previously had COVID or who have COVID antibodies are not exempt from this rule. Cookie Policy. While the rule's deadline for full vaccination was October 1, 2021, the Mills Administration announced on September . This article from Texas Law Help discusses the EEOC's guidance for employees who are required to get the COVID-19 vaccine. Circuit Court of Appeals. Locate the exemption PDF document you downloaded to your computer in Step 2. Florida law requires all employers, including health care employers, to provide broad exemptions to a COVID-19 vaccine mandate: Medical Exemption from COVID-19 Vaccination . This documentation must contain all information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive and the recognized clinical reasons for the contraindications. Finally, the regulation applies to physicians who have admitting privileges or are treating patients in-person within such facilities. On Jan. 19, 2022, the U.S. District Court for the Northern District of Texas, Amarillo Division, Covered Facilities should establish exceptions as a part of their policies and procedures, consistent with federal law. You can schedule online at, If you are already vaccinated (or are getting vaccinated between now and 11:59 p.m., April 19, 2022) but received your vaccine at a place other than UTMB Employee Health or UTMB Student Health,please email a scan of your COVID-19 Vaccination The mandate was issued Nov. 5, by CMS, and covers healthcare facilities who participate in the Medicare program. How does receipt of an intent to terminate notice affect an employees annual performance review? On immigration, are these two unicorns or realists? The order only applies to employees of the federal executive branch. including forms. Employers have the legal right to mandate that their employees receive a COVID-19 vaccination, according to guidance released by the U.S. If you received your first dose of a COVID mRNA vaccine before Jan. 31, 2022, you will need to receive the second dose by 11:59 p.m., April 19, 2022. Ask us! US Executive Branch Update March 2, 2023. This executive order prohibits any entity in Texas from requiring a personto get a COVID-19 vaccine if they have objections: GA-40 expands uponthe governor's previous executive orders about vaccines,GA-38and GA-39. This Texas Tribune article discusses Governor Abbott's newest executive order banning any type of vaccine mandate. Recognized medical conditions for which vaccines are contraindicated or because you are subject to a CDC-recommended vaccine deferral; and. U.S. Const. Healthcare workers may seek a medical or religious exemption under the new emergency federal COVID-19 vaccination mandate, but a test opt-out does not exist, a top Centers for Medicare &. You're ready to start filling it out. pay. The CMS Rule also addresses situations for certain individuals for whom a vaccination should be temporarily delayed (e.g., because of a recent COVID-19 diagnosis due to clinical precautions and considerations, as recommended by CDC). The Centers for Medicare & Medicaid Services (CMS) today issued an interim final rule requiring COVID-19 vaccinations for workers in most health care settings, including hospitals and health systems, that participate in the Medicare and Medicaid programs. Facilities will also be in compliance if they allow staff to work who received a vaccine listed by the World Health Organization (WHO) for emergency use that is not approved NLRB Places New Limitations on Confidentiality and Non-Disparagement Settlement Will Benefit Many Aging-Out Children in the Green Card SEC Commissioner Discusses Reform to Regulation D, Massachusetts AG Settles Enforcement Action Against Auto Lender. Exemption from required immunizations for religious, philosophical, or conscientious reasons is not allowed under Mississippi law. So You're Green Prove It or Be Prosecuted: ACCC Sweep Finds 57 California Court of Appeal Addresses When Violations are Willful or Whats new in Belgium on the employment front? In an interim final rule released Nov. 5, the agency laid out the organizations that are exempt from the mandate. BIPA ALERT: Illinois Supreme Court Opens the Door to Punitive, President Biden to Nominate Julie Su as New Secretary of Labor, The European Unitary Patent: Why Retailers Should Care, New York City Employers Prepare for AI Bias Law [VIDEO], Administration's WOTUS Rule Muddies Jurisdictional Waters. Medicare- and Medicaid-certified facilities are expected to comply with all regulatory requirements, and CMS has established a variety of enforcement remedies. Locking Tik Tok? An individual's exemption request will be denied if, based on the committees review, it does not meet the criteria for an approved exemption and accommodation request. The orderwould have permitted employees with