New White House Plan: Expanded Vaccine Mandates, Boosters, Testing, Provider Help

Regulation | September 09, 2021 | by Linda Couch

The White House’s “Path Out of the Pandemic” COVID-19 action plan, announced September 9, has several elements of interest to aging services providers and other stakeholders.

The White House’s “Path Out of the Pandemic” COVID-19 action plan, announced September 9, has several elements of interest to aging services providers and other stakeholders.

Expanded Vaccine Mandates

As part of the White House plan, CMS will expand its vaccination mandate for all Medicare- and Medicaid-funded nursing home staff to include workers in most health care settings that receive Medicare or Medicaid reimbursement, including but not limited to hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies. The requirement will apply to nursing home staff as well as staff in hospitals and other CMS-regulated settings, including clinical staff, individuals providing services under arrangements, volunteers, and staff who are not involved in direct patient, resident, or client care.

LeadingAge had vigorously pushed back on Medicare- and Medicaid-funded nursing homes being singled out by the White House’s initial, narrow vaccine mandate. In an August 23 letter to CMS, LeadingAge President and CEO Katie Smith Sloan urged the agency to “broaden its mandate requiring vaccines as a condition of employment to all health care providers that participate in Medicare and/or Medicaid” noting “LeadingAge has encouraged its members to make a COVID-19 vaccination a condition of employment. But federal mandates that single out one health care setting will leave millions of older Americans unprotected and risk doing more harm than good.”

In line with LeadingAge’s advocacy on this issue, the White House said the new, broad mandate “will create a consistent standard across the country, while giving patients assurance of the vaccination status of those delivering care.” More than 17 million employees of Medicare- and Medicaid-funded healthcare settings will be covered by the mandate.

All employers with 100+ employees will be required to ensure their workers are vaccinated or tested weekly, and to provide paid time off for vaccinations. As part of the plan, OSHA is developing a rule that will require all employers with 100 or more employees to ensure their workforce is fully vaccinated or require any workers who remain unvaccinated to produce a negative test result on at least a weekly basis before coming to work.

OSHA will issue an Emergency Temporary Standard (ETS) to implement this requirement. This requirement will impact over 80 million workers in private sector businesses with 100+ employees, the White House says. OSHA is also developing a rule that will require employers with more than 100 employees to provide paid time off for the time it takes for workers to get vaccinated or to recover if they are under the weather post-vaccination.


Boosters will be widely available for eligible Americans. The Administration is preparing for boosters to start as early as the week of September 20, subject to authorization or approval by the FDA and a recommendation from ACIP. The White House’s plan says booster shots will be free, and widely available across 80,000 locations – from pharmacies to doctors’ offices to health centers.


The White House is using the Defense Production Act to ensure adequate supply of point-of-care and at-home tests are available. “These tests will be available to support a range of needs, including long-term care facilities, community testing sites, critical infrastructure, shelters serving individuals experiencing homelessness, prisons and jails, and other vulnerable populations and congregate settings,” the White House said. Testing will also be expanded by an agreement with retailers to sell rapid tests at-cost for the next three months, having Medicare cover at-home tests for beneficiaries, sending 25 million free at-home rapid tests to 1,400 community health centers and hundreds of food banks, and expanding free pharmacy testing.

Economic Injury Disaster Loans

Improving the Economic Injury Disaster Loan (EIDL) Program. The EIDL, which provides long-term, low-cost loans to small businesses, will increase the maximum amount of funding a small business can borrow through this program from $500,000 to $2 million, which can be used to hire and retain employees, purchase inventory and equipment, and pay off higher-interest debt. SBA will offer a 30-day exclusive window of access where only small businesses seeking loans of $500,000 or less will receive awards after the new improved loan product launches.


Improving the Paycheck Protection Program (PPP) Loan Forgiveness Process. The White House says the SBA has made it easier, with changes made in early August, for more than 3.5 million PPP borrowers with loans of $150,000 or less to get their loans wiped clean.

Federal Staff Deployments

The Administration will also increase support for COVID-burdened hospitals by deploying Defense Department clinician teams, continue to increase the average weekly pace of shipments of free monoclonal antibody treatment to states, and launch monoclonal antibody strike teams to deploy clinical personnel through HHS, FEMA, and DOD to help hospitals and health systems stand up the delivery of this key treatment option.

The action plan also includes strategies for keeping schools safely open.

The Path Out of the Pandemic can be found here.