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Federal District Court Issues First Court Opinion Regarding EKRA’s Commission Based Payments

By James A. Hoover, Esq., Burr & Forman, LLP

A Federal District Judge in the United States District Court, District of Hawaii issued the first court opinion interpreting the prohibition of the payment of commissions by clinical laboratories to employees or independent contractors that was implemented by the Eliminating Kickback in Recovery Act of 2018 (“EKRA”).  Judge Kodayashi entered her decision on October 18, 2021 in the case S&G Labs Hawaii, LLC v Graves.  

In S&G Labs, the court ruled that the commission payments made to an employee of a clinical laboratory were legitimate compensation payments and did not violate EKRA notwithstanding the fact the payments were made to a salesman who introduced S&G Labs to physicians, counseling centers and other entities that referred patients to the lab. In so ruling, the Court emphasized the salesman had no contact with any individual whose own specimens were tested.  

As a refresher, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the “SUPPORT Act) seeks to prohibit “patient brokering” practices by some recovery homes and treatment facilities. Section 1822 of the SUPPORT Act, signed into law and effective as of October 24, 2018, contains EKRA, now codified at 18 U.S.C. § 220. Although EKRA was created to address “patient brokering,” EKRA arguably prohibits a much broader scope of conduct by stating:

“whoever, with respect to services covered by a health benefit program… knowingly and willfully (1) solicits or receives any remuneration… directly or indirectly, overtly or covertly, in cash or in-kind, in return for referring a patient or patronage to… a laboratory, or (2) pays or offers any remuneration… directly or indirectly, overtly or covertly, in cash or in-kind (A) to induce a referral of an individual to a… laboratory or (B) in exchange for an individual using the services of that … laboratory, shall be fined not more than $200,000, imprisoned not more than 10 years, or both, for each occurrence”)

18 U.S.C. 220(a) (emphasis added).

EKRA also contains an exception to the prohibition set out above.  The exception states that “a payment made by an employer to an employee or independent contractor…if the employee’s payment is not determined by or does not vary by–(A) the number of individuals referred to a particular… laboratory; (B) the number of tests or procedures performed; or (C) the amount billed to or received from, in part or in whole, the health care benefit program from the individuals referred to a particular… laboratory.” 18 U.S.C. 220(b)(2).

EKRA on its face implicates any financial relationship between a clinical laboratory and an individual or legal entity that generates business for the lab. Although EKRA’s text is similar to the federal healthcare program anti-kickback statute, 42 U.S.C. 1320-7b(b) (the “AKS”), it is arguably much broader in scope for a number of reasons.  First, EKRA defines “laboratory” to include any CLIA-certified laboratory.  Second, the statute defines “health benefit program” to mean “any public or private plan or contract… under which any medical benefit, item, or service is provided to any individual.” Thus, EKRA applies to payments by any payor, such as commercial insurance and even self-pay, not just by government-funded plans.   

Relating to EKRA, the question before the Court in S&G Labs dealt directly with compensation paid by S&G Labs to an employee.  The compensation arrangement involved a compensation arrangement that included a base salary of $50,000.00 and a percentage of monthly net profits generated by the employee’s client accounts and by the client accounts handled by S&G employees whom the relevant employee managed.  The employee’s commission-based compensation resulted in him receiving more than $1.8 million in 2018 alone.

S&G Labs is a medical testing facility that performs urinalysis screening for legal substances, as well as for controlled substances for physicians, substance abuse treatment facilities and other types of entities.  The Court analyzed the definition of “laboratory” and “clinical laboratory” and concluded that S&G Labs was a laboratory for EKRA purposes.  

Next, the Court compared EKRA’s statutory language of “remuneration” and “individual” with the AKS’ statutory language for those terms.  The Court ruled, in light of the statutory construction of EKRA and the AKS, that the employee’s compensation from S&G constituted remuneration under EKRA.  