disabilities, medical conditions, or religious beliefs that prevent vaccination to request accommodations. As the CMS Rule only applies to Medicare- and Medicaid-certified facilities, and as CMS does not have regulatory authority over care settings such as Assisted Living Facilities or Group Homes, these requirements do not apply to ALFs or Group Homes. Section 161.0085of the Texas Health & Safety Code prohibits state and local governmentsfrom issuing documentation of a person's COVID-19 vaccination status: Section 161.0085 also says that businesses can't require proof of vaccination from their customers. DHS requires its employees to be fully vaccinated against COVID-19 pursuant to Executive Order 14043 of the President of the United States. However,the Texas Workforce Commission issued a letter to Texas employers that states that employees can report violations of GA-40 to TWC over the phone or via e-mail. Librarians at the State Law Library can provide information about the law, but cannot give legal advice. Facilities should review these regulations and comply with any other federal requirements as necessary. Under federal law, including the ADA and Title VII of the Civil Rights Act of 1964, individuals who cannot be vaccinated because of medical conditions or sincerely held religious beliefs, practice, or observance may be entitled to an accommodation. In assessing the various vaccination mandates, including the CMS Omnibus Staff Vaccination Rule, the Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, the OSHA COVID-19 Healthcare Emergency Temporary Standard, or the new OSHA Emergency Temporary Standard (100+ employees), CMS states that if a Medicare- or Medicaid-certified provider or supplier falls under the requirements of the CMS Rule, it should look to those requirements first. Thank you to everyone who has completed TC's Proof of COVID-19 Vaccination Form - more than 1,100 individuals have uploaded their documentation so far! The order would have required all covered contractor employees to be fully vaccinated against COVID-19 by January 4th, 2021 (this date was pushed back from the initial date of December 8th, 2021). On January 3, the FDA amended the Pfizer-BioNTech COVID-19 vaccine (PDF)EUA to authorize the use of third pediatric doses (orange cap) for 511-year-old solid organ transplant patients or patients with a similar level of immunocompromise. A sample COVID-19 Vaccine Exemption form is included along with the letter. This statute prohibits government entities from issuing vaccine passports to certify a person's COVID-19 vaccination status. Secure .gov websites use HTTPSA [3]For purposes of this regulation, CMS currently considers staff fully vaccinated if it has been two weeks or more since they completed a primary vaccination series for COVID-19. Responds to calls as requested by dispatch. State of Texas | Statewide Search | Report Fraud in Texas | Texas Statutes, Site Map | Library Policies | Accessibility | Employment Opportunities, 205 West 14th Street, Austin, Texas 78701-1614. In anticipation of state legal challenges or legislative prohibitions on vaccine mandates, CMS asserts that a Covered Facility is required to follow the regulation because, under the Supremacy Clause of the U.S. Constitution, it pre-empts any state law to the contrary. Individuals subject to a CDC-recommended deferral should request a medical exemption through the established process. Employers nationwide are implementing mandatory COVID-19 vaccination policies in light of the September 9, 2021 announcement of President Biden's "Path Out of the Pandemic" COVID-19 Action Plan. The Future of Stablecoins, Crypto Staking and Custody of Digital White House Climate and Environmental Justice Screening Tool. State Bar of Texas Lawyer Referral Service, COVID-19 Vaccine Requirements Prohibited in Texas, Federal Vaccine Requirements for Employees, executive orders and proposed federal regulations. must be vaccinated.[2]. According toguidance fromthe Safer Federal Workforce Task Force, workers must be fully vaccinated by November 22, 2021. The updated vaccine targets the original COVID-19 viral strain and 2 Omicron variants (BA.4/BA.5). GSA19R-22.pdf [PDF - 678 KB ] PDF versions of forms use Adobe Reader . Greg Abbott bans any COVID-19 vaccine mandates including for private employers (10/12/21), The Equal Employment Opportunity Commission (EEOC). CMS expects that vaccine administration will occur within the United States for the majority of individuals and that those will receive a COVID-19 vaccine authorized for emergency use orlicensed by the FDA. Step 3: Open the form and fill it out. If you would ike to contact us via email please click here. Legislative Package Includes Bills to Advance Biofuels Research, PTO to Begin Issuing Electronic Patent