Medicare Compliance & Reimbursement

Critical: COVID variants continue to impact policymaking.

Read on for three new updates, including the latest news on vaccination mandates, booster shots, and payments.

1. COVID Booster Shots Commence This Fall

After months of intensive data analysis and research, the feds feel that a COVID-19 booster shot will help stem the intensity of the virus and fortify the original vaccinations by “maximiz[ing] vaccine-induced protection and prolong[ing] its durability,” explained the Biden administration’s top health experts in a joint statement from the Department of Health and Human Services (HHS) and Food and Drug Administration (FDA) on Aug. 18.

The group intends to commence a booster-a-thon “for all Americans beginning the week of September 20 and starting 8 months after an individual’s second dose,” the release said. “At that time, the individuals who were fully vaccinated earliest in the vaccination rollout, including many health care providers, nursing home residents, and other seniors, will likely be eligible for a booster.” Residents of long-term care facilities are prioritized for the follow-up inoculation, too.

But: Distribution and administration of the additional vaccination will be “subject to FDA conducting an independent evaluation and determination of the safety and effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines and [Centers for Disease Control and Prevention] CDC’s Advisory Committee on Immunization Practices (ACIP) issuing booster dose recommendations based on a thorough review of the evidence” first, the release noted.

Due to its late arrival on the COVID-19 vaccination scene, the feds are still researching the Johnson & Johnson (J&J) vaccine. However, according to the health experts, a forthcoming J&J COVID booster is expected in the coming months, the release indicated.

2. Feds Move Forward With COVID Vaccination Mandates

First: Since healthcare workers are on the front lines caring for patients, it shouldn’t be a surprise that HHS set a COVID vaccination requirement for its 25,000+ workforce.

“Staff at the Indian Health Service (IHS) and National Institutes of Health (NIH) who serve in federally-operated health care and clinical research facilities and interact with, or have the potential to come into contact with, patients will be required to receive the COVID-19 vaccine,” the agency noted in an Aug. 12 release. “This includes employees, contractors, trainees, and volunteers whose duties put them in contact or potential contact with patients at an HHS medical or clinical research facility.”

Additionally, members of the U.S. Public Health Service Commissioned Corps, who often assist in disaster and crisis situations and are referred to as “emergency responders,” will be required to get vaccinated as well as healthcare workers at the Department of Veterans Affairs (VA), the release said.

“Vaccines are the best tool we have to protect people from COVID-19, prevent the spread of the Delta variant, and save lives,” said HHS Secretary Xavier Becerra in a release. “As President Biden has said, we have to do all we can to increase vaccinations to keep more people safe. Instructing our HHS health care workforce to get vaccinated will protect our federal workers and the patients and people they serve.”

Nursing homes: On Aug. 18, the Centers for Medicare & Medicaid Services (CMS) announced that it, “in collaboration with the Centers for Disease Control and Prevention (CDC), is developing an emergency regulation requiring staff vaccinations within the nation’s more than 15,000 Medicare and Medicaid-participating nursing homes,” according to a CMS release.

“The data are clear that higher levels of staff vaccination are linked to fewer outbreaks among residents, many of whom are at an increased risk of infection, hospitalization, or death,” CMS Administrator Chiquita Brooks-LaSure said in the release. “We will continue to work closely with our partners at the CDC, long-term care associations, unions, and other stakeholders to advance policies that keep residents and staff safe. As we advance these new requirements, we’ll work with nursing homes to address staff and resident concerns with compassion and by following the science.”

About 62 percent of nursing home staff are currently vaccinated, CMS says. (CMS requires nursing homes to report that data.) “Vaccination among staff at the state level ranges from a high of 88 percent to a low of 44 percent,” the agency reported. Many recent COVID outbreaks have been “occurring in facilities located in areas of the United States with the lowest staff vaccination rates,” CMS added in the release.

While the agency doesn’t expect to issue the requirement until September, “CMS strongly encourages nursing home residents and staff members to get vaccinated as the Agency undergoes the necessary steps in the rule-making process over the course of the next several weeks,” it said. “CMS expects nursing home operators to act in the best interest of residents and their staff by complying with these new rules.”

3. CMS Revises At-Home Vaccination Payment Policy… Again

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

Refresher: Back in June, CMS offered Medicare providers a major financial incentive for administering at-home COVID-19 vaccinations to beneficiaries (see Medicare Compliance & Reimbursement, Vol. 47, No. 12).