The Court also analyzed whether the remuneration paid to the employee was paid to “induce a referral of an individual to” S&G labs.  The Court opined that undoubtedly the employee’s “…commission-based compensation structure induced him to try to bring more business to S&G, either directly through the accounts he serviced himself, or through the accounts of the personnel under his management. However, the ‘client’ accounts they serviced were not individuals whose samples were tested at S&G. Their ‘clients’ were ‘the physicians, substance abuse counseling centers, or other organizations in need of having persons tested.’”  Thus, the Court concluded the compensation arrangement did not violate § 220(a) and the exception in § 220(b) was not applicable.  

Although the commission-based sales compensation arrangement in the employment agreement was upheld in this instance, this opinion is extremely narrow in its implications.  As a result, notwithstanding this opinion, EKRA remains a thorny problem for all laboratories and those who refer to them and requires much thought and consideration before using such commission-based compensation arrangements for clinical laboratories.  

Jim Hoover is a Partner at Burr & Forman LLP and practices exclusively in the firm’s Healthcare Practice Group. Jim may be reached at (205) 458-5111 or jhoover@burr.com.

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OIG Revises Self-Disclosure Protocol for First Time Since 2013

By: Catherine (Cat) Kirkland, Partner at Burr Forman, LLP

The Office of Inspector General (“OIG”) provides a way for physicians and other healthcare providers to voluntarily disclose evidence of potential fraud directly to the government through its Health Care Fraud Self-Disclosure Protocol (“SDP”). Self-disclosure through the SDP gives physicians and other providers with an opportunity to avoid or mitigate government investigations, civil/administration litigation, and hefty fines. 

On November 8, 2021, the OIG issued a revised SDP, with several notable updates from the OIG’s previous 2013 version:

  • Online SDP Submissions Only. The OIG requires all disclosures to be made online via the OIG’s website. Previously, disclosures could be mailed, faxed, or even emailed (with permission) to OIG contacts. While online submissions are now required, providers can still tailor their submission by uploading supporting documents (including, for example, a letter outlining the reason for the disclosure) through the OIG’s online portal.
  • Damage Estimates Required. The OIG requires disclosures to include an estimate of damages to each Federal health care program (broken out by program type) and/or a certification from the disclosing party stating that a damages estimate will be supplemented within ninety (90) days of disclosure.
  • Minimum Settlement Amounts Increased. The OIG revised the minimum settlements under the SDP.  Kickback-related submissions now require a minimum settlement of $100,000 (up from $50,000) and all other SDP matters require a minimum settlement of $20,000 (up from $10,000). These minimum settlement amounts apply even if the estimated damages are significantly less than the minimum amount.
  • SDP Inappropriate for Disclosures Related to HHS Grants or Contracts. The OIG also used this update to carve out disclosures related to HHS grants or contracts through a separate disclosure process.
  • OIG Coordination with the Department of Justice (“DOJ”). The OIG also clarified that it would coordinate, as needed, with the DOJ to resolve self-disclosures involving potential criminal conduct.

The SDP remains a valuable way for physicians or other providers to mitigate risk related to potential fraud. For self-disclosures made via the SDP, the OIG has “instituted a presumption against requiring integrity agreement obligations” and the OIG believes “that persons that use the SDP and cooperate with the OIG during the SDP process deserve to pay a lower multiplier on single damages than would normally be required[.]”[1]

A physician or other healthcare provider may utilize the SDP when the provider has reasonably assessed that a potential violation of Federal criminal, civil, or administrative laws has occurred. Examples of conduct that could be disclosed via the SDP include: employment of an individual who has been excluded from Medicare or Medicaid, billing for services provided by an unlicensed and/or non-credentialed individual, and/or arrangements resulting in a kickback or payment for a referral.

The OIG regularly publishes SDP settlements online with the provider’s name and a brief description of the settlement. Examples of recent settlements involving physicians and/or physician practices that self-disclosed to the OIG include:

  • In August 2021, a New York based primary care and urgent care group agreed to pay $50,000 after disclosing that its providers and their immediate family members received cost-sharing write-offs, gifts, and/or meals, potentially in violation of physician self-referral and anti-kickback laws.  
  • In May 2021, a family medicine group in Illinois agreed to pay $62,000 after disclosing that the group had submitted claims to Medicare for services provided by a nurse who was later discovered to be unlicensed. 
  • In March 2020, a multi-specialty group in Hawaii agreed to pay $240,000 after disclosing that the group had submitted claims for evaluation and management services provided by a physician that were not supported by the medical record.