Grants, OSHA to Expand the Use of Instance-by-Instance Penalties. A vaccine mandate just means that if you don't, businesses, schools, and others can legally stop you from entering the building or using their services if they choose to. The CMS rule, which essentially mandates vaccination with limited exceptions, applies to an estimated 76,000 health care facilities and 17 million workers . WHAT WE FOUND People have a right to seek medical and religious exemptions under federal. of their request. Greg Abbott signs bill to restrict "vaccine passports" (Texas Tribune) (6/7/21), Please take our patron satisfaction survey, submit to weekly COVID-19 testing and wear a face covering at work if the worker remains unvaccinated. On November 5, 2021, the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services, published its Omnibus COVID-19 Health Care Staff. Get important, CMS released this toolkit for providers, and a, Help the health care system quickly administer vaccines as they're available, Increase the number of providers who can administer the vaccine, Ensure adequate Medicare paymentfor administering the vaccine, Ensure private insurers and Medicaid programs understandtheir responsibility to cover the vaccine at no cost to patients, Health care providers play an important role and we're committed to ensuring you have the necessary tools to respond to the COVID-19 public health emergency (PHE). If the Mandatory Arbitration Agreements Remain Valid in California, Antitrust Practitioners Expect Activity With Climate Issues. What if an individual received a mix of vaccines as part of their COVID-19 primary vaccination series? Of note, CMS published an emergency regulation in September 2020 that established new requirements for Long Term Care facilities (nursing homes) to test facility residents and staff for COVID-19. Theorder would have requiredall federal contractors and subcontractors tocomply with COVID-19 workplace safety guidance from the Safer Federal Workforce Task Force. No attorney-client or confidential relationship is formed by the transmission of information between you and the National Law Review website or any of the law firms, attorneys or other professionals or organizations who include content on the National Law Review website. Does that count toward the vaccination requirement? VI 2. For example, a third dose of mRNA vaccines is now recommended for individuals who are immunocompromised, and boosters are recommended or available for individuals who are 65 or older? On August 19, 2022, the FDA amended the Novavax COVID-19 vaccine, AdjuvantedEUA to authorize the use for all patients 1217 years old. Healthcare industry stakeholders are concerned that the mandate will further strain staffing shortages in the field. UTMB decided to present these notices to all employees who are not yet fully compliant with the vaccine mandate to provide ample time for them to understand the timeline for compliance and the consequences of non-compliance and to act accordingly. CMS provided additional guidelines to mitigate the spread of COVID-19, and UTMB created a risk reduction plan to comply with this mandate requirement. White House Requires Removal of TikTok App from FDA Withdraws Proposed Rule on General Principles for Food Standards New FAQs Dramatically Expand Scope of California Labor Contractor Today is the Day Dont Miss the Employer Deadline to Report to OSHA, PTO Seeks Comments on Role of Artificial Intelligence in Inventorship. AG Clamps Down on Local Solar and Battery Storage Moratoria. The vaccine remains available under EUA, including: The FDA authorized an additional formulation (gray cap) for the Pfizer-BioNTech COVID-19 vaccine (PDF)for patients 12 years and older. How Modern Manufacturing Plants Can Protect Against Ransomware, FTC Will Host May 23, 2023, Workshop on Recyclable Claims and the Appellate Court Affirmed An Order Denying A Beneficiarys Request For An Overview of Why Class Action Privacy Lawsuits May Have Just Gotten Gold Dome Report Legislative Day 26 (2023). If you require legal or professional advice, kindly contact an attorney or other suitable professional advisor. Look for: Template No.1: Nursing Home Request. What is the process for requesting a medical exemption? CMS indicated that exemptions could be appropriate in certain limited circumstances, but no exemption should be provided to any staff for whom it is not legally required (under the ADA or Title VII of the Civil Rights Act of 1964) or who requests an exemption solely to evade vaccination. The stadium and parking lots will be completely smoke-free, including a ban on electronic cigarettes and smokeless tobacco products. For EEOC guidance regarding Sweeping new vaccine mandates could force millions of vaccine holdouts to become inoculated against