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Maryland to Mandate Vaccinations for Healthcare Workers in Hospitals and Nursing Homes, Effective September 1, 2021

As the number of new cases of the Delta variant of COVID-19 continues to grow nationwide, Maryland Governor Larry Hogan announced, on August 18, 2021, measures to prioritize patient safety in nursing homes and hospitals. Effective August 18, 2021, Maryland is requiring employees in the state’s nursing homes and hospitals to provide proof of vaccination or to adhere to a regular COVID-19 screening and testing protocol. This protocol includes mandatory weekly COVID-19 testing on-site for individuals who fail to show proof of full vaccination status and the required wearing of personal protective equipment (PPE) provided by the facility.

The Maryland Department of Health issued a directive and order mandating that more stringent requirements be rolled out by September 1, 2021. Beginning Wednesday, September 1, 2021, employees of Maryland nursing homes and hospitals statewide will be “required to show proof of [a] first dose or single dose of COVID-19 vaccination.” Many hospitals, such as the University of Maryland Medical System and Johns Hopkins Medicine, have already begun to implement compliant policies and procedures, but this mandate makes the requirements effective for every healthcare system in the state. The directive and order—MDH No. 2021-08-18-01—applies to all hospital and extended care facilities in Maryland, both state-run and privately administered nursing home facilities licensed under Health-General Article Title 19, subtitles 3 and 14, and COMAR 10.07.02, and all hospitals as defined under Health-General Article section 19-301. Though only a first dose or single dose is required by September 1, “[a]ll staff are required to complete the full shot regimen, including any booster shot.”

The directive and order direct private facilities to develop procedures to resolve situations in which staff members fail to comply with MDH No. 2021-08-18-01 by failing to show proof of vaccination by September 1, 2021. Under the directive and order, those procedures may not be less stringent than weekly COVID-19 testing and PPE protocols. Maryland will also require that all vaccine providers give notice of a vaccine administration within 24 hours of the event via the Maryland Department of Health’s ImmuNet system.

Nursing homes face additional staff requirements to protect patients. Maryland may enforce fines, civil penalties, and possible enforcement actions if a nursing home fails to comply with the new vaccination protocols or report vaccination data to state agencies.

Maryland public-sector healthcare employers may want to prepare for continued reasonable accommodation requests (e.g., based on disability or sincerely held religious belief) from vaccine-hesitant employees, given trends nationwide. MDH No. 2021-08-18-01 provides for this possibility by permitting any “staff individual [to] request an accommodation by providing appropriate and sufficient documentation for bona fide medical or religious reasons.” MDH No. 2021-08-18-01 further states that accommodation requests “shall be made to and reviewed and documented by the requesting staff’s agency Equal Employment Opportunity/Fair Practices office.” The Maryland Department of Health also advises private-sector facilities to develop reasonable accommodation procedures to provide to all staff members.

As there remains a substantial unvaccinated and vaccine-hesitant population within Maryland and in the United States, this issue is likely to draw a number of questions and concerns.

© 2023, Ogletree, Deakins, Nash, Smoak & Stewart, P.C., All Rights Reserved.National Law Review, Volume XI, Number 232

About this Author


Rob Niccolini is co-chair of the firm's Healthcare Practice Group. He represents management in employment litigation and labor disputes, with special experience in the health care, technology, insurance, manufacturing, government contracting, hospitality and retail industries. His practice includes all facets of employment discrimination, harassment, wage and hour, ADA, FMLA, ERISA, covenants not to compete and employment torts, as well as labor arbitration, union campaigns and unfair labor practice proceedings.  He also has extensive experience with class and collective actions.

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Patrick T. Wilson Employment Law and Litigation Attorney Ogletree Deakins Washington D.C.

*Licensed to practice in Maryland only. Practice in D.C. under supervision pursuant to Rule 49 of the D.C. Court of Appeals.

Patrick Wilson is an attorney in the firm’s Washington, D.C. office. Patrick represents and counsels management on a range of labor and employment, as well as workplace safety matters. Patrick focuses his practice on defending employers against claims of discrimination, harassment, retaliation, wrongful termination, wage and hour, and other employment related claims. He also defends and counsels employers facing charges of Unfair Labor Practices before the...