ANSWERS TO FREQUENTLY ASKED QUESTIONS FOR EXECUTIVE ORDER 2021-22
The Illinois Chiropractic Society truly understands and wants to help with the challenges that some of you are facing, either personally or with your employees, stemming from last week’s Executive Order on mandated vaccines and testing.
The ICS wants the very best for the profession, our members, and our members’ practices and we have been working diligently for you to analyze the Executive Order and its impact on your practice.
This article is a supplement to the original informational article released on August 26 and includes answers to many questions and how-to-steps for our members.
Frequently Asked Questions:
Are There Religious and Medical Exemption Forms?
It is important to note that the requirements are exactly the same for those who choose to not vaccinate (i.e., “not been fully vaccinated against COVID-19”) and those who have a religious or medical exemption. All “shall undergo, at a minimum, weekly testing as provided for in Subsection (d).” This, in short, means that there is not currently a government-mandated form required to choose weekly testing as an alternative to vaccination.
What Are the Steps for Documenting Executive Order Compliance?
The ICS recommends that health care offices document the steps they take to comply with the E.O. In order to best inform our members on the requirements for both themselves and their employees, the ICS has divided its recommendations into the categories below. Please refer to the section that applies to your specific situation:
- For Those Who Have Chosen to Fully Vaccinate Against COVID-19 (last dose by September 5, 2021):
Owners of healthcare facilities must request of all workers (themselves included) one of the following:
- A copy of the CDC COVID-19 vaccination record card,
- Documentation of vaccination from a health care provider,
- Documentation of vaccination from the worker’s health record, or
- A copy of the health care worker’s state immunization record.
These document copies should be put into the human resources file for each worker.
- For Those Who Choose Weekly Testing:
Owners of healthcare facilities must either test (see testing FAQ below) or request documentation of a negative test weekly from all workers who have “not been fully vaccinated against COVID-19.”
- For tests administered at your healthcare facility, create a simple form on your letterhead that includes the following: worker name, date of test, name of test, name of person administering the test, and test result, or
- For those testing outside of your healthcare facility, request a copy of their test results (may be obtained through many patient portals).
These document copies should be put into the human resources file for each worker.
- For Those Who Have Started Vaccination but are Not Two Weeks After Final Dose:
- Until the worker (including the owner) is fully vaccinated (two weeks following the final COVID-19 vaccination dose), please follow the guidelines listed above in the For Those Who Choose Weekly Testing section.
- After the worker is fully vaccinated (two weeks following the final COVID-19 vaccination dose), please follow the guidelines listed above in the For Those Who Have Chosen to Fully Vaccinate Against COVID-19 section.
If you have workers in differing categories, use the individual section that applies to each worker.
Can Chiropractic Physicians Administer COVID-19 Tests?
Yes. In Illinois, Chiropractic Physicians can administer COVID-19 tests in their offices.
The Executive Order also allows for tests to be completed outside of your healthcare facility. Please see the section above For Those Who Choose Weekly Testing for more information on documentation.
Important Note: Some COVID-19 tests require a CLIA certification. If you do not have a CLIA certificate, please choose a different test (see below).
What Tests are Allowable Under the EO?
[Updated 9/7/2021] The Executive Order specifies that the test must have Emergency Use Authorization (EUA) by the FDA or be operating per the Laboratory Developed Test requirements by the U.S. Centers for Medicare and Medicaid Services.
After careful analysis of the Executive Order, we recommend that doctors use a test that has EUA to detect acute SARS-CoV-2 (COVID-19). For clarification, IDPH indicates that “Antibody tests should not be used to diagnose a current infection and are not recommended to meet the requirements of Executive Order 2021-22.”
- Here is a link to FDA EUA rapid antigen tests. There are several “Home” tests that do not require a CLIA certificate. However, please verify CLIA requirements for tests not listed as “Home” tests.
- Here is a link to FDA EUA molecular tests (i.e., PCR).
Where Can We Find Tests Allowable Under the EO?
There are many outlets and several doctors have even purchased rapid at-home tests from retail outlets (i.e., Walmart and Amazon). However, please verify the product has FDA EUA for detecting acute SARS-CoV-2 (COVID-19).
