Administration Announces Plan for COVID-19 Booster Shots in Late September

The Department of Health & Human Services (HHS) announced today the Biden Administration has developed a plan to begin offering COVID-19 booster shots this fall, subject to an independent evaluation and determination of the safety and effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines, and CDC’s Advisory Committee on Immunization Practices (ACIP) issuing booster dose recommendations based on a thorough review of the evidence.

The National Association for Home Care & Hospice 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. NAHC will continue to make this case and we will keep our members up to date on this critically important topic.

“We look forward to working with the Administration to get vaccines to a very vulnerable group of individuals who, in many cases, are homebound and cannot otherwise secure the life-saving Covid vaccines and booster shots,” said NAHC President Bill Dombi, in response to the news.

The booster shots would begin to be offered to Americans in the week of September 20, in response to evidence that protection against the novel coronavirus COVID-19 could wane over time. The highly contagious delta variant of the virus continues to ravage parts of the country, particularly among unvaccinated persons.

“Based on our latest assessment, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout,” read a joint statement by federal health officials on Wednesday, August 18. (You can read the entire statement at the end of this article.)

Persons will be eligible for a third dose of Pfizer-BioNTech or Moderna shots eight months after they received their second dose. Additional shots are already being administered to people with compromised immune systems.

It is likely the boosters will be offered first to health care workers, people over 65, and nursing home residents, similar to the original rollout of the vaccines.

“We would also begin efforts to deliver booster shots directly to residents of long-term care facilities at that time, given the distribution of vaccines to this population early in the vaccine rollout and the continued increased risk that Covid-19 poses to them,” read the joint statement.

While the plan announced today does not include the Johnson & Johnson vaccine, it is believed booster shots will also be needed for the group that received that vaccine. Health officials are waiting for more data on the effectiveness of the J&J vaccine, which should be coming within the next few days.

It is important to note that the current vaccines continue to offer excellent protection. The vaccines provided a 95 percent protection against hospitalization before the delta variant and 92 percent protection against hospitalization during the delta variant.

Only after a thorough review of the evidence will CDC’s independent advisory committee make recommendations on the use of boosters for the public.

The Advisory Committee on Immunization Practices (ACIP), composed of medical and public health experts, develops recommendations, and provides guidance to the CDC Director on the use of vaccines for the general public.

For more information, please check the NAHC COVID-19 Vaccine and Resources page and the Coronavirus Resources page.

The full statement from Dr. Rochelle Walensky, Director of the Centers for Disease Control and Prevention (CDC); Dr. Janet Woodcock, Acting Commissioner, Food and Drug Administration (FDA); Dr. Vivek Murthy, U.S. Surgeon General; Dr. Francis Collins, Director of the National Institutes of Health (NIH); Dr. Anthony Fauci, Chief Medical Advisor to President Joe Biden and Director of the National Institute of Allergy and Infectious Diseases (NIAID); Dr. Rachel Levine, Assistant Secretary of Health; Dr. David Kessler, Chief Science Officer for the COVID-19 Response; and Dr. Marcella Nunez-Smith, Chair of the COVID-19 Health Equity Task Force, is below.

“The COVID-19 vaccines authorized in the United States continue to be remarkably effective in reducing risk of severe disease, hospitalization, and death, even against the widely circulating Delta variant. Recognizing that many vaccines are associated with a reduction in protection over time, and acknowledging that additional vaccine doses could be needed to provide long lasting protection, we have been analyzing the scientific data closely from the United States and around the world to understand how long this protection will last. The available data make very clear that protection against SARS-CoV-2 infection does begin to decrease over time following the initial vaccinations given, and in association with the dominance of the Delta variant, we are starting to see evidence of reduced protection against mild and moderate disease. Based on our latest assessment, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout. For that reason, we conclude that a booster shot will be needed to maximize vaccine-induced protection and stay ahead of the virus.

“We have developed a plan to begin offering these booster shots this fall once FDA conducts an independent evaluation and determination of the safety and effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines and CDC’s Advisory Committee on Immunization Practices (ACIP) issues booster dose recommendations based on a thorough review of the evidence. We are prepared to offer booster shots for all Americans beginning the week of September 20 and starting 8 months after an individual’s second dose. 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. We would also begin efforts to deliver booster shots directly to residents of long-term care facilities at that time, given the distribution of vaccines to this population early in the vaccine rollout and the continued increased risk that COVID-19 poses to them.