COVID-19, although individuals of faith or people with disabilities may still be exempt from . Recent CFPB Actions Focus on Protecting Military Families, New and Updated Guidance on the Scope of the UK Plastic Packaging Tax. Privacy Policy. Candidate Exemption Request Form. employee achieves full compliance by the stated deadline, UTMB will not proceed with the termination, and the notice of intent to terminate is considered voided. Termination generally occurs only after providing a facility with an opportunity to make corrections and come into compliance. As a result, UTMB is now required to comply with this federal regulation. Heres what you should know (2/3/22), Texas Gov. (NBC12) Gov. Part 1 training plans. Please note that social, philosophical, political or economic views and/or other personal preferences will not meet the criteria for an approved exemption and accommodation request. The OSHA COVID-19 Employer Emergency Temporary Standard (for facilities with greater than 100 employees) applies to employers that are not subject to the preceding two regulations. Your use of this website constitutes acceptance of Haymarket MediasPrivacy PolicyandTerms & Conditions. HELENA - A coalition of 22 states, led by Montana Attorney General Austin Knudsen, today formally called on the Biden administration to withdraw its vaccine mandate for healthcare workers and all related guidance. As such, staff must be fully vaccinated[3]by January 4, 2022 in order to meet the requirements of the CMS Rule.[4]. On November 5, 2021, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule establishing COVID-19 vaccination requirements for staff working for certain Medicare- and Medicaid-certified providers and suppliers. Ultimately, all partially vaccinated employees need to fully comply by 11:59 p.m., April 19, 2022. JOB SUMMARY. On Nov. 4, 2021, the Centers for Medicare & Medicaid Services (CMS) issued its Health Care Staff Vaccination Interim Final Rule, which applies to all Medicare and Medicaid-certified providers and supplier types, but later suspended its COVID-19 vaccination Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration and Cost-Sharing under Medicaid, the Children's Health Insurance Program, and Basic Health Program resource toolkit For health & drug plans Billing, Coverage and Patient Information resource toolkit (PDF) UPDATED (4/6/2022) We're just part of the solution. In a Monday statement, AMDA suggested how medical exemption forms might allow the most accurate determination of a requests validity. Employee Exemption Request Form EXPOSED: Does a New NCLC Ex Parte Filing Expose Their True Agenda to Little Weight Given to Conclusory Expert Declaration That Repeats IPR Department of Homeland Security Provides Information Related to EB-5 PTAB: Vidal Refocuses Guidance On Fintiv Factors And Discretionary Aluminum Is Now A Hot Topic In Supply Chain And Trade. Part-Time. Additionally, a statement by the authenticating practitioner recommending that the staff member be exempted from the facilitys COVID-19 vaccination requirements is also expected. students, volunteers and contractors who fall into this category and have received their first dose of COVID mRNA vaccine in the past four weeks will be allowed eight weeks for the second dose. Which physician specialty is the happiest? Beginning Feb. 21, 2022, all employees, students, volunteers and suppliers/contractors who 8a-6:30p. Phillipfocuses his practice on healthcare. If you believe you qualify for an exemption, please review the Process for Requesting an Exemption from COVID-19 Vaccination document and complete the appropriate request form. Individuals without direct patient-facing duties will be required to The Virginia Commissioner of Health said in August 2020 that he will mandate a COVID-19 vaccine for all Virginians barring only medical exemptions. CMS Press Release: CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19 [PDF - 400 KB] CDC and CMS Issue Joint Reminder on NHSN Reporting Healthcare Facility HAI Reporting Requirements to CMS via NHSN Current and Proposed Requirements January 2019 [PDF - 300 KB] Under the amended CDC guidance, individuals 12 through 64 years of age and who are not moderately or severely immunocompromised may receive their second mRNA vaccine dose eight weeks after their first dose, instead of after three to four weeks. The Equal Employment Opportunity Commission (EEOC)enforces federal employment discrimination laws in the U.S. This information, in addition 02/28/2022 04:30 AM EST. Receiving an intent to terminate notice will not have an effect on an employees annual performance review. This vaccination requirement is critical part of the University's overall plan to . Under the CMS rule, employees of facilities that participate in Medicare and Medicaid will