CMS Boosts Payment for at-home COVID Vaccinations

The Biden Administration is turning its attention to the approximately 1.6 million seniors covered by Medicare who experience difficulty leaving their homes.

The federal government will have to act with a sense of urgency to meet President Biden’s goal of getting 70 percent of American adults vaccinated against COVID-19 by the Fourth of July – so in addition to encouraging individuals to go get vaccinated, they’re also doing more to bring the vaccine to them.

The Centers for Medicare & Medicaid Services (CMS) announced Wednesday that it was introducing 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,” federal officials said, listing the number of individuals over 65 who fit that description at approximately 1.6 million.

“CMS is committed to meeting the unique needs of Medicare consumers and their communities – particularly those who are homebound or who have trouble getting to a vaccination site. That’s why we’re acting today to expand the availability of the COVID-19 vaccine to people with Medicare at home,” CMS Administrator Chiquita Brooks-Lasure said in a statement, a little more than two weeks after being confirmed for the position via U.S. Senate vote. “We’re committed to taking action wherever barriers exist and bringing the fight against the COVID-19 pandemic to the door of older adults and other individuals covered by Medicare who still need protection.”

The White House announced in late March that by late April, 90 percent of Americans would live within five miles of a retail pharmacy, physician office, vaccination site, or other facility offering the COVID-19 vaccine; but even so, the number of vaccines being administered daily has fallen from a reported high of nearly 3.4 million earlier this year to barely 1 million this week.

As such, Medicare announced that it 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 approximately $40 to approximately $75 per vaccine dose ($150 for the administration of a two-dose vaccine, or approximately $70 more than the current rate).

“Delivering COVID-19 vaccination to access-challenged and hard-to-reach individuals poses some unique challenges, such as ensuring appropriate vaccine storage temperatures, handling, and administration,” CMS said in a press release issued Wednesday. “The Centers for Disease Control and Prevention (CDC) has outlined guidance to assist vaccinators in overcoming these challenges. Today’s announcement now helps to address the financial burden associated with accommodating these complications.”

The additional payment amount also accounts for the clinical time needed to monitor a beneficiary after the vaccine is administered, as well as 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.

“As today’s action demonstrates, a person’s ability to leave their home should not be an obstacle to getting the COVID-19 vaccine,” CMS added. “As states and the federal government continue to break down barriers – like where vaccines can be administered – resources for connecting communities to vaccination options remain key.”

CMS noted that unvaccinated individuals and those looking to assist friends and family can:

• Visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby;
• Text GETVAX (438829) for English or VACUNA (822862) for Spanish for near-instant access to details on three vaccine sites in the local area; or
• Call the National COVID-19 Vaccination Assistance Hotline at 1-800-232-0233 (TTY: 1-888-720-7489) for assistance in English and Spanish.

The federal government is continuing to provide the COVID-19 vaccine free of charge or with no cost-sharing for all people living in the United States, CMS noted, and as a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers cannot charge patients any amount for administering the doses.

Quoting CDC statistics, the New York Times reported this week that approximately 171.7 million Americans (64 percent of adults) have received at least one dose of a COVID vaccine, with more than 140 million being fully vaccinated. But rates vary widely among states, the newspaper added, from just 35 percent in Mississippi to 72 percent in Vermont. Rates tend to be higher in Northeast and Pacific coastal states, lower in the Midwest and South.

Experts have estimated that 70 to 90 percent of the total population (adults and children alike) is the threshold at which the nation may begin to achieve some level of herd immunity, but the Times estimates that at the current rate of vaccination, the lower end of that range won’t be reached until mid-October, while the higher end may not be reached until March 2022.

The COVID-19 virus has reportedly infected nearly 175 million people worldwide, killing 3.77 million, including more than 34 million cases and 613,000 deaths in the U.S. alone. At current rates of infection, India may overtake the U.S. as the nation with the most recorded cases in the world in a matter of weeks.

For more information on Medicare payment for COVID-19 vaccine administration – including a list of billing codes, payment allowances, and effective dates – go online to https://www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment.

For more information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients, go to https://www.cdc.gov/vaccines/covid-19/vaccination-provider-support.html.