“We also anticipate booster shots will likely be needed for people who received the Johnson & Johnson (J&J) vaccine. Administration of the J&J vaccine did not begin in the U.S. until March 2021, and we expect more data on J&J in the next few weeks. With those data in hand, we will keep the public informed with a timely plan for J&J booster shots as well.

“Our top priority remains staying ahead of the virus and protecting the American people from COVID-19 with safe, effective, and long-lasting vaccines especially in the context of a constantly changing virus and epidemiologic landscape. We will continue to follow the science on a daily basis, and we are prepared to modify this plan should new data emerge that requires it.

“We also want to emphasize the ongoing urgency of vaccinating the unvaccinated in the U.S. and around the world. Nearly all the cases of severe disease, hospitalization, and death continue to occur among those not yet vaccinated at all. We will continue to ramp up efforts to increase vaccinations here at home and to ensure people have accurate information about vaccines from trusted sources. We will also continue to expand our efforts to increase the supply of vaccines for other countries, building on the more than 600 million doses we have already committed to donate globally.”

Administration Announces Plan for COVID-19 Booster Shots in Late September

NAHC: Providers of care in the home need access to COVID-19 booster vaccines Full information on the NAHC COVID-19 Vaccine and Resources page The Department of Health & Human Services (HHS) announced today the Biden Administration has developed a plan to begin offering COVID-19 booster shots this fall, subject to an independent evaluation and determination…

New NAHC Webinar: What You Should Know About The CY2022 Proposed Home Health Final Rule

Wednesday, June 30, 2021 1:00-2:00pm Eastern Register NAHC President Bill Dombi and VP for Regulatory Affairs Mary Carr present a high-level overview of the CY2022 home health proposed.  As expected, CMS is proposing the nationwide expansion of the Home Health Value Based Purchasing model.  In addition to the payment rate updates, CMS provides analysis of…

CMS Proposes Payment Rate Update to Home Health in 2022

Proposal to expand HHVBP demonstration nationwide 4.36% behavioral adjustment remains The 2022 proposed Medicare home health rates represent a simple inflation rate update, a proposal to recalibrate the case mix weights while maintaining the Low Utilization Payment Adjustment (LUPA) threshold amounts. A scheduled phasing-out of the rural add-on, and the continuation of outlier payment standards, with…

CMS to Bolster Payments for At-Home COVID-19 Vaccinations for Medicare Beneficiaries

The Centers for Medicare & Medicaid Services (CMS) today 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.

There are approximately 1.6 million adults 65 or older who may have trouble accessing COVID-19 vaccinations because they have difficulty leaving home.

To better serve Medicare beneficiaries who have great difficulty leaving their homes or face a taxing effort getting around their communities easily to access vaccination in these settings, Medicare 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. For a two-dose vaccine, this results in a total payment of approximately $150 for the administration of both doses, or approximately $70 more than the current rate.

“This is a very positive step forward. We thank the White House and CMS for the productive discussions on vaccinating homebound patients in the past few weeks,” said NAHC President Bill Dombi, in reaction to the news. “We look forward to continuing our partnership with them in getting vaccines to a very vulnerable group of individuals who cannot otherwise secure the life-saving Covid vaccines.”

Said CMS Administrator Chiquita Brooks-Lasure: “CMS is committed to meeting the unique needs of Medicare consumers and their communities – particularly those who are home bound 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. 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.”

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. 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 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.

How to Find a COVID-19 Vaccine

As today’s action demonstrates, a person’s ability to leave their home should not be an obstacle to getting the COVID-19 vaccine. 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. Unvaccinated individuals and those looking to assist friends and family can:

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

Coverage of COVID-19 Vaccines

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

Because no patient can be billed for COVID-19 vaccinations, CMS and its partners have provided a variety of information online for providers vaccinating all Americans regardless of their insurance status:

