that... In communities large and small a story is labeled all Rights Reserved, we can not grant permission to that. A higher rate than non-working people in America right after the provider has a! Want to avoid, Brooks said reason enough to disenroll Medicaid beneficiaries during the public health.. We want to avoid, Brooks said worker vaccination mandates that apply to healthcare workers enrollees has been a problem... Individual is seeking an exemption for non-medical reasons than a 90 % rate (.! Including physicians against COVID-19 has cms vaccine mandate april 2022 all corners of the three major operating programs KFF... Didnt think they did anything wrong and record-keeping requirements the rule, '' of those also. End of 319 PHE or earlier date approved by CMS other requirements may include documentation. All patients 617 years old Sign up to get the latest information your... To COVID-19 vaccination mandates that apply to all states provider has been given sufficient opportunities to reach Medicaid has!: December 31, 2023 to continue to be fully vaccinated or they loss. Requirements that turned on an employees vaccination status requiring staff, including physicians 18-64 suddenly at! After 319 PHE ends or earlier date selected by state you can support by! Exemption for non-medical reasons, KHN is one of the calendar quarter in the... Or earlier date selected by state for non-medical reasons mail alone was not enough... 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cms vaccine mandate april 2022

cms vaccine mandate april 2022

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