Additionally, healthcare workers may also choose to visit a local pharmacy or healthcare system for weekly testing. However, we are uncertain whether or not insurance will cover these tests.
If you are unable to locate tests, the Illinois Chiropractic Society has negotiated bulk pricing for ICS members with Medek Health Systems for CareStart™ COVID-19 Antigen Home Tests (no CLIA certificate required). The price is $22 per test plus shipping. Please reach out to Aaron Cowen, Senior Vice President at email@example.com or (321) 626-6861. Please note this is not an endorsement by the ICS, but is merely a negotiated rate on behalf of ICS members. We have received no remuneration for providing this information and negotiated rate. Our best information is that at this time this test has FDA emergency use authorization to detect acute SARS-CoV-2 (COVID-19).
Who Is Responsible for Costs Related to Testing?
[Updated 9/7/2021] According to the FAQ released by IDPH on September 7, 2021, “Pursuant to a federal Executive Order and guidance from CMS, Department of Labor, and Department of Treasury, health plans must provide coverage for COVID-19 diagnostic tests for individuals who are asymptomatic and who have no known or suspected exposure to COVID-19. Such testing must be covered without cost-sharing, prior authorization, or other medical management requirements.”
This means that insurance companies are still required to cover the costs of COVID-19 tests regardless of medical necessity determinations.
What Do We Do If We Have an Employee That is Claiming a Religious Exemption for Both Vaccination and Testing?
The Executive Order specifically states, “Health Care Facilities shall exclude Health Care Workers who are not fully vaccinated against COVID-19 from the premises unless they comply with the testing requirements.” In short, the Executive Order would not allow an unvaccinated worker, who also refuses to test, to work in the healthcare facility.
Some health care workers have cited the Health Care Right of Conscience Act (745 ILCS 70/) to support their exemption from both vaccination and testing, arguing that the Act does not permit health care employers to require their employees to comply with vaccination or testing. In response, the legislature recently amended the law by adding a new Section 13.5, effective on June 1, 2022:
Sec. 13.5. Violations related to COVID-19 requirements. It is not a violation of this Act for any person or public official, or for any public or private association, agency, corporation, entity, institution, or employer, to take any measures or impose any requirements, including, but not limited to, any measures or requirements that involve provision of services by a physician or health care personnel, intended to prevent contraction or transmission of COVID-19 or any pathogens that result in COVID-19 or any of its subsequent iterations. It is not a violation of this Act to enforce such measures or requirements….
The interpretation of the current law and the new section 13.5 are complicated legal questions that ultimately the courts will probably determine. Because this conflict has not yet been resolved in the courts, the ICS cannot answer the question at this time and would suggest that you seek specific individual legal counsel if faced with this situation. The potential ramification for challenging this untested legal conflict is covered in the penalties section below.
What Are the Enforcement Provisions of the Executive Order?
The Executive Order does not specifically address how it will be enforced. However, most similar compliance requirements are complaint-driven. In the healthcare profession, patients and staff are typically the primary complainants. The ICS believes they could file complaints with the Illinois Department of Financial and Professional Regulation to open a license investigation and other regulatory agencies such as the Occupational Safety and Health Administration (OSHA).
In addition to complaints, enforcements audits by the Illinois Department of Public Health or other regulators could be initiated following a positive case involving an unvaccinated healthcare worker.
What Are the Penalties for Non-Compliance in the Executive Order?
Like enforcement, the Executive Order does not specifically address the penalties for non-compliance. Since chiropractic clinics (healthcare facilities) must be owned by physicians, the licensed physician is ultimately responsible for all healthcare workers in the facility.
Generally, legal experts believe that the IDFPR would open an investigation and could consider violating an Executive Order of this nature as a violation of Section 22 of the Medical Practice Act under the section on dishonorable, unethical, or unprofessional conduct.
The Illinois Chiropractic Society is sensitive to the immense pressure and strains the Executive Order requirements are placing on some of our members. We hope this information, as well as developing information that we will continue to provide, will help you navigate the requirements. As always, the ICS wants the very best for the profession, our members, and our members’ practices.