Navigating whether self-disclosure to the OIG is appropriate and how to comply with the SDP rules can be challenging.  Please do not hesitate to contact us should you have any questions about the SDP or any of the underlying issues that could give cause to disclose. 

Catherine (Cat) Kirkland is a Partner at Burr & Forman LLP and practices with the firm’s Health Care Industry Group. Cat may be reached at ckirkland@burr.com or at 251-340-7271.


[1]      OIG’s Health Care Fraud Self-Disclosure Protocol, issued on April 17, 2013, and amended on November 8, 2021, is available at: https://oig.hhs.gov/documents/self-disclosure-info/1006/Self-Disclosure-Protocol-2021.pdf.

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Summary of SB 15 (new state law regarding parental consent for COVID vaccine)

Summary of SB 15 (new state law regarding parental consent for COVID vaccine)

NOTE: As introduced, SB15 would have added new lawsuit opportunities against pediatricians and pediatric practices into the vaccine passport law. The Medical Association worked successfully with the Alabama Chapter of the American Academy of Pediatrics and others to stop that. However, attempts to resolve the vaccine passport law’s broad language currently applying to all vaccinations – including childhood vaccinations – were unsuccessful. That issue will have to be resolved at some point in the future. Other than the new parental consent requirement detailed below for a minor to receive a COVID-19 vaccine, the vaccine passport law’s effect on pediatric practices remains unchanged.

During the recent Special Legislative Session, the State Legislature passed and the Governor signed into law Senate Bill 15 (“SB15”), which effectively requires written consent from a parent or legal guardian before administration of a COVID-19 vaccine to a minor. Prior to enactment of SB 15, Alabama’s general consent law for minors provided that:

“Any minor who is 14 years of age or older, or has graduated from high school, or is married, or having been married is divorced or is pregnant may give effective consent to any legally authorized medical, dental, health or mental health services for himself or herself, and the consent of no other person shall be necessary.” Ala. Code §22-8-4 (1975).

However, during the Special Session, the Legislature created an exception to §22-8-4 in the text of SB15 by using the phrase “Notwithstanding section 22-8-4, Code of Alabama 1975…” prior to the new requirement for written parental consent. Thus, any minor who meets the conditions of §22-8-4 and is allowed to seek medical treatment on his or her own may still do so, EXCEPT when seeking a COVID-19 vaccine, which will now require parental consent.

Physicians who are unfamiliar with §22-8-4 should note that while this statute allows a minor who meets one of the above-stated conditions to consent for medical treatment without the additional consent of a parent, it does not prohibit a parent or legal guardian of a minor who meets one of these conditions from being able to consent on behalf of the minor. Therefore, SB15 does not create a situation where physicians must obtain consent from one party for a COVID-19 vaccine and another party for all other treatment.

However, the Legislature did not address within the text of SB15 another less-used consent statute for minors:

“Any minor who is married, or having been married is divorced or has borne a child may give effective consent to any legally authorized medical, dental, health or mental health services for himself or his child or for herself or her child.” Ala. Code §22-8-5 (1975).

Section 22-8-5 duplicates some of the conditions from §22-8-4, but also provides a distinctly separate condition, allowing any minor who has “borne a child” to not only give effective consent to medical treatment for herself, but also for her child. While the number of minors who have a child old enough to safely receive a COVID-19 vaccine is likely low at this time, this could change if vaccines are approved for use in children under the age of 5. Nevertheless, written consent from a minor for a COVID-19 vaccine for her own child would be in compliance with SB15 as it is written. The situation left unresolved by SB15 is whether a minor who has borne a child can seek a COVID-19 vaccination without the written consent of her parent. Physicians should consider on a case by case basis the circumstances of a minor who meets this condition and is seeking a COVID-19 vaccine.