need . Individuals seeking a religious exemption will be notified in writing of the status Recognized medical conditions for which vaccines are contraindicatedor because you are subject to a CDC-recommended vaccine deferral; and. Copyright 2023 Haymarket Media, Inc. All Rights Reserved This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Free Speech Shines Bright, Illuminates Patent Owners Right to Allege California Supreme Court to Address Rounding of Employee Time. Additionally, accrediting organizations will be required to update their survey processes to assess facilities they accredit for compliance with vaccination regulations. This guidance from the Safer Federal Workforce Task Force answers questions about COVID-19 vaccine requirements for federal employees and contractors. effective for preventing infection, and . The remedy for non-compliance among hospitals and certain other acute and continuing care providers is termination; however, CMSs goal is to bring healthcare facilities into compliance. Medicare covers the updated COVID-19 vaccine at no cost to you. Note We have received a lot of questions about two sets of recent executive orders. GT's The Performance Review Episode 19: Is the Fight Over AB 51 5 Reasons Community Associations Need an Attorney That Specializes in New York Proposes Regulatory Review and Approval of Material Health CMS Issues Long-Awaiting Medicare Advantage RADV Final Rule, Preventing the Use of Cryptocurrencies to Evade Sanctions. Desperate Times, Desperate Measuring Cups FTC Brings Enforcement Trending in Telehealth: February 20 26, 2023, IRS Sets Deadline For Using 401(K) Plan Forfeitures, How Generative AI Generates Legal Issues in the Games Industry, DOJ Announces New Nationwide Voluntary Self-Disclosure Policy. President Joe Biden unveiled a new six-pronged national COVID-19 strategy on Thursday, including stronger requirements around vaccinations for U.S. workers.. Home health agencies were among the health care organizations explicitly mentioned in the plan. Physicians see income drop what happens next? White House Reviewing Proposed Regulations on Reinstated Superfund You Dont Need a Machine to Predict What the FTC Might Do About Is It Compensable? Federal employees lawsuit. Can Nonprecedential Decisions Be Relied Upon? are not capable of being vaccinated due to religious beliefs, observances or practices may request an exemption. or authorized by the FDA, or who received a vaccine during their participation in a clinical trial. COVID-19 Vaccinations and Your Employment (TexasLawHelp.org), The EEOC Updates Guidance Clarifying Mandatory COVID-19 Vaccinations, Department of Labors Occupational Safety and Health Administration (OSHA), COVID-19 Vaccination and Testing; Emergency Temporary Standard, OSHA COVID-19 Vaccination and Testing ETS FAQ, Fact Sheet: Biden Administration Announces Details of Two Major Vaccination Policies (11/4/21), Executive Order on Ensuring Adequate COVID Safety Protocols for Federal Contractors, Safer Federal Workforce Task Force Vaccinations Guidance, New Guidance on COVID-19 Workplace Safety for Federal Contractors, Centers for Medicare & Medicaid Services (CMS), Medicare and Medicaid Programs: Omnibus COVID-19 Health Care Staff Vaccination, CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule FAQ, Biden-Harris Administration to Expand Vaccination Requirements for Health Care Settings, guidance fromthe Safer Federal Workforce Task Force, Executive Order on Requiring Coronavirus Disease 2019 Vaccination for Federal Employees, Section 161.0085of the Texas Health & Safety Code, Texas Governor's Executive Order No. Linking and Reprinting Policy. Your patients may know these as "updated COVID-19 vaccines": Pfizer-BioNTech: all patients 12 years and older Moderna: all patients 18 years and older To improve immune response for those individuals with moderately or severely compromised immune systems who received either the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine, CDC advises an additional (third) dose after completing the primary vaccination series. CMS has since revised the compliance time line. Does the regulation include exemptions for individuals that show they have COVID-19 antibodies? Licensed practitioners, including community physicians with UTMB privileges, If you are not vaccinated and not requesting an exemption, please get your vaccine as soon as possible. Specifically, staff . Eligible COVID-19 vaccinations administered to individuals outside of the United States include those that are FDA licensed or authorized for emergency use or those that are listed by the WHO for emergency use. However, this statute does not prevent Texas businesses from putting COVID-19 screening procedures in place: Additionally, Governor Abbott's Executive Order GA-39from