Why are we extending the deadline to require booster doses?

The deadline to comply with booster requirements was extended to March 1, 2022 to account for implementation challenges related to the recent Omicron surge. The unprecedented increase in cases due to Omicron has introduced a number of barriers to the delivery of timely booster doses, including critical staffing shortages.

Why are we requiring booster doses at this time?

Current vaccine requirements of staff in health care settings are not proving sufficient to prevent transmission of the more transmissible Omicron variant. Boosters have been available in California since September 2021.

Based on the emergence of Omicron, additional statewide facility-directed measures are necessary to ensure we maintain adequate staffing levels within our healthcare delivery system. Additionally, given the current hospital census, even a moderate surge in cases and hospitalizations could materially impact California's health care delivery system within certain regions of the state. Accordingly, making boosters mandatory and requiring additional testing of workers eligible for boosters who are not yet boosted are necessary at this critical time.

When does this amended order go into effect?

The requirement for booster doses goes into effect December 22, 2021, and the deadline for booster-eligible covered workers to receive their booster is March 1, 2022, or within 15 days of becoming eligible for a booster if they are not eligible as of March 1, 2022. All facilities must begin testing of booster-eligible workers (who have not yet received their booster dose) by December 27, 2021 and be in full compliance by January 7, 2022.

The CDC recently updated their timeframe for those that received the Pfizer-BioNTech vaccine to 5 months after receiving the second dose, but the Table in the Order still reflects 6 months. Which timeframe should I follow?

The Order was written based on the most current information from the CDC at the time it was issued. Covered facilities should continue to use the timeframe provided in the order. However, CDPH encourages all persons to get boosted as soon as they become eligible.

With this new requirement, will all vaccinated workers who have not yet received their booster be required to test?

Not necessarily. Only those who are currently eligible for a booster, according to Table A in the order, would be required to test on the cadence specified in the order, until such time as they become boosted. For those workers who are vaccinated, but not yet eligible for a booster, they are not required to test, but will be required to test once they become eligible for a booster but remain unboosted. For example, if a worker received their full series of the Moderna vaccine within the last two months, they would not be considered booster-eligible and therefore would not be required to test, but will be required if they remain unboosted 6 months after they complete the second dose of the Moderna vaccine.

Which tests qualify for workers who have a valid exemption or for booster-eligible workers who have not yet received their booster (e.g., point of care tests, rapid tests, community testing sites)?

Antigen, PCR, or any Nucleic acid amplification (NAAT) test would qualify. 

Do tests need to be approved by the FDA?

Tests must be cleared, approved, or authorized, including in an Emergency Use Authorization (EUA), by the United States Food and Drug Administration (FDA) to detect current infection with the SARS-CoV-2 virus or be operating per the Laboratory Developed Test requirements by the U.S. Centers for Medicare and Medicaid Services.

Can a worker opt to regularly test instead of getting vaccinated or boosted?

No. For workers covered by this Order, testing will be an alternate means for satisfying this Order only for those who qualify for an exemption pursuant to the Order.

When do booster-eligible workers have to come into compliance with this new amendment?

Booster-eligible workers who have not yet received their booster must be in compliance by no later than March 1, 2022. For those not yet eligible for a booster, they must be in compliance no later than 15 days once they become eligible for a booster.

Does the Order apply to workers that conduct autopsy?

Coroner's offices and those conducting autopsy would not be considered health care workers for purposes of this Order but are covered under the July 26 Order as a covered worker in a correctional facility. However, CDPH strongly recommends all eligible staff to be vaccinated.

Does this apply to all correctional staff or just the medical staff?

Covered staff includes workers providing health care to inmates, prisoners, and detainees. In correctional hospitals, skilled nursing facilities, intermediate care facilities, or the equivalent, it also applies to persons not directly involved in delivering health care, but who could be exposed to infectious agents that can be transmitted in the health care setting (e.g., clerical, dietary, janitorial services, laundry, correctional officers, facilities maintenance staff, administrative, inmate workers, and volunteer personnel).