SB15 provides a penalty for non-compliance within the act, allowing the Attorney General to seek an injunction to stop “a threatened or continuing violation of this section.” Physicians should consider a standard written consent form for COVID-19 vaccinations for minors and should fully document the circumstances of any judgment calls presented by §22-8-5, to avoid an injunction from the State.

Read SB15 here.

By Brandy Boone, General Counsel
Medical Association of the State of Alabama

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ALAPAC Announces Second Round of Contributions of 2022 Election Cycle

The Alabama Medical PAC (ALAPAC), the official political committee of Alabama physicians and the Medical Association, has announced its second round of contributions for the 2022 election cycle.

In 2021, ALAPAC launched a new governance model comprised of Regional Boards which work in conjunction with the Board of Directors to vet candidates for local legislative and Congressional races as well as statewide races. This model grants local physicians across the state authority in determining how physician contributions to ALAPAC are dispersed. If you have interest in participating on an ALAPAC Regional Board, please contact us here.

Regarding candidates for the Alabama Senate and Alabama House, in October, ten of ALAPAC’s 11 Regional Boards met and considered contributions for candidates. In all, 33 candidates for legislative races were recommended to receive ALAPAC support from the respective Regional Boards of physicians in those areas. The ALAPAC Board of Directors then considered and concurred in each recommendation made by the Regional Boards.    

“Each of the candidates receiving ALAPAC support at this time are men and women the Medical Association has worked well with across a multitude of issues,” ALAPAC Chair David Herrick, M.D., said. “ALAPAC will continue to identify and support candidates for office medicine can work with to address the increasing number of challenges facing patients, physicians and our state.”

To see who ALAPAC contributed in the first round, click here.

Alabama Senate

Sen. Greg Albritton (R) – Range
Sen. Gerald Allen (R) – Tuscaloosa
Sen. Vivian Figures (D) – Mobile
Sen. Randy Price (R) – Opelika

Sen. David Sessions (R) – Grand Bay
Sen. Shay Shelnutt (R) – Trussville
Sen. Larry Stutts (R) – Tuscumbia

Alabama House of Representatives

Rep. Russell Bedsole (R) – Alabaster
Rep. Chris Blackshear (R) – Smiths Station
Rep. Napoleon Bracy (D) – Prichard
Rep. Chip Brown (R) – Mobile
Rep. Corley Ellis (R) – Columbiana
Rep. Jeremy Gray (D) – Phenix City
Rep. Laura Hall (D) – Huntsville
Rep. Corey Harbison (R) – God Hope
Rep. Wes Kitchens (R) – Arab
Rep. Kelvin Lawrence (D) – Hayneville
Rep. Joe Lovvorn (R) – Auburn
Rep. Parker Moore (R) – Decatur
Marcus Paramore (R) – Troy

Rep. Kenneth Pascal (R) – Pelham
Rep. Phillip Pettus (R) – Killen
Rep. Ben Robbins (R) – Sylacauga
Rep. Proncey Robertson (R) – Mount Hope
Rep. Ginny Shaver (R) – Leesburg
Rep. Randall Shedd (R) – Baileyton
Rep. Matt Simpson (R) – Daphne
Rep. Kyle South (R) – Fayette
Rep. Scott Stadthagen (R) – Hartselle
Rep. David Standridge (R) – Hayden
Rep. Shane Stringer (R) – Citronelle
Kerry Underwood (R) – Tuscumbia
Rep. Margie Wilcox (R) – Mobile

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Discussion with Decisionmakers: Rep. Ed Oliver

Discussions with Decisionmakers

Representative Oliver represents Alabama’s 81st District covering Chilton, Coosa, and Tallapoosa Counties. He is the Vice-Chair on the House Health Committee. After graduating from the University of Alabama, Representative Oliver attended the Command and General Staff College and served in the Army as a helicopter pilot and then an ambulance helicopter pilot. He is also an avid and knowledgeable hunter.

What first prompted you to consider running office?

I get to do work for rural Alabama and I understand rural health. It felt like a great opportunity and I took it.

How does your background help serve you on the Health Committee and also the Legislature?

Everybody is a product of their experiences. I enjoy speaking with physicians.

What are some of your legislative priorities this term?