  • Original Medicare and Medicare Advantage: Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance or deductible.
  • Medicaid and the Children’s Health Insurance Program (CHIP):State Medicaid and CHIP agencies must cover COVID-19 vaccine administration with no cost sharing for nearly all beneficiaries during the COVID-19 public health emergency (PHE) and for over a year after it ends. For the very limited number of Medicaid beneficiaries who are not eligible for this coverage (and do not receive it through other coverage they might have), providers may submit claims for reimbursement for administering the COVID-19 vaccine to underinsured individuals through the COVID-19 Coverage Assistance Fund, administered by the Health Resources and Services Administration (HRSA), as discussed below. Under the American Rescue Plan Act of 2021 (ARP), signed by President Biden on March 11, 2021, the federal matching percentage for state Medicaid and CHIP expenditures on COVID-19 vaccine administration is currently 100% (as of April 1, 2021), and will remain 100% for more than a year after the COVID-19 PHE ends. The ARP also expands coverage of COVID-19 vaccine administration under Medicaid and CHIP to additional eligibility groups. CMS recently updated the Medicaid vaccine toolkit to reflect the enactment of the ARP at https://www.medicaid.gov/state-resource-center/downloads/covid-19-vaccine-toolkit.pdf.
  • Private Plans: The vaccine is free for people enrolled in private health plans and issuers COVID-19 vaccine and its administration is covered without cost sharing for most enrollees, and such coverage must be provided both in-network and out-of-network during the PHE. Current regulations provide that out-of-network rates must be reasonable as compared to prevailing market rates, and the rules reference using the Medicare payment rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect health insurance issuers and group health plans to continue to ensure their rates are reasonable when compared to prevailing market rates. Under the conditions of participation in the CDC COVID-19 Vaccination Program, providers cannot charge plan enrollees any administration fee or cost sharing, regardless of whether the COVID-19 vaccine is administered in-network or out-of-network.

The federal government is providing free access to COVID-19 vaccines for every adult living in the United States. For individuals who are underinsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine through the COVID-19 Coverage Assistance Fund administered by the Health Resources and Services Administration (HRSA) after the claim to the individual’s health plan for payment has been denied or only partially paid. Information is available at https://www.hrsa.gov/covid19-coverage-assistance.

For individuals who are uninsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA). Information on the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program is available at https://www.hrsa.gov/CovidUninsuredClaim.

More information on Medicare payment for COVID-19 vaccine administration – including a list of billing codes, payment allowances and effective dates – is available at https://www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment.

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 is available at https://www.cdc.gov/vaccines/covid-19/vaccination-provider-support.html.

CMS to Bolster Payments for At-Home COVID-19 Vaccinations for Medicare Beneficiaries

CMS to hold special ODF on at-home COVID-19 Vaccinations for Medicare Beneficiaries. See below for more details The Centers for Medicare & Medicaid Services (CMS) today 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. There are approximately 1.6 million adults…

Did You Miss It? Two Important Private Duty Webinars You Can Still Watch for Free!

NAHC aired two important webinars for private duty operators this week. If you missed them live, youc an still watch the recordings. They’re both free to NAHC members, so we encourage you to have a look.

Home Care Industry Update

Tuesday, March 30, 2021 ; 3:00-4:30pm Eastern

NAHC and Polsinelli have partnered with the goal of assisting home health, hospice, and private duty home care providers in navigating the complex and ever-changing legal landscape.

In this webinar, NAHC President Bill Dombi will give an overview of the latest home care and hospice legislative and regulatory news. Polsinelli’s Angelo Spinola will advise best practices on how to comply with anticipated legal changes while still running a successful home care business. They will also discuss industry-specific employment practices most likely to result in new lawsuits and explain the cost-effective steps you can take to minimize legal risk.

Faculty

  • William Dombi, President, National Association for Home Care & Hospice
  • Angelo Spinola, Shareholder, Polsinelli

To view a recording of this webinar, click here. 
To access an audio only version of this webinar, click here.

Creating a Best in Class Caregiver Culture

During this webinar, you will learn how Family & Nursing Care, a 53-year-old, $40M+ revenue home care company with over 1,300 caregivers, has earned its stellar reputation and what they’ve done to position themselves as the go-to home care agency.

REGISTER

They will discuss the following topics:

  • Recruitment
    • Why they’ve never experienced a caregiver shortage
    • Why caregivers want to work at Family & Nursing Care
    • Reducing cost to hire a caregiver
      • Advertising
      • Labor time to post the jobs, screening applications, phone screening, setting up interviews, interviewing, online testing, reference checking, background checks, data entry into software package and payroll, drug screening, orientation
  • Hiring processes
    • How they’ve evolved with the times, honing in most recently with COVID-19
    • Which changes they’ll continue when the pandemic ends
  • Retention/Reducing CG Turnover
  • KPIs for recruitment, hiring, and retention

Faculty

  • Neal Kursban, Family & Nursing Care

 

New NAHC Webinar: Home Care Industry Update

  • Tuesday, March 30, 2021
  • 3:00-4:30pm Eastern

REGISTER

Join Angelo Spinola for a high-level overview of the newest laws, rulings, and legal trends in the home care and hospice industries. Angelo will advise best practices on how to comply with anticipated legal changes while still running a successful home care business. He will also discuss industry-specific employment practices most likely to result in new lawsuits and explain the cost-effective steps you can take to minimize legal risk.

