Biden bolsters payments for at-home COVID-19 vaccinations for Medicare beneficiaries

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In an effort to increase vaccine access, the Centers for Medicare and Medicaid Services has announced an additional payment amount for administering in-home COVID-19 vaccinations to Medicare beneficiaries who have difficulty leaving their homes or are otherwise hard to reach.

Data from the U.S. Department of Health and Human Services shows about 1.6 million adults 65 or older may have trouble accessing COVID-19 vaccinations because they have difficulty leaving home.

While many Medicare beneficiaries can receive a COVID-19 vaccine at a retail pharmacy, physician's office or a mass vaccination site, leaving home or moving around in the community can still be a persistent issue for some.

In targeting that group, Medicare is incentivizing providers and will pay an additional $35 per dose for COVID-19 vaccine administration in a beneficiary's home, increasing the total payment amount for at-home vaccination from about $40 to about $75 per vaccine dose. 

For a two-dose vaccine, this results in a total payment of roughly $150 for the administration of both doses, or about $70 more than the current rate.

There are challenges that come with ensuring vaccines for the access-challenged and those who are hard to reach, such as ensuring appropriate vaccine storage temperatures, handling and administration. The Centers for Disease Control and Prevention has outlined guidance to assist vaccinators on that front.

The additional payment amount, said CMS, also accounts for the clinical time needed to monitor a beneficiary after the vaccine is administered, as well as the upfront costs associated with administering the vaccine safely and appropriately in a beneficiary's home. The payment rate for administering each dose of a COVID-19 vaccine, as well as the additional in-home payment amount, will be geographically adjusted based on where the service is furnished.

WHAT'S THE IMPACT?

The federal government is providing the COVID-19 vaccine free of charge or with no cost-sharing for all Americans. As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers cannot charge patients any amount for administering the vaccine.

Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance or deductible. State Medicaid and CHIP agencies, meanwhile, must cover COVID-19 vaccine administration with no cost sharing for nearly all beneficiaries during the public health emergency, and for more than a year after it ends.

For the limited number of Medicaid beneficiaries who aren't eligible for this coverage – and don't receive it through other coverage they might have – providers can submit claims for reimbursement for administering the COVID-19 vaccine to underinsured people through the COVID-19 Coverage Assistance Fund, administered by the Health Resources and Services Administration.

THE LARGER TREND

According to the White House, 63% of adult Americans had been vaccinated as of June 2, including 73% of Americans aged 40 and over. COVID-19 cases and deaths have plummeted as a result, with cases falling more than 90% since January 20. Deaths are down over 85% in that time period. Nearly 600,000 Americans have died from COVID-19 since the pandemic began in early 2020.

In May, the Biden Administration set a goal of getting 70% of adults at least one vaccine dose, and 160 million Americans fully vaccinated, by July 4.

The plan to achieve this goal is to shift focus to accessibility. Gone are the days of scrambling online to find a highly sought-after vaccine appointment. Instead, pharmacies participating in the federal pharmacy program are gearing up to offer same-day and walk-in vaccinations, which could prove useful if studies find the vaccines require a booster shot six months after a second dose.

The U.S. will also redirect resources from the Federal Emergency Management Agency to establish more mobile and pop-up vaccination clinics, and will ship new allocations of the vaccine to rural health clinics.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com