I’m working on a 9-1-1 bill that establishes a standard for 911 operators.

 What are some health-related issues important to your district and your constituents?

Access to healthcare. Specifically, when it comes to ambulance care. People really value quick and efficient healthcare.

What do you think people understand the least about our health care system?

Medical workers are not trying to rip you off, they are simply trying to keep their doors open. Doctors are good people.

If you could change anything about our state’s health care system, what would it be?

I would like to see smaller and rural hospitals more financially well off and offer more service.

How can the Medical Association – and physicians statewide – help you address Alabama’s health challenges?

What you all do is the best thing.  All of our services are in populated areas.  I would like to see doctors and nurses get paid better in my district and in rural areas.  It is very hard to get a doctor to stay in a rural area.

What is the one thing you would like to say to physicians in your district?

I appreciate all that they do and I want them to stay in my district.

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2022 Medicare Physician Fee Schedule Rule – Conversion Factor and More

2022 Medicare Physician Fee Schedule Rule – Conversion Factor and More

By: Anthony Romano, Burr & Forman, LLP

On November 2, 2021, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (the “PFS Rule”) which includes updates for Medicare payments under the Physician Fee Schedule, and other Medicare Part B issues, on or after January 1, 2022.  The PFS Rule is described as part of a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation. Multiple policy changes were included in the PFS Rule, a few of which are highlighted below: 

Conversion Factor –

The PFS Rule set the fixed-dollar conversion factor (the amount CMS pays per RVU) for 2022 at $33.59.  This is a decrease of $1.30 from the 2021 conversion factor.  CMS noted that they took the 2021 calendar year conversion factor (without the 3.75% increase provided by the CAA) and multiplied it by the budget neutrality adjustment required to offset the spending impact of any changes exceeding $20 Million from what the 2022 expenditures would have been absent any changes.  

Billing for Physician Assistant (“PA”) Services –

Beginning January 1, 2022, Medicare can make direct payment to PAs for professional services that PAs furnish under Part B.  As you likely know, Medicare payment for PA services currently can only be paid to a PA’s employer and cannot be billed directly by the PA (unlike nurse practitioners and clinical nurse specialists who can bill Medicare and be paid directly). Effective January 1, 2022, PAs may bill Medicare directly for their professional services, may reassign their rights to payment for their professional services, and may incorporate as a group comprised solely of PAs and bill Medicare for PA services.  The PFS Rule did not change the requirement that PA services be performed under physician supervision.  

Rural Health Clinics (“RHCs”) and Federally Qualified Health Centers (“FQHCs”) – 

Absent changes in the definition of “mental health visits,” RHCs and FQHCS would no longer be paid by Medicare for mental health care services delivered via telecommunications technology after the COVID-19 public health emergency. In order to avoid potentially problematic interruptions to mental health care in rural and vulnerable populations, for 2022, CMS revised the definition for RHC or FQHC “mental health visits” to include visits furnished using interactive, real-time telecommunications technology. This change will allow RHCs and FQHCs to report and receive payment for mental health visits furnished via real-time telecommunication technology in the same way they currently do when visits take place in-person, including audio-only visits when the beneficiary is not capable of, or does not consent to, the use of video technology. The PFS Rule does require an in-person, non-telehealth visit at least every 12 months for these services; subject to certain exceptions which are documented in the patient’s medical record. 

Opioid Treatment Program (“OTP”) Payment For Audio-Only Interaction – 

The PFS Rule provides Medicare coverage and payment for OTP’s furnishing counseling, individual therapy, and group therapy services via audio-only interaction (such as telephone calls) after the conclusion of the COVID-19 public health emergency in cases where audio/video communication is not available to the beneficiary, including circumstances in which the beneficiary is not capable of or does not consent to the use of devices that permit a two-way audio/video interaction, provided all other applicable requirements are met.  When services are furnished using audio-only technology, practitioners must certify that they had the capacity to furnish the services using two-way audio/video communication technology, but instead, used audio-only technology because audio/video communication technology was not available to the beneficiary.

Please do not hesitate to contact us should you have any questions about the PFS Rule or how the PFS rule may impact you or your practice.