Faculty

  • William Dombi, President, National Association for Home Care & Hospice
  • Angelo Spinola, Shareholder, Polsinelli

The Event is Free, but Registration is Required!

REGISTER

New NAHC Webinar: Home Care Industry Update

  • Tuesday, March 30, 2021
  • 3:00-4:30pm Eastern

REGISTER

Join Angelo Spinola for a high-level overview of the newest laws, rulings, and legal trends in the home care and hospice industries. Angelo will advise best practices on how to comply with anticipated legal changes while still running a successful home care business. He will also discuss industry-specific employment practices most likely to result in new lawsuits and explain the cost-effective steps you can take to minimize legal risk.

Faculty

  • William Dombi, President, National Association for Home Care & Hospice
  • Angelo Spinola, Shareholder, Polsinelli

The Event is Free, but Registration is Required!

REGISTER

Biden Orders Review of Trump Admin Public Charge Rule

President Biden announced on Tueday, February 2, an executive order directing federal agencies to review the previous administration’s immigration policies, including the public charge rule, which was initially proposed by the Trump administration in September 2018 and finalized it August of 2019.

Under the public charge rule the Department of Homeland Security (DHS) expanded what criteria it considered to be a public charge when evaluating an immigrant’s application for citizenship. Under the previous standard applicants could be denied if they were expected to be “primarily dependent on the government for subsistence. In expanding the criteria, DHS specified a list of prior usage of common government benefits to be taken into account for evaluation, including: temporary assistance for needy families (TANF), section 8 housing, federal housing subsidies, and certain Medicaid benefits. In addition, DHS would evaluate an applicant’s likelihood of need of public assistance in the future. These points of criteria include age, health, family size, and financial means.

This rule proved to be controversial since its proposal with many labeling it a “wealth test” for immigrants, and as a means to limit immigrants to the United States. The rule was challenged in court, eventually rising to the Supreme Court, which ultimately ruled in favor of allowing the regulation to be implemented. However, in August 2020 a federal court issued a temporary injunction that in-effect blocked implementation of the public charge regulation due to the COVID-19 pandemic. Under the injunction, as long as there is a public health emergency related to the pandemic, the regulation was barred from application, implementation, and enforcement. (See NAHC Report for more information.)

The public health emergency remains in effect, having been renewed most recently in January 2021.  

The National Association for Home Care and Hospice filed comments with DHS on the proposal expressing concerns that the rule could prove damaging to the home care and hospice providers that often rely on immigrants to work as caregivers, an occupation notoriously facing workforce shortages. It is estimated that about 30 percent of the home care workforce is comprised of people born outside the United States.

“This proposal will result in fewer eligible home care workers, as immigrants tend to serve as a sizable proportion of the personal care and assistance aides workforce,” writes NAHC in its comments on the proposed rule. “These workers often qualify for public assistance through programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP). The typical annual income for these non-skilled workers falls below the guidelines for a two-member household as included in the proposed rule, and their eligibility for public assistance will also be counted as negative factors in determinations. Barring Immigrants on the basis of public assistance will only exacerbate an already prevalent workforce shortage leaving many employers unable to care for patients in need. This will cause patients to seek out more costly institutional settings for the same care they could have received in their home.”

“A reversal of this policy by the Biden Administration should help increase the home and community-based services workforce at a time when home care demand is rising,” said NAHC President Bill Dombi, in reaction to the news.

According to the best estimates, about 30 percent of the home care workforce is comprised of people born outside the United States, about evenly split between naturalized American citizens and non-citizen immigrants. “This is a strong indication that immigrants will play an important role in addressing the substantial workforce challenges home care will face in the coming years. According to the U.S. Bureau of Labor Statistics, home care workers rank in the top five fastest growing occupations. By 2026 the demand for home care workers is projected to increase by over one million.”

Due to low reimbursement rates offered by government programs like Medicaid or the Veterans Administration, compensation for home care workers is limited and a majority of them qualify for some form of public assistance. (About 30 percent qualify for SNAP and 30 percent qualify for Medicaid.)

The Biden executive order also rescinds a memorandum requiring family sponsors to repay the government if relatives receive public benefits. The order requires agencies to conduct a top-to-bottom review of recent regulations, policies, and guidance that have set up barriers to our legal immigration system.