The state has reversed course and removed dental care workers from those required to be vaccinated against COVID-19, under a final version of the rules published this week.

Emergency medical service workers also were left out of the final version of the mandate after initially being included.

The absence of COVID-19 outbreaks associated with dental health facilities was cited as a reason for excluding that industry. And Jeanne Lambrew, Maine’s health and human services commissioner, said Wednesday that EMS workers were removed because they are covered by a mandate issued by the Maine Board of Emergency Medical Services.

Under the emergency version of the rules, health care workers had until Oct. 29 to comply with a vaccination mandate. Workers covered by the rule were required to show proof that they are immunized against COVID-19 or lose their jobs.

A final version of the Mills’ administration’s COVID-19 vaccine mandate was officially issued Wednesday, replacing the emergency rule. The sweeping mandate still applies to thousands of workers at hospitals, nursing homes, assisted-living centers, outpatient surgery centers and many other health care facilities.

The final version of the rule was adopted 90 days after it was originally announced in August to allow Maine DHHS to consider feedback from the public, which led to the revised rule, Lambrew said Wednesday.

The vast majority of workers complied with the emergency mandate, and many of them publicly supported the mandate as a way to protect co-workers and patients. By the end of October, 97.7 percent of covered health care workers had gotten their shots, according to state data.

But there also was vocal opposition among workers in all sectors who argued the mandate violated their constitutional rights. Some also warned that the loss of workers who refused to be vaccinated would worsen staffing shortages and limit health care services.

Maine’s mandate also is facing a challenge in federal court by anonymous plaintiffs who say it violates their religious freedom because there is no religious exemption. The U.S. Supreme Court has refused to block the Maine mandate while the case proceeds.

EMS services across the state have suffered staffing shortages for years. Last month, emergency medical providers and municipalities warned that the vaccine mandate might result in a further loss of workers, forcing some departments to the breaking point. Those concerns were somewhat lessened after a survey showed there was a 97 percent compliance rate among EMS workers.

On Wednesday, Lambrew said those workers are covered by a similar rule that the state EMS board adopted, and so “to avoid any conflict or confusion” they were removed from the state’s final rule.

The Maine EMS board’s current rule requires emergency medical providers to be vaccinated against COVID-19 if they are required to treat a patient, said Windham Fire Chief Brent Libby, the board’s chairman. The rule expires on Nov. 22 and the board has proposed a new rule that would require all emergency medical providers to not only be vaccinated against COVID-19, but against influenza, mumps and rubella as well. Virtual public hearings on the new rule will be held Nov. 22-23.

Libby said the decision to leave EMS workers out of the state’s vaccine mandate sits well with him, though the restrictions have resulted in the loss of some workers. In Windham, the department lost two of 14 firefighters/emergency responders as a result of the mandate imposed by the EMS board, Libby said.

“I think the state’s decision is good because emergency medical providers have a board in place that will regulate who can treat patients,” he said.

Though the state faced opposition from some workers in the dental health industry, the president of the Maine Dental Association said in August that the organization fully supported the mandate.

Lambrew said this week that dental practices were removed based on “a review of data and comments that were submitted on jurisdiction.”

The review of data was a reference to a lack of documented outbreaks related to the dental industry.

In a summary of comments and changes to the mandate posted by Maine DHHS on Wednesday, “the department removed dental health practices from this rule because there are no identified COVID-19 outbreaks originating from a dental health practice in Maine. In contrast, almost 300 COVID-19 outbreaks were identified in Maine Designated Healthcare Facilities since the beginning of the pandemic.”

There doesn’t appear to be any data regarding compliance at dental practices before the rule was changed to exclude them. But most offices already have complied with the emergency rule, so most employees are vaccinated, said Kathy Ridley, interim executive director of the Maine Dental Association. Employees at dental practices also are covered under different rules under the “State Board of Dental Practice,” she said.

“Maine dentists have high vaccination rates and have taken many steps to help prevent the spread of COVID-19 in their offices. There have been no identified COVID-19 outbreaks originating from a dental health practice in Maine. We have strongly encouraged and helped dentists, dental hygienists, and dental employees to be vaccinated,” Ridley said.

State offices were closed Thursday and officials weren’t available to respond to questions about the changes in the mandate.

The health care facilities covered by the final rule achieved a high level of compliance by the end of October, according to the Maine CDC.

The vaccination rate was 98.1 percent at hospitals, 96.8 percent at nursing facilities, 95.6 percent at intermediate care facilities, 92.6 percent at ambulatory care facilities and 96.8 percent at assisted-living facilities, the Maine CDC said.

The agency said this week that the near-100 percent compliance is evidence the mandate worked as planned, and it said it would be contacting facilities with lower vaccination rates about coming into compliance.

Facilities covered by the final rule also will have to file annual compliance reports and submit to random audits and complaint-driven investigations.

Staff Writer Dennis Hoey contributed to this report.

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