Anthony Romano practices with Burr & Forman LLP in the firm’s Health Care Industry Group. Anthony may be reached at aromano@burr.com or (205) 458-5210.

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Discussions with Decisionmakers: Sen. Donnie Chesteen

Discussions with Decisionmakers

What first prompted you to consider running office?

In 2010, I felt a call to step into the political arena.

How does your background help serve you on the Healthcare Committee and also the Legislature?

I had a career in medical sales, I feel as if that set me up. It is important to serve those that need help.

What are some of your legislative priorities this term?

My main priority has been to provide broadband to rural areas.

If you could change anything about our state’s health care system, what would it be?

There should be more education on topics such as obesity or diabetes and it would serve the state of Alabama tremendously in helping control these issues.

How can the Medical Association – and physicians statewide – help you address Alabama’s health challenges?

I am not an expert in healthcare, so it is important that I speak with our physicians to further understand important health issues, and how to solve them.

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President Biden’s Executive Order to Expand Vaccination Requirements for Healthcare Facilities and Federal Contractors

President Biden’s Executive Order to Expand Vaccination Requirements for Healthcare Facilities and Federal Contractors

by:  Jim Hoover

As most people know by now, on September 9, 2021 President Biden announced his Path Out of the Pandemic: COVID-19 Action Plan.  As part of the plan, the President signed Executive Order 14042, Ensuring Adequate COVID Safer Protocols for Federal Contractors.  The Executive Order is a six-prong, comprehensive plan outlining the President’s plan to combat COVID-19 and its variants. One prong of that plan includes expanding vaccination requirements for federal contractors including Medicare and Medicaid-certified facilities. This requirement is expected to apply to approximately 50,000 healthcare providers and cover a majority of healthcare workers across the country.

To combat the spread of COVID-19, the Centers for Medicare & Medicaid Services (CMS) is using its authority to expand the emergency regulations that require vaccinations for nursing home workers to encompass additional healthcare providers and suppliers who participate in Medicare and Medicaid. As a condition for participating in the Medicare and Medicaid programs, CMS will require that staff of all Medicare and Medicaid-certified facilities be vaccinated.

CMS indicated the Medicare and Medicaid-certified facilities will include hospitals (acute care, critical access hospitals, and inpatient rehabilitation facilities), outpatient facilities (ambulatory surgical centers, comprehensive outpatient rehabilitation facilities, federally qualified health centers, and rural health clinics), long-term care facilities & skilled nursing facilities, durable medical equipment suppliers, home health agencies, hospices, clinical labs, and ambulances.  At this time, it is uncertain whether physician practices would fall under the new vaccination mandate.

Based on indications from the White House, we anticipate staff who must be vaccinated will include, but will not be limited to, clinical staff, individuals providing services under arrangements, volunteers, and staff who are not involved in direct patient, resident, or client care.

CMS is developing an Interim Final Rule with a comment period and plans to issue the rule in October 2021. CMS is encouraging all certified Medicare and Medicaid facilities to begin complying with these expected regulations by urging workers who are not currently vaccinated to get vaccinated immediately. Healthcare facilities are encouraged to use all available resources, including employee education and clinics, to meet the new federal requirements.

In support of another prong of the President’s plan, the Safer Federal Workforce Task Force released guidance on September 24, 2021 detailing COVID-19 vaccination and other pandemic-related workplace safety requirements for federal contractors. The guidance attempts to answer many of the questions raised by federal contractors about the requirements, however additional information should be forthcoming by the Task Force in the coming weeks. 

Covered federal contractors are responsible for ensuring that all covered full-time or part-time contractor employees are fully vaccinated for COVID-19, unless the employee is legally entitled to an accommodation. The guidance also requires masking and physical distance in compliance with Centers for Disease Control guidelines at covered contractor workplaces. A covered contractor workplace is a location the contractor controls at which an employee of a covered contractor is likely to be present at any point during the period of performance.

Covered federal contractors are those with contract language mandating adherence with the guidance. Agencies will be required to incorporate contractual language into renewals, extensions, or exercised options of existing contracts, as well as new solicitations and contracts issued, that are above the simplified acquisition threshold (currently $250,000) by October 15, 2021. Though not required, it is likely that the government will encourage modifications of long-term contracts to include the new clause. 

