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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

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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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HHS Announces $25.5 Billion in Provider Funding for Covid-19 Relief

HHS Announces $25.5 Billion in Provider Funding for Covid-19 Relief

More help is on the way for health care providers affected by the Covid-19 pandemic. The U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), is providing $25.5 billion in new funding. This includes $8.5 billion for the American Rescue Plan (ARP) and $17 billion for Phase 4 of the Provider Relief Fund (PRF). 

ARP Rural is intended to help address the disproportionate impact that COVID-19 has had on rural communities and rural health care providers. The ARP Rural payments will be based on the amount of Medicaid, CHIP, and Medicare services provided to patients living in rural areas. The payments will generally be based on Medicare rates. Providers who serve any patients living in  HHS Federal Office of Rural Health Policy defined rural areas with Medicaid, CHIP, or Medicare coverage, and who otherwise meet the eligibility criteria, will receive a minimum payment.

The Provider Relief Fund provides payments for healthcare-related expenses or lost revenue due to coronavirus. These distributions generally do not need to be repaid. The PRF Phase 4 payments will be based on the provider’s lost revenue and expenditures between July 1, 2020 and March 31, 2021. Smaller providers will be reimbursed at a higher rate than larger providers. PRF Phase 4 payments will include bonus payments for serving Medicaid, CHIP and Medicare patients. These bonus payments will be reimbursed at Medicare rates. 

Providers may apply for both programs with one application. The application portal opens September 29, 2021. To prepare, providers should start gathering supporting documentation, such as most recent tax documents and financial statements for the second half of calendar year 2020 and the first quarter of calendar year 2021. Providers should also search the Rural Health Grants Eligibility Analyzer to see what areas qualify as rural for the ARP rural payments.

For more information about how to apply for the PRF Phase 4 and ARP Rural payments, visit:

Providers who believe their Phase 3 PRF payment was not calculated correctly may now request a reconsideration. HHS has released detailed information about the methodology utilized to calculate Phase 3 payments. Additional detail on this reconsideration process will be forthcoming from HHS. 

HHS has also announced a final 60-day grace period to comply with PRF reporting requirements for the September 30, 2021 deadline. The deadline to use the funds and the reporting time period will not change. Additional information may be found regarding the  PRF Reporting requirements.

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Discussions with Decisionmakers: Rep. Anthony Daniels

Discussions with Decisionmakers

Representative Daniels was elected to the Alabama House of Representatives in 2014. He represents Alabama’s 53rd District covering Madison County. In 2017, he became the youngest person and the first minority to ever become the House Minority Leader in Alabama. He is a graduate of Alabama A&M and is an elementary school teacher by trade. He also owns several small businesses with his wife.

What first prompted you to consider running office?

When I was 23, I became very involved with members of congress and the Bush administration. I think that’s where it started.

How does your background help serve you on the Legislature?

As a small business owner, and as teacher, I am constantly looking for ways to advocate. I am a leader before I am a teacher.

What are some of your legislative priorities this term?

Expanding access to quality healthcare which will in turn help our state, and help us provide quality care to those who are living check to check and can’t afford it. It would also help small businesses.

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

I think that they want access to quality healthcare providers. We take for granted access to OBGYN’s or specialists and things like that, while many communities don’t have access to those types of physicians.

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

I think they don’t really understand the number of people that need access to healthcare and the number of communities that don’t have access to quality healthcare. The different communities have big differences in quality of healthcare and that is a problem.

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

We need to look at how we reform our system. It needs to help people first. We need more flexible hours for things such as emergency care or telemedicine. Giving people the opportunity to have flexibility when they go to the doctor is very important to me.

Do you have a position on the expansion of Medicaid?

I am 100% in favor of it. I think it is a fundamental right. We’ve seen, during Covid, the exposure of underlying health conditions, many are because of lifestyle. These people aren’t just sitting at home doing nothing. They just need a helping hand, plain and simple.

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

I think that MASA can start building broader coalitions. People trust their doctors. I also think we need to educate people on what the expansion of Medicaid entails and not what it isn’t.

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

Continue to work hard and provide the quality care you always provide. Because of the hospital closures, it may feel overburdening, but expanding access to healthcare can help fix many issues.

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Rep. Kirk Hatcher Wins the Special General Election for Senate District 26

Democratic Candidate, State Rep. Kirk Hatcher, won the special general election against Republican candidate, William Greene, for Senate District 26 seat on Tuesday, March 2, 2021. The seat was previously held by David Burkette (D).

According to the Alabama Political Reporter, Hatcher received 4,565 votes of the 5,827 votes, 78.3%. He vacated his House District 78 seat when he was sworn in to the Senate on March 3, 2021. Governor Ivey will issue a proclamation for a special election on House District 78 to fill the vacancy.

Click here to read more about the election from the Alabama Political Reporter.

As the political action committee for the Medical Association, ALAPAC supports candidates who best represent the interests of physicians and their patients. This is why ALAPAC supported Kirk Hatcher (D) for Senate District seat 26.

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Ben Robbins Wins the Special General Election for House District Seat 33

Republican candidate, Ben Robbins, won the special general election against Democrat candidate, Fred Crum, for house district seat 33 yesterday, Tuesday, January 19, 2021. The house district seat was previously held by Rep. Ron Johnson (R) who passed away on July 14, 2020.

