Arkansas lawmakers OK vaccine mandates for some state-run health care facilities

Medicare, Medicaid funds seen at stake

Rep. Rick Beck asks a question during the Arkansas Legislative Council meeting Friday during which lawmakers approved requests from three state agencies to implement covid-19 vaccination requirements for employees in facilities that receive Medicare and Medicaid funding.
(Arkansas Democrat-Gazette/Thomas Metthe)
Rep. Rick Beck asks a question during the Arkansas Legislative Council meeting Friday during which lawmakers approved requests from three state agencies to implement covid-19 vaccination requirements for employees in facilities that receive Medicare and Medicaid funding. (Arkansas Democrat-Gazette/Thomas Metthe)

Arkansas lawmakers Friday approved requests from three state agencies to implement covid-19 vaccination requirements, with religious and medical exemptions, for employees in facilities that receive Medicare and Medicaid funding.

The heads of the Arkansas Department of Human Services, the Arkansas Department of Veterans Affairs and the University of Arkansas for Medical Sciences said they will enact the policies and start processing exemption requests as soon as possible.

President Joe Biden's administration issued a mandate in November for health care workers to be fully vaccinated or receive exemptions, with noncompliant facilities at risk of losing federal funding. The rule directly conflicts with Act 977, a state law passed last year that says covid-19 vaccination "shall not be a condition of education, employment, entry, or services from the state or a state agency or entity" unless the Arkansas Legislative Council approves an exception.

State legislators repeatedly asked the three agency leaders if they will process and approve religious and medical exemption requests, and all three said they would. UAMS Chancellor Cam Patterson said the hospital has 400 pending exemption requests.

Exempted employees at all three agencies will be required to wear masks and be tested for coronavirus weekly.

UAMS has long offered religious and medical exemptions for other vaccines, Patterson said.

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"I'm happy to say that I'm not aware of any employee resignations because of these requirements," he said. "That gives me hope that we can manage this just as well without loss of staff."

Arkansas was one of 10 states that challenged the federal mandate, and a federal judge blocked its enforcement at the end of November. However, the U.S. Supreme Court upheld the mandate in a 5-4 decision Jan. 13.

The three state agencies submitted requests to the Legislative Council within days of the high court's ruling.

Patterson previously submitted a request for a vaccination requirement in November but withdrew it after the federal judge's initial injunction. Patterson said UAMS would not be able to care for its patients without the more than $600 million it receives in Medicare and Medicaid funds. An additional $100 million or more in funding from the National Institutes of Health would also be at risk if the hospital does not follow the Centers for Medicare and Medicaid Services rule, officials said.

The Department of Human Services runs seven facilities -- five human development centers, the State Hospital and the Arkansas Health Center -- that receive more than $120 million in Medicare and Medicaid funding, Secretary Cindy Gillespie said.

The Department of Veterans Affairs runs state veterans homes in North Little Rock and Fayetteville, providing veterans with nursing home services like hospice care, and physical and occupational therapy. These facilities receive about $4 million in Medicare and Medicaid funding, and they could only operate for six months without that funding, Secretary Nate Todd said.

The federal mandate's initial deadline for full vaccination or exemptions was Jan. 4. The Centers for Medicare and Medicaid Services set new deadlines Friday for first shots or exemptions by Feb. 14 and second shots by March 14.

'MORE THAN MONEY'

Gillespie previously told the Legislative Council that she feared the federal mandate would drive staff members to leave the seven affected facilities, which she said Friday are already short-staffed by hundreds.

The Booneville Human Development Center has the lowest staff vaccination rate of all seven facilities, with 66%. The center in Conway has a 77% staff vaccination rate, the Arkadelphia center has 82%, the Southeast Arkansas Human Development Center in Warren has 85% and the Jonesboro center has 89%, Gillespie said Friday.

The Arkansas State Hospital has 88% of its staff fully vaccinated, and the Arkansas Health Center has 82%, she said.

All of those percentages have increased since Jan. 19, compared with data Human Services spokeswoman Amy Webb provided to the Arkansas Democrat-Gazette at the time. The Conway Human Development Center saw the largest spike, from 56% to 77%.

Patterson and Gillespie wrote letters to the Centers for Medicare and Medicaid Services, saying the federal agency had failed to consider the impact of the vaccination mandate before issuing it.

Gillespie said in her letter that the Department of Human Services opposed the vaccination mandate on principle, while Patterson said the "accelerated timeline for implementation" was a burden on health care facilities because it did not give them enough time to create vaccination protocols, administer vaccines to employees who choose them and consider exemption requests from those who do not.