Does the Order only apply to correctional facilities that have integrated hospitals, skilled nursing facilities or intermediate care facilities, or does the Order also apply to correctional and detention facilities that have clinics or provide other healthcare services (that don't fall into the category of hospital, skilled nursing or intermediate care)?

The Order applies to (1) all paid or unpaid workers who provide healthcare or healthcare services to inmates, which would include healthcare services in a clinic setting or any other healthcare setting, and (2) all workers who are regularly assigned to work within hospitals, skilled nursing facilities, intermediate care facilities, or the equivalent that are integrated into the correctional facility or detention center in areas where health care is provided.

Are there any exemptions to the vaccination mandate?

The Order allows for two exemptions: (1) the worker is declining vaccination based on sincerely held religious beliefs or (2) the worker is excused from receiving any COVID-19 vaccine due to Qualifying Medical Reasons. To receive an exemption, a worker must participate in their employer's interactive process.

What are Qualifying Medical Reasons?

To determine qualifying medical reasons, the physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician should refer to guidelines from the CDC, Clinical considerations, as well as, COVID-19 vaccine Contraindications and Precautions which also includes:

• Documented history of severe allergic reaction to one or more components of all the COVID-19 vaccines available in the U.S.
• Documented history of severe or immediate-type hypersensitivity allergic reaction to a COVID-19 vaccine, along with a reason why you cannot be vaccinated with one of the other available formulations.

Additionally, the linked reference above provides information on what are neither contraindications nor precautions to COVID-19 vaccination, which include:

• Allergic reactions (including severe allergic reactions) not related to vaccines (COVID-19 or other vaccines) or injectable therapies, such as allergic reactions related to food, pets, venom, or environmental allergies, or allergies to oral medications.

Will CDPH be providing a template declination / exemption form for use?

No, CDPH will not be providing a template declination/exemption form for use. Facilities may use any existing form or process previously used for other mandated vaccines, or any process to ensure that the requirements as stated in the Order are met, including for a written health care provider's statement where applicable, and testing records pursuant to section (3) of the Order.

Who is authorized to provide a Qualified Medical Reason exempting a worker from the COVID-19 vaccine requirements?

Only a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician can provide a Qualified Medical Reasons exemption. In this context, the term "physician" refers specifically to an individual having a valid certificate or license to practice medicine and surgery issued by the Medical Board of California or the Osteopathic Medical Board of California.

How will you verify workers are vaccinated, boosted or tested?

Each facility will be required to verify and keep record of vaccination status or test results. Pursuant to the CDPH Guidance for Vaccine Records Guidelines & Standards, facilities have multiple options to verify vaccine status.

Who is responsible for enforcement of the requirements under this Order?

Each covered facility is required under the Order to enforce the vaccine mandate and testing requirements of their respective staff (including any staff that may come from a contracted staffing agency).

To the extent that the covered facilities are subject to state regulation, the state's regulating entities will ensure each facility is meeting the requirements for vaccine verification/exemptions. Local health jurisdictions may also enforce the orders with respect to local facilities.

What should a facility do if they suspect a fraudulent vaccine card is being presented as proof?

Facilities should work with their legal counsel, and may report suspected cases of healthcare fraud to the federal Health and Human Service through their website or through their tip line at 1-800-HHS-TIPS.

When did the original Order take effect?

The original Order went into effect August 19, 2021.

Does a worker need to be fully vaccinated by October 14, 2021?

No. They must have either their first dose of a one-dose regimen or their second dose of a two-dose regimen by October 14, 2021. Workers are not considered fully vaccinated until two weeks after completing the full vaccine regimen.

Will the July 26 Public Health Order continue to apply?

Yes. The July 26 Public Health Order for Health Care Worker Protections in High-Risk Settings requiring all unvaccinated workers to be tested weekly remains in effect and applies to any worker not subject to the State and Local Correctional Facilities and Detention Centers Health Care Worker Vaccination Requirement of December 22, 2021.

Originally published on 12/22/2021