According to the Alabama Daily News, Robbins received 2,232 of the 3,269 votes, 68%, Tuesday. He is an attorney in Sylacauga.

Click here to read the full article about the election from Alabama Daily News.

As the political action committee for the Medical Association, ALAPAC supports candidates who best represent the interests of physicians and their patients. This is why ALAPAC supported Ben Robbins (R) for the house district seat 33.

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Major Changes Coming to 2021 E/M Coding

Major Changes Coming to 2021 E/M Coding

Considerable changes are being made to Medicare outpatient evaluation and management (E/M) codes. The transition will take effect on January 1, 2021 and will likely affect physicians across all specialties.

The changes are currently restricted to new and established outpatient visits (CPT codes 99202-99205, 99211-99215) and will impact everyone who assigns codes, manages patient information, or pays claims including physicians, health information managers, coders, payers, health systems, and hospitals. 

Why was modification needed?

Because of advocacy by the Medical Association and other organizations, the Centers for Medicare and Medicaid Services (CMS) adopted a revised E/M documentation methodology proposed by the American Medical Association (AMA). 

The goal of the suggested adjustments is to reduce physician burden by simplifying documentation requirements and administrative responsibilities. By reducing managerial concerns, physicians will have the ability to spend more in-depth, quality time with their patients. 

What are the changes?

There will be various changes to office and outpatient E/M visits. However, the most notable is the removal of the Level 1 new patient visit (99201), a new 15-minute extended services code that can be used with codes 99205 and 99215, and the following modifications of office code selection:

  • History and physical exams are no longer elements for code selection
  • Physicians can choose to use total time or medical decision making as the basis of their E/M documentation
  • Medical decision-making criteria has been revised and clarified
    • Removed ambiguous terms and concepts
    • Defined vague terms
    • Re-established data elements to move away from adding up tasks and instead focusing on how those tasks affect the patient’s care

What can you do to prepare?

  • Visit our website to find more resources on the 2021 E/M coding and guideline changes
  • Watch our NEW Online E/M Coding Changes for 2021 webinars hosted by Dr. Thomas Weida and Kim Huey and earn CME
  • Contact your medical billing company and/or coders to develop a plan for training office staff to ensure a smooth transition at the first of the year
  • Connect with your Electronic Health Records (EHR) provider to confirm that your practice’s system will be ready to implement the new coding changes
  • Reach out to your payers to negotiate implementing the new E/M rates

With changes this substantial, we encourage you to prepare early. Watch for more information in the coming weeks on our website and email alerts. If you have further questions, please email us at

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Discussions with Decisionmakers: Finance Director Kelly Butler

Discussions with Decisionmakers: Finance Director Kelly Butler

About Kelly Butler:

Kelly Butler was appointed as the Director of the Alabama Department of Finance by Governor Kay Ivey on December 1, 2018, after serving as acting State Finance Director since August 15, 2018. As the State’s chief financial officer, Butler serves as an advisor to the governor and the Legislature in all financial matters and is charged with protecting the financial interests of the State of Alabama. He is responsible for the administration and oversight of the Department of Finance and serves on various advisory boards and authorities.

Butler has worked for the state of Alabama for over 30 years and previously served as Assistant State Finance Director for Fiscal Operations since December 2016. Mr. Butler was also the State Budget Officer since June 2014. Prior to his employment with the Finance Department, he worked for 19 years with the Legislative Fiscal Office, most recently serving as the Senate Fiscal Officer. Earlier in his career, Mr. Butler worked as a revenue examiner with the Alabama Department of Revenue, where his duties included serving as a corporate income tax and financial institution excise tax auditor and serving as an assistant to the Chief of the Income Tax Division.

Mr. Butler is a graduate of Auburn University Montgomery (BSBA) and Troy University (MBA).

COVID-19 Grant Program

As the Alabama Director of Finance, Mr. Butler is in charge of overseeing the disbursement of all COVID-19 funds received via the CARES Act, including the new Health Care and Emergency Response Providers Grant Program. We recently hosted a Zoom call with Mr. Butler to discuss this program and answer any questions Alabama physicians might have.

Simply click the video below to begin watching where the Q&A with Mr. Butler begins.

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Medical Association Recognizes Racism as a Threat to Public Health

Medical Association Recognizes Racism as a Threat to Public Health

At the most recent Board of Censors meeting, the Medical Association of the State of Alabama pledged to recognize and confront racism and racial inequalities within our society and the healthcare system. The Medical Association further recognizes the need to end systemic racism in our country and to work towards a better, fairer, and more just society. 

The Medical Association released the following statement following their meeting last week:

  • The Medical Association opposes all forms of racism
  • The Medical Association considers racism a public health crisis and a threat to public health
  • The Medical Association understands the elimination of health disparities will not be achieved without first acknowledging the contributions of all races to health and social inequalities
  • The Medical Association understands that we have a responsibility to actively work to eliminate discriminatory policies and practices across all of healthcare
  • The Medical Association supports ending racial discrimination in medical care and the equitable access to quality health care services
  • The Medical Association encourages current and future physicians to be advocates for justice

We recognize that worsening inequities, unequal access to care, and the racial disparities of practicing physicians all have roots in systemic racism and must be confronted. The Medical Association of the State of Alabama understands that there is still tremendous work to be done to ensure that everyone has the opportunity, resources, and conditions to achieve optimal health. The Medical Association is committed to being a part of that solution.


President John S. Meigs, MD and Board of Censors

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