Prime contractors must ensure that compliance clauses are incorporated into its contracts with subcontractors except those solely providing products.  All covered federal contractors and subcontractors must comply regardless of business size.

For covered federal contractors with active contracts, employees must be fully vaccinated by December 8, 2021. For covered federal contractors awarded new contracts (or options, renewals, or extensions), employees must be fully vaccinated by the first day of performance under the new contract, option, renewal, or extension. 

Employees who work from home must be fully vaccinated, but do not have to comply with the masking or physical distancing requirements discussed below.  Employees who work outside must also be vaccinated. However, the mandate does not apply to any employees who work outside of the United States or its outlying areas.

Covered federal contractors must review employees’ documentation to prove vaccination status. Covered federal contractors must require employees provide one of the following documents: a copy of the record of immunization from a healthcare provider or pharmacy; a copy of the employee’s COVID-19 Vaccination Record Card; a copy of immunization records from a public health or State immunization information system; or a copy of any other official documentation verifying vaccination that includes all of the following information: (a) vaccine name, (b) date(s) of administration; (c) name of the health care professional or clinic site who administered the vaccine. Employers can accept digital copies of these records. For example, photographs, scanned documents, or PDFs are acceptable forms of proof. 

If an employee has lost or does not have a copy of the required documentation employees should be directed to obtain new copies or verification of their vaccination status. Employees should be able to obtain new copies of their vaccination card from their vaccination provider. If the vaccination provider is no longer operating, employees may contact their State or local health department’s immunization information system (IIS) for assistance. 

Covered federal contractors still need to accommodate employees with closely held religious beliefs or ADA-qualifying disabilities that inhibit their ability to receive a COVID-19 vaccine. Accommodations must also be offered to employees who are unable to wear masks due to an ADA-qualifying disability or closely held religious belief.

Covered federal contractors must continue to enforce other measures such as masking or social distancing.  There are differing requirements based on the location of the worksite.  The rules state that covered contractors must ensure that all individuals and visitors (regardless of vaccination status) comply with the published CDC guidance for masking at workplaces in areas of high or substantial community transmission. In areas with low or moderate community transmission, fully vaccinated individuals do not need to wear masks. Fully vaccinated individuals do not need to practice social distancing, regardless of the level of community transmission. Individuals who are not fully vaccinated must wear a mask indoors and in crowded outdoor settings or outdoor settings that require sustained close contact with other individuals who are not fully vaccinated regardless of the level of community transmission. 

Masks will not be required if an individual who is not fully vaccinated is alone in an office with floor to ceiling walls and a closed door, in brief times when an individual is eating or drinking so long as physical distance of at least 6 feet is maintained, or if the individual obtains an accommodation pursuant to an ADA-qualifying disability or a sincerely held religious belief.

Covered federal contractors may also allow exceptions for employees who are engaging in activities in which masks may get wet, during high-intensity activities, or when wearing a mask would create a risk to workplace health, safety, or job duty as determined by a workplace risk assessment. These exceptions must be approved in writing by an authorized representative of the covered federal contractor. 

The full text version of the Task Force Guidance can be found here. 

Jim Hoover is a partner at Burr & Forman LLP practicing exclusively in the firm’s Healthcare Industry Group. Jim may be reached at (205) 458-5111 or jhoover@burr.com.

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Special Session on Corrections Issues Concludes

The Legislature convened last week for the first of what are expected to be two special sessions this fall. Gov. Ivey – who has authority under Alabama law to call the legislature into a “special and extraordinary session” – had asked Alabama legislators to begin work on Monday, Sept. 27 to take up corrections related issues including prison construction and sentencing reforms. The House and Senate concluded their work in record time on Friday, Oct. 1, using the minimum five legislative days required to pass a bill.

By Friday at the conclusion of the special session, four bills were sent to the governor for her signature, three dealing with new prison construction and existing facility infrastructure updates and renovations and one dealing with reforming a portion of the pardons and paroles process.

