CMS Vaccine Mandates for ICF Providers

The CMS Vaccine Mandate only applies to providers subject to federal Conditions of Participation (COPs). For IDD services, this only applies to ICFs not HCS or TxHmL services.

Requirements apply to direct care staff, administrative staff, staff from other programs that may fill shifts in an ICF, volunteers and contractors in the facility.

Requirements do not include a testing option. Staff must be 100 percent vaccinated except with medical or religious exemptions (including temporary medical exemptions following COVID infections, etc). Providers must have mitigation strategies in-place for unvaccinated staff that meet this criteria. Mitigation strategies are up to the provider but could include: weekly testing, N95 mask wearing requirements, prevention of unvaccinated staff working with at-risk individuals, etc).

Provider Resources:

CMS Texas Guidance and Timelines

  • Enforcement begins 30 days following issuance of letter (February 19), 100% receive first shot or granted/pending request for qualifying exemption or temporary delay status OR above 80% have completed the above steps and have a plan to achieve a 100% within 60 days the facility would not be subject to additional enforcement action.
  • Second shot is enforced 60 days following issuance of letter (March 21), 100% of staff have granted a qualifying exemption received their primary vaccine series (both shots), or have been, or temporary delay status, OR above 90% have completed the above steps and have a plan to achieve a 100% within 30 days, the facility would not be subject to an enforcement action.
  • New employees must have first shot prior to working with individuals

ICF Surveyor Guidance


EEOC Guidance for Religious & Medical Exemptions – Click here to view guidance providers can use for developing vaccine exemption policy guidance.

Additional from CMS RE: Day Habilitation Services contracted by ICFs

CMS Response: The staff vaccination mandate requirement for ICFs is to ensure vaccination of the staff (employees, volunteers and contracted) providing care and treatment of clients within the facility. The ICF may be more prescriptive to include as part of their contracted services (Ex: Day treatment programs) outside of the facility that others be included in this requirement to mitigate the risk of transmission.  We would hope that contract providers that have a history of providing services to ICF/IIDs outside of the ICF facility would understand the need to meet these requirements for public health and safety as well as from a business necessity.

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