CMS to Proceeed with Targeted Probe and Educate

The Centers for Medicare & Medicaid Services (CMS) has decided to continue to proceed with the Targeted Probe and Educate (TPE) medical review, which they resumed on September 1, 2021. (Please see NAHC Report CMS Resumes Targeted Probe & Educate.) Although, the Medicare Administrative Contractors (MACs) have been conducting limited medical review since August 2020, a…

CMS to Resume Provider Enrollment Activities

The Centers for Medicare & Medicaid Services (CMS) has announced the resumption of several provider enrollment activities that have been paused since the beginning of the public health emergency related to the COVID-19 pandemic. Beginning in October 2021, the following activities will be resumed. Application Fees – 42 C.F.R. 424.514 Criminal background checks associated with…

CMS Resumes Targeted Probe & Educate

NAHC urges CMS to suspend TPE until the public health emergency ends The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that it will resume the targeted probe and educate (TPE) program that was suspended in March 2020 (as were most medical reviews) due to the COVID-19 public health…

U.S. Renews Public Health Emergency

On July 19, Secretary of Health & Human Services (HHS) Xavier Becerra renewed the Public Health Emergency (PHE) that has been in effect since January 27, 2020 due to the outbreak of the novel coronavirus COVID-19.

As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Xavier Becerra, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective July 20, 2021, the January 31, 2020, determination by former Secretary Alex M. Azar II, that he previously renewed on April 21, 2020, July 23, 2020, October 2, 2020, and January 7, 2021, and that I renewed on April 15, 2021, that a public health emergency exists and has existed since January 27, 2020, nationwide.

This latest renewal of the PHE will last for 90 days, at which point it will lapse or be renewed again.

This news is not a surprise, as the Biden administration had hinted for some time that a renewal was coming.

A declaration of a PHE permits, among other things, emergency use authorization of vaccines, the access to funding to address the emergency, and deployment of military trauma care providers.

The COVID-19 outbreak is not the only PHE that currently exists in the United States. On July 7, Secretary Becerra renewed a PHE for the opioid crisis that has been in effect for years.

U.S. Renews Public Health Emergency

On July 19, Secretary of Health & Human Services (HHS) Xavier Becerra renewed the Public Health Emergency (PHE) that has been in effect since January 27, 2020 due to the outbreak of the novel coronavirus COVID-19. As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after…

CMS Releases Updated Emergency Preparedness Guidance

The Centers for Medicare & Medicaid Services (CMS) has released emergency preparedness (EP) guidance for surveyors, as well as providers and suppliers, with assessing a facility’s compliance with the EP requirements. Both home health agencies and hospice providers must conduct exercises to test the emergency plan at least annually, and both inpatient and outpatient providers that activate…

NAHC Supports The Resetting the IMPACT Act

The National Association for Home Care & Hospice (NAHC) has joined the other major post-acute care organizations (American Health Care Association, American Medical Rehabilitation Providers Association, National Association of Long Term Hospitals, Leading Age+VNAA) to commend members of Congress for the introduction of The Resetting the IMPACT Act (TRIA) of 2021 and urge legislators to…

NAHC Submits Comments on FY2022 Hospice Proposed Rule

On April 14, 2021 the FY2022 Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, Hospice and Home Health Quality Reporting Program Requirements proposed rule was published. In addition to the proposed payment updates the rule contains numerous provisions on a wide variety of topics and solicits feedback on a number of issues.  To read a…

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…