Eli's Hospice Insider

Published on Wed Sep 15, 2021 PDF

Hospices join the push to get as many vaccinated as possible.

The federal government’s goal of increasing COVID-19 vaccination rates in the face of the Delta surge and new eight-month booster shots may get a helping hand from a newly revised payment policy.

Old way: Effective in June, the Centers for Medicare & Medicaid Services implemented “a new add-on payment with a national rate of $35.50 when a COVID-19 vaccine is administered in the beneficiary’s home,” CMS explained in the physician fee schedule payment rule issued July 13. “Providers and suppliers administering a COVID-19 vaccine in the home will be paid a national average payment $75.50 dollars per dose ($40 for COVID-19 vaccine administration and $35.50 for the additional payment for administration in the home, and both payments are geographically adjusted),” CMS summarized in the rule published in the July 23 Federal Register.

The rule contained some caveats, including that the add-on would apply to only one patient in the home, meaning other residents receiving vaccinations were not paid at the higher rate; and that shots given in communal areas in congregate living residences such as assisted living facilities, group homes, and apartments/condos would not qualify.

New way: “Healthcare providers can now receive additional payments for administering vaccines to multiple residents in one home setting or communal setting of a home,” CMS clarifies in an Aug. 24 release. The change allows “vaccine providers to receive the increased payment up to five times when fewer than ten Medicare beneficiaries get the vaccine on the same day in the same home or communal setting,” CMS elaborates.

The new methodology “aims to further boost the administration of COVID-19 vaccination — including second and third doses — in smaller group homes, assisted living facilities, and other group living situations,” CMS says. “This policy will help ensure that at-risk patients in smaller settings have the same opportunities as others to receive the vaccination,” the release notes.

“We are doing everything we can to remove barriers to vaccinations, including ensuring appropriate payment levels for vaccine providers to connect with more people in their communities who are unable to receive the vaccine in a traditional setting,” CMS Administrator Chiquita Brooks- LaSure says in the release. “We’ve seen the difference that vaccinations have in communities, and we are calling on providers to join us as we continue to increase vaccination rates across the country. Today’s actions ensure that everyone has the ability to be vaccinated against COVID-19, including older adults with mobility or transportation challenges and other at-risk individuals.”

To best achieve that goal, CMS must put vaccines directly into in-home care providers’ hands, insists the National Association for Home Care & Hospice. The trade group “has strongly communicated to HHS how important it is that shipments of booster vaccines be sent directly to home care providers, so that safe and efficient booster vaccinations of the elderly and disabled — the most at-risk population — can take place in the home,” it says in its member newsletter.

Note: Medicare COVID vaccination payment information is at www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment. Information on enrolling as a COVID-19 vaccine provider is at www.cms.gov/medicare/covid-19/enrollment-administering-covid-19-vaccines.