HB 2 by Rep. Jim Hill (R–Springville) — HB 2 was one of two sentencing reform proposals considered during the session. The measure facilitates the supervised release of certain inmates near the end of their sentences by use of electronic monitoring devices administered by the Alabama Board of Pardons and Paroles. A more controversial proposal would have made retroactive a 2013 law allowing nonviolent offenders to be resentenced based on the state’s presumptive sentencing guidelines.

HB 4 by Rep. Steve Clouse (R–Ozark) and Sen. Greg Albritton (R-Atmore), the Chairmen of the General Fund, sets forth a $1.3 billion construction plan to build new mega-prisons, and renovate and repurpose a slate of existing facilities. The plan calls for the closure of the Kilby, St. Clair, Staton and Elmore facilities. The House clotured debate on the measure on Wednesday, approving it by a vote of 74-27. On Friday, the Senate spent a little over two hours on the measure before passing by a vote of 27-2. The $1.3 billion needed to support the plan will be sourced from federal COVID relief funds ($400m), the General Fund ($135m) and a bond issue (up to $785m).

HB 5 by Rep. Clouse and Sen. Albritton is the appropriation measure authorizing the allocation of $400m in COVID-relief funds to support the plan outlined in HB 4. There have been arguments made regarding whether the state’s intended use of those funds is allowed under federal guidelines. A legislature fiscal officer addressed the Senate Finance and Taxation Committee on the General Fund following the committee’s approval of the bill and advised senators that, while the guidelines do not include express direction on using the funds for prisons, it is permissible to apply the resources to infrastructure and public facilities which, he indicated, include prisons.

HB 6 by Rep. Clouse and Sen. Albritton is the appropriation bill authorizing $135m from the General Fund budget to be spent on the construction, renovation, acquisition and improvement of facilities.

Several other corrections-related bills were also filed during the special session but did not pass the House and Senate. One of those bills was HB 1 by Rep. Hill, which failed to advance out of the House and would have impacted around 700 inmates, though would not necessarily result in a reduced sentence in each instance. Many lawmakers consider it to be a logical change to achieve consistency in the law, while it has been criticized by others as being soft on crimę making it a hard bill for some Republicans to vote for in an election cycle with a qualifying deadline still months away. Another such bill was SB 6 by Sen. Billy Beasley, who has three corrections facilities in his district and who filed his own prison construction bill which was similar to Rep. Clouse’s bill but would build smaller prisons and increase requirements before existing prisons can be closed.

Other bills unrelated to those issues outlined in the governor’s agenda for a special session require a much higher threshold of affirmative votes in order to move forward. A couple of coronavirus-related bills and resolutions were also filed which did not pass. Those include HB 11 by Rep. Andrew Sorrell (R-Tuscumbia), which would have prevented public K-12 schools or school districts from issuing mask mandates and would have penalized schools and districts which did not comply; as well as HJR 6 by Rep. Mike Jones (R-Andalusia), which condemned the Biden Administration’s administration actions regarding vaccine mandates for COVID-19 vaccines.

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Discussions with Decisionmakers: Rep. Rhett Marques

Discussions with Decisionmakers

Rep. Marques was elected to the House of Representatives in 2018. He is the owner of Goodson Tire & Auto and lives in Enterprise. He is on the House Health Committee.

What first prompted you to consider running office?

Since I was in college, I enjoyed the political side of things. I enjoy serving people.

How does your background help serve you on the Health Committee and also the Legislature?

I truly enjoy helping people, and being part of the Health Committee is an extension of that.

What are some of your legislative priorities this term?

As of right now, I don’t have any legislative priorities myself, but something needs to be done about the prison system.

What do you think people understand the least about our health care system?

I think people believe that the medical field is making a lot more money than they are. People think doctors are making too much money, which I believe is incorrect.

If you could change anything about our state’s health care system, what would it be?

Drawing doctors into rural areas. They need to be incentivized to do it.

How can the Medical Association – and physicians statewide – help you address Alabama’s health challenges?

I think the Medical Association has done a fantastic job in the three years I’ve been there. They have good representation and a strong voice.

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