AMDA Releases Guidance for Medical Exemptions to Vaccination and Statement on Supreme Court Ruling on Vaccine Mandates

January 17, 2022

Columbia, MD – Workers in Medicare- or Medicaid-funded health-care provider organizations are now required by the Centers for Medicare & Medicaid Services (CMS) to be vaccinated against COVID-19 as a condition of participation in Medicare and Medicaid. Employees/ practitioners may request exemptions from such vaccine mandates for medical or sincerely held religious reasons, and medical directors likely will be involved in evaluating such requests.

AMDA – The Society for Post-Acute and Long-Term Care Medicine believes that, to maximize the opportunity for medical directors to make decisions on the validity of medical exemption requests, SNFs should use a standardized Medical Exemption Request form and that such forms:

  • List the acceptable medical exemptions at the top of the form to eliminate the opportunity for free-texting and/or making a blanket statement that the individual should be exempted.
  • Include the duration of the requested exemption (even if it is indefinite/permanent).    
  • Include a statement that the practitioner who is signing the medical exemption is in an ongoing professional relationship with the individual seeking exemption, has a thorough knowledge of the condition being listed, and has not been engaged solely for the purpose of providing the exemption.
  • Do NOT include the question of religious exemptions, as that issue is not in the jurisdiction of the medical director.

AMDA’s guidance also lists acceptable medical exemptions, including severe adverse reaction after a previous dose of or component of the vaccine, and active myocarditis or COVID-19 infection. The Society has developed templates that can be used to document such exemptions.

Read AMDA’s entire guidance, template #1 (Nursing Home Request for Medical Exemption from COVID-19 Vaccination), and template #2 (Template for Staff with Vaccination Exemptions).

Statement on Supreme Court Ruling on Vaccine Mandate

This should be attributed to Christopher E. Laxton, CAE, AMDA’s executive director:

“We applaud the Supreme Court’s ruling allowing the vaccine mandate for Medicare and Medicaid provider staff to go forward.  This step will help protect our nation’s most vulnerable citizens who reside in nursing homes, and those who care for them. It will save lives, both among residents and patients, who continue to suffer from breakthrough COVID infection, and nursing home staff, who are becoming sickened and dying in higher numbers than we have seen previously. Higher levels of staff vaccination and boosting is a key step in preventing the unnecessary and avoidable increase in illness and death among staff and residents in our setting of care. It will bring comfort to families who can be reassured that their loved ones will be safe.

“We are, however, disappointed that the court chose to continue the stay on the OSHA rule requiring workers at large employers to be vaccinated or be subject to testing. This means that the unvaccinated staff who work in assisted living communities without corporate mandates will continue to be a vector of COVID transmission to their vulnerable residents. The stay also provides a path for vaccine-hesitant nursing home staff to move to assisted living or other work venue that does not require vaccination.”




AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.