August 25th, 2021, also prohibits public and private entities that receive public funding from requiring consumers to provide proof of COVID-19 vaccination status: How are we doing? This federal regulation applies to the following individuals, both current and new, regardless of clinical responsibility or patient contact: CMS established the deadlines by which covered Texas facilities must comply with the COVID vaccination mandate. their request. In March, 56% of U.S . What if an individual was denied for a religious exemption but others with the same beliefs were approved? $12 Hourly. President Biden also issued Executive Order1404on September 9, 2021. The completion of a primary vaccination series for COVID-19 is defined in the rule as the administration of a single-dose vaccine (such as the Johnson & Johnson COVID-19 Vaccine), or the administration of all required doses of a multi-dose vaccine (such as the Pfizer-BioNTech COVID-19 Vaccine (interchangeable with the licensed Comirnaty Vaccine) or the Moderna COVID-19 Vaccine). The vaccine remains available under EUA, including: Patients who are moderately or severely immunocompromised (have a weakened immune system) are at increased risk of severe COVID-19 illness and death. Individuals should submit a complete exemption request as soon as possible. and will not survey for compliance with the CMS vaccine mandate rule. NoteThe OSHA rule has been blocked by a ruling from theU.S. Supreme Court. On November 5, 2021, OSHA issued a second emergency temporary standard requiring worker vaccinations for any employers with 100 or more employees or weekly testing for those who remain unvaccinated without an eligible exemption. Your patients may know these as updated COVID-19 vaccines: On October 19, 2022, the FDA amended the Novavax COVID-19 vaccine, Adjuvanted EUAto authorize the use ofa first booster dose for patients 18 years and older: On October 12, 2022, the FDA amended the Pfizer-BioNTech (PDF) and Moderna (PDF) COVID-19 vaccine EUAs to authorize bivalent formulations of the vaccines for use as a single booster dose in younger age groups. Accepting Cryptocurrency and Digital Asset Donations: What Charities Need to Know. For Phase 1, within 30 days (i.e. When you're ready to fill out the exemption application: Minimize this web browser window. It also recommended not including the question of religious exemptions, as that issue is not in the jurisdiction of the medical director, the organization said. Facilities have the flexibility to establish their own processes that permit staff to request a religious exemption from the COVID-19 vaccination requirements. Our Legal Help guide has information on free legal hotlines, legal clinics, and legal aid organizations, as well as information on how to find a lawyer who could represent you. Failure to achieve full compliance will result in termination from UTMB. [1]CMS has also indicated that the vaccination requirements may under the circumstances apply to non-hospital employees when considering the frequency of presence, services provided, and proximity to patients and staff. Please note that the legal status of various vaccine requirements is being decided by the courts and is subject to change quickly. The order allows for some exceptions. Templates for documenting the exemptions can be found on AMDA's website, on the COVID-19 Resource Page, under AMDA Guidance, Resources, and Tools. CMS will work directly with the State Survey Agencies to regularly review compliance with Medicare/Medicaid regulations across multiple healthcare settings. This Friday is St. Louis Blues Night at the Cardinals vs Reds and . BREAKING DOWN THE PRIVACY ACT REVIEW REPORT #3: Removal of The Small White House Releases National Cybersecurity Strategy, Illinois High Court Rules Per-Scan Damages Can Be Awarded Under BIPA, Grassley-Wyden Bill Aims to Fix Broken Tax Whistleblower Law, Lessons Learned From 2022s Trade Secret Verdicts, Mass. Dear Members of the TC Community, Last week, we wrote to you about the process for submitting proof of vaccination to fulfill the College's COVID-19 vaccine requirement for new and returning students, faculty, staff and TC housing affiliates. Individuals whoare not capable of being vaccinated due to religious beliefs, observances or practices may request an exemption. You have been given an approved CDC-recommended temporary delay, allowing you the time to be safely vaccinated Missouri, the Centers for Medicare & Medicaid Services (CMS) issued guidance in QSO-22-09-ALL ("January 14 Memo") on application of the November 5, 2021, CMS interim final rule regarding COVID-19 vaccine immunization of staff among Medicare- and Medicaid-certified providers and suppliers ("Vaccine Rule") in 24 states that had previously been mandate pending litigation.