Patterson's Nov. 29 letter, provided to the Arkansas Democrat-Gazette on Friday, asked the Centers for Medicare and Medicaid Services for "an extended timeline and flexibility" so UAMS could find a way to follow the federal mandate and the conflicting state law.

The federal agency has not responded as of Friday, Patterson told the Legislative Council.

Nearly 2,000 UAMS employees are unvaccinated, he said Friday and at a previous council hearing in November.

State Sen. Kim Hammer, R-Benton, asked Patterson if UAMS had a plan to deal with a labor shortage of nearly 2,000 people. Patterson said he does not expect that many employees to choose neither vaccination nor an exemption.

"I think it's going to be much closer to zero, which is our historical response to the annual vaccine mandate that we have for influenza," Patterson said.

State Sen. Jack Ladyman, R-Jonesboro, asked if the real issue at hand was whether the Legislative Council was willing to "sell the state and our freedoms" for the collective hundreds of millions in Medicaid and Medicare funding that supports the three agencies.

"This is a very difficult situation, but if you really believe that people should have the freedom to decide [whether to be vaccinated] -- and I understand there's another side, and it's protecting general health -- we're putting a dollar value on that, and in my mind that's wrong," Ladyman said.

The request for a vaccination mandate was "about more than money," Gillespie said, because almost every resident of the five human development centers are Medicaid recipients, and the loss of funding at the centers would prevent those residents from receiving care.

The safety of the residents of the two veterans homes, as well as their families, is paramount to the Department of Veterans Affairs, Todd said.

"Some of them have comorbidities," he said. "We're very concerned about the safety of our staff members also, [and] we have had testing and mask requirements in the nursing homes and will continue to have those."

'THOUGHTFUL CONSIDERATION'

The Centers for Medicare and Medicaid Services conducts surveys of health care facilities nationwide to check for compliance with its rules. Several legislators, including Hammer and Ladyman, asked the agency heads if the centers might overturn any medical or religious exemptions that any of the agencies choose to grant.

Gillespie said repeatedly that Centers for Medicare and Medicaid Services surveyors do not assess the validity of exemptions but simply ensure that a policy is in place and being properly followed and documented.

She also said the Department of Human Services could finalize and start implementing its exemption process Monday with approval from the Legislative Council on Friday. Webb confirmed via email that the vaccination and exemption policies should be "finalized early next week."

A "deeply held belief" has historically been the basis for exemptions, and this could include the belief "that natural immunity precludes the need for a vaccine," Patterson told lawmakers, prompted by a question from Hammer.

Patterson emailed UAMS staffers Friday afternoon to inform them of the Legislative Council's decision and the hospital's exemption policy.

"I know that this will cause some angst for many of you who have chosen not to be vaccinated," Patterson wrote. "I want you to know that the decision to proceed with the mandate was not made lightly but after thoughtful consideration by both the ALC and UAMS."

According to the medical school's exemption policy, UAMS employees must provide documentation supporting their requests. A medical professional must sign off on a medical exemption request, and a religious exemption request can include a letter from a religious leader or a detailed statement under oath from the employee.

UAMS has the same requirements for employees who wish to be exempted from vaccination against other illnesses, including influenza and hepatitis-B, according to the form on the UAMS website.

Staffers who work remotely and never visit a UAMS campus are exempt from the covid-19 vaccination requirement, Patterson said in the email.

The federal vaccination mandate also applies to most private hospitals and clinics in the state, though most private facilities implemented vaccination requirements last year. Act 977 does not apply to private entities.

Several private hospitals in Arkansas have reached full compliance with the federal mandate. However, 75% of Baptist Health employees are fully vaccinated, communications director Cara Wade said in an email.

When asked if Baptist Health has a plan to reach full compliance, Wade said the hospital "is reviewing the mandates" to "understand the nature and scope" of the federal requirement.

The mandate covers 17 million health care workers at 76,000 health care facilities across the U.S., including home health providers.

CORRECTION: The Centers for Medicare and Medicaid Services will require workers in federally supported health care facilities to receive their first doses of covid-19 vaccine, or exemptions, by Feb. 14 and second shots by March 14. An earlier version of this story gave incorrect deadlines.


  photo  The request for a vaccination mandate was “about more than money,” Cindy Gillespie, secretary of the Arkansas Department of Human Services, told lawmakers Friday. Almost every resident of the state’s five human development centers are Medicaid recipients, and the loss of funding at the centers would prevent those residents from receiving care at other facilities, she said. (Arkansas Democrat-Gazette/Thomas Metthe)
 
 



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