Independent physician practices and urgent care clinics are among many health care providers that are excluded from Maine’s COVID-19 vaccine mandate.

The emergency rule requiring health care workers to be fully vaccinated by Oct. 1 applies to all employees of designated health care facilities, dental health practices and emergency medical service organizations.

“Designated health care facilities” is a specific term defined in Maine law as “a licensed nursing facility, residential care facility, intermediate care facility for persons with intellectual disabilities, multilevel health care facility, hospital or home health agency.” A multilevel health care facility offers a combination of assisted living, congregate housing and home health services.

Not covered by the mandate are private physician practices, urgent care clinics and other health care providers not affiliated with a hospital or other facility specified in the emergency rule.

Among those excluded are a variety of independent health care providers, including family physicians, eye doctors, dialysis clinics, physical therapists, chiropractors, naturopaths, private duty nurses and others that operate outside hospital-based health care systems such as MaineHealth, Northern Light Health and Central Maine Health Care.

“The vaccination rule does not include physicians’ offices, health care clinics or any other health care organizations to which the immunization rule has not previously applied, with the exception of EMS and dental organizations,” said Jackie Farwell, spokeswoman for the Maine Department of Health and Human Services.

Farwell explained that independent physicians’ offices and other private health care practices operate under the license of an individual medical director or other professional who is overseen by the state.

The limited scope of the vaccine mandate surprised Colleen O’Reilly and other Mainers who thought it applied to every health care worker.

“I would think every health care worker would be covered by the mandate and want to comply with it to protect their patients,” said O’Reilly, a South Portland resident.

Issued by the Mills administration on Aug. 12, the COVID-19 vaccine mandate expanded upon an existing rule that said certain health care workers must be immunized against measles, mumps, rubella, chicken pox, hepatitis B and influenza.

Farwell did not answer why the COVID-19 vaccination rule was expanded to include dental practices and EMS organizations, but not other health care workers also previously excluded from the immunization mandate.

While the mandate has been criticized and publicly protested by some health care workers as a violation of personal choice – prompting the Mills administration to extend the deadline of its enforcement until Oct. 29 – it has been applauded by organizations representing Maine’s hospitals, nursing homes, physicians, dentists and primary care providers.

At least 13 states and cities have passed similar mandates, including California, Colorado, Illinois, Maryland, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Washington, Philadelphia and Washington, D.C.

“With this requirement, Maine became one of the most aggressive states in the nation in requiring vaccination of health care workers, including the scope of health care settings to which the rule applies,” Farwell said. “The requirement will protect health care personnel and Maine people in health care facilities, safeguard Maine’s health care capacity, and limit the spread of the virus.”

About 50 medical practices in Maine are considered independent, or about 20 percent of the 2,400 active physicians who are members of the Maine Medical Association, spokesman Dan Morin said.

Those independent practices include InterMed, Martin’s Point Health Care and at least eight private urgent care clinics operating across southern Maine as franchises of ConvenientMD Urgent Care, AFC Urgent Care and ClearChoiceMD Urgent Care. Hospital systems also operate urgent care clinics.

The medical association may ask the Mills administration to include independent physician practices in the mandate when it goes through the formal rule-making process this fall, Morin said.

“We have heard from a number of private physician practices saying they would be interested in being included in the mandate,” Morin said.

Some independent physicians believe that being included in the mandate would help maximize vaccine compliance among their staff members, Morin said.

Morin noted that most physicians in Maine and more than 96 percent nationwide are vaccinated, according to the American Medical Association. However, some independent physicians have reported growing concern among their patients about the vaccination status of their employees.

“Some independent physicians have informed us that patients have called and asked whether everyone in their practice is vaccinated,” Morin said. “Some patients have canceled surgical appointments when they learned a practice didn’t have a staff mandate for vaccination.”

The Mills administration has no current plan to expand the reach of the COVID-19 vaccine mandate, according to the state’s website. However, it says “(DHHS) will accept comments on potential changes to a forthcoming proposed final rule, such as which health care providers should be subject to the immunization requirements, which will be issued after the 90-day emergency period ends.”

Whether independent health care providers will require staff members to be vaccinated likely will vary from practice to practice.

Despite the exclusion of independent practices, InterMed, which operates primary care and specialty practices in Portland, South Portland and Yarmouth, is requiring all employees be vaccinated in line with the governor’s mandate, spokesman John Lamb said.

InterMed employees must receive a one-dose Johnson & Johnson vaccine by Oct. 1, or be fully vaccinated with a two-dose series of the Moderna or Pfizer vaccines by Nov. 1.

“Prior to (Gov. Janet Mills’) announcement, our vaccination rate was more than 90 percent, and it has been increasing, as more employees are stepping up and requesting a vaccine,” Lamb said. “In addition to the vaccine mandate, we are requiring anyone in our buildings to wear a mask, to help ensure a safe environment for patients and staff.”

Martin’s Point and ConvenientMD Urgent Care, which operates private urgent care clinics in Portland, Westbrook, Saco, Brunswick, Ellsworth and Bangor, did not respond Friday to requests for comment on the mandate and their COVID-19 vaccination requirements.

In its announcements about the mandate, the Mills administration hasn’t mentioned the wide range of health care workers who are excluded from the rule. Some official statements implied a reach more sweeping than reality.

“Maine’s hospitals, clinics, nursing facilities and other health providers are on the front lines of the fight against COVID-19,” DHHS Commissioner Jeanne Lambrew said in an Aug. 12 statement. “We thank those who have already taken this critical step for themselves, their patients and their communities, but with the arrival of the delta variant in Maine, it is more important than ever to protect these workers through vaccination.”

Lacking a broader mandate, the Mills administration encourages Mainers to ask their health care providers what measures they are taking to prevent the spread of COVID-19, including vaccination of staff.

“Information on health care facility-specific COVID-19 vaccination rates can be found at Maine’s COVID-19 vaccination website,” said Farwell, DHHS spokeswoman. “We also urge all Maine people, including health care personnel working in any setting, to get vaccinated as soon as possible.”

This story has been updated at 10:50 a.m. on September 4 to correct the term designated health care facility.