CMS Expands Medicare Payments for At-Home COVID-19 Vaccinations

August 24, 2021

Part of Biden-Harris Administration Vaccine Outreach, CMS Boosts Vaccine Access in Smaller Group Homes, Assisted Living Facilities, and Other Group Living Situations

As part of the Biden-Harris Administration’s ongoing commitment to increasing access to vaccinations and improving health equity, CMS is expanding opportunities for people to receive COVID-19 vaccinations in their home. To ensure Medicare beneficiaries who have difficulty leaving their homes or are otherwise hard-to-reach can receive the vaccination, health care providers can now receive additional payments for administering vaccines to multiple residents in one home setting or communal setting of a home.

This announcement 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 by allowing vaccine providers to receive the increased payment up to 5 times when fewer than 10 Medicare beneficiaries get the vaccine on the same day in the same home or communal setting. This policy will help ensure that at-risk patients in smaller settings have the same opportunities as others to receive the vaccination.

“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,” said CMS Administrator Chiquita Brooks-LaSure. “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.”

While many Medicare beneficiaries are able to receive a COVID-19 vaccine at a retail pharmacy or from a health care provider, some people have great difficulty leaving their homes or cannot easily access vaccination in these settings. These individuals are often at-risk patients who could require complex care if they contracted COVID-19 and needed to be hospitalized. To better serve this group, Medicare previously increased the total payment amount for at-home vaccination from approximately $40 to approximately $75 per vaccine dose, in certain circumstances.

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. Along with the CDC guidance, this announcement helps vaccine providers meet these challenges and successfully administer vaccinations.

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, is geographically adjusted based on where the service is furnished.

How to Find a 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 (English) or (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 Medicare beneficiaries. 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 (generally) 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.
  • Private Plans: The vaccine is free for people enrolled in most private health plans. The COVID-19 vaccines and the administration are 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 action, CMS expects 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.

For individuals who are underinsured, vaccine providers may submit claims for reimbursement for administering the COVID-19 vaccine through the COVID-19 Coverage Assistance Fund administered by HRSA after the claim to the individual’s health plan for payment has been denied or only partially paid.

For individuals who are uninsured, vaccine providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by HRSA. See information on the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program.

More information on Medicare payment for COVID-19 vaccine administration – including a list of billing codes, payment allowances and effective dates – is available on the Medicare COVID-19 Vaccine Shot Payment webpage.

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 on the CDC COVID-19 Vaccination Program Provider Requirements and Support webpage.

Webinar: What’s Next for Telehealth? A State & Federal Policy Debrief

Date: September 2, 2021

Time: 1:00 PM CT


The practice and delivery of healthcare is changing with an emphasis on improving quality, safety, efficiency, and access to care. Telemedicine can help you achieve these goals! The Arizona Telemedicine Program, Southwest Telehealth Resource Center, and Arizona Department of Health Services invite you to a free webinar on the implementation and practice of telemedicine.

Learning Objectives:

  • CTeL’s Telehealth Cost Impact Research
    • Initial findings and how our research could impact public policy
  • Congress and the Administration
    • Sticking points: Reducing Health Disