WASHINGTON, D.C. (January 14, 2022)—The Supreme Court handed down a split decision on two Biden administration workplace rules to stop the spread of COVID-19, blocking an Occupational Saftey and Health Administration (OSHA) rule requiring businesses with at least 100 employees to compel their workers to get vaccinated or wear masks and test negative at least once per week, but upholding a separate rule from the Centers for Medicare & Medicaid Services (CMS) requiring vaccination for about 20 million health care workers.

The OSHA rule would have covered about 80 million workers and administration estimated it would save about 6500 lives in six months.

Industry Reactions

“Today’s decisions from the U.S. Supreme Court brings homecare a step closer to the essential clarity that is needed to determine what is required for compliance,” said National Association for Home Care & Hospice (NAHC) President William A. Dombi in response to the rulings. “The OSHA rule is blocked from implementation and enforcement for the moment. The CMS rule can full take effect for the moment. Both cases return to the lower courts for further adjudication. The administration has further options [as well]. We strongly encourage both Congress and the administration to quickly reach a conclusion so that affected health care businesses can focus on providing care. Infection control in patient care and staffing is an essential responsibility in all of health care. Homecare is committed to protecting its patients and its staff from COVID-19.”

“Vaccines and boosters are the most powerful tools we have in the battle against COVID-19; they save lives,” said Katie Smith Sloan, president and CEO of LeadingAge, in a statement. “While mandates can sometimes make it harder for employers to keep or find qualified workers—especially as omicron surges and workforce challenges are growing—we encourage all members, regardless of care setting or community type, to ensure staff get vaccinated. Many LeadingAge providers implemented mandates months before the federal government announced its plans, and a recent poll of our mission-driven members reveals the vast majority are ready to move forward on the CMS health care worker mandates.”

A Court Divided

The decision once again laid bare the sharp ideological differences that exist on the court.

“Although Congress has indisputably given OSHA the power to regulate occupational dangers, it has not given that agency the power to regulate public health more broadly,” wrote the court’s six-member conservative majority. “Requiring the vaccination of 84 million Americans, selected simply because they work for employers with more than 100 employees, certainly falls in the latter category.”

The court’s three liberal justice dissented fiercely, writing that the majority was replacing OSHA’s expertise with its own, which lacks the necessary knowledge in public health.

“In the face of a still-raging pandemic,” wrote the dissent, “this court tells the agency charged with protecting worker safety that it may not do so in all the workplaces needed. As disease and death continue to mount, this court … usurps a decision that rightfully belongs to others. It undercuts the capacity of the responsible federal officials, acting well within the scope of their authority, to protect American workers from grave danger.”

NAHC prepared bullet points to help providers understand what these rulings mean for homecare and hospice, which we share below. 


  • Court majority (6-3) finds that OSHA does not have the authority to issue a broad-based rule that is not specifically focused on occupational hazard affecting workers.
  • Majority views the OSHA rule as more a “public health” action rather than an occupational health one. OSHA does not have public health regulatory authority;
  • OSHA can regulate worker safety “where the virus poses a special danger” because of the employee’s job functions or workplace. Examples include where the employee is working with the virus or working in a crowded environment.
  • While the court’s action stops the OSHA rule in its current form, OSHA may consider refining the rule to target certain workers in certain workplaces. This clearly could include health care settings for those entities not subject to the CMS rule. Such action is not likely to occur quickly but is a strong possibility.
  • States that had been on the fence with respect to employer mandates may now move forward given the limitation on federal power and the court’s direct recognition that states have such power.
  • While the court suggested that Congress might have the power to enact similar requirements to those under the OSHA rule, it is highly unlikely that such would pass in the current Congress. Earlier, a majority of the Senate opposed the OSHA rule.
  • NAHC recommends that home care companies return to focus on the expired OSHA health care ETS as it may be the next generation of OSHA action as it is more targeted to a specific workplace hazard.
  • While the OSHA case has been returned to the lower court for further adjudication, it can be expected that OSHA will ultimately lose on the existing rule. A new, targeted rule remains possible with the likelihood that new litigation will follow.

The OSHA rule was originally blocked by lower courts, but a three-judge panel of the U.S. Court of Appeals for the Sixth Circuit reversed the lower court rulings, calling the rule “an important step in curtailing the transmission of a deadly virus that has killed over 800,000 people in the United States, brought our health care system to its knees, and cost hundreds of thousands of workers their jobs.”

The Supreme Court ruling reverses the Sixth Circuit Court of Appeals decision.

CMS Rule

  • Court majority (5-4) finds clear authority for CMS to require measures, including vaccines, to protect patients and regulate provider staff qualifications.
  • “Health and safety” rulemaking authority provides CMS with the ability to address a broad range of issues within its expertise.
  • Majority concludes that such authority is inferred for all providers subject to conditions of participation even without express language. e.g. home infusion providers.
    • Court explains that there is a provision in the rule that permits severing parts of the rule that are deemed outside of CMS authority.
    • This may create an issue for the lower courts to address as the Supreme Court sent the case back for continuing review since it was acting only on the issue as to whether a preliminary stay of the rule should continue.
  • NAHC expects CMS will move quickly to bring to rule into enforcement consistent with the recent guidance issued that is applicable to the states where the injunction was not in place.
  • NAHC expects that CMS will prevail ultimately in the validity of the rule. As such, we highly recommend that affected providers move forward to full compliance.

CMS released the following statement after the Supreme Court decision, setting compliance dates for the 24 states that had been subject to the injunction against the CMS rule.

“As a result of this decision, health care providers subject to the Omnibus Health Care Staff Vaccination rule in the 24 states (Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia, and Wyoming) covered by this decision will now need to establish plans and procedures to ensure their staff are vaccinated and to have their employees receive at least the first dose of a COVID-19 vaccine.

"Today’s decision does not affect compliance timelines for providers in the District of Columbia, the territories, and the 25 states where the preliminary injunction was previously lifted. See the guidance released on Dec. 28, 2021, for additional information."

Previously, two federal appeals courts halted enforcement of the CMS rule in 24 states, but it did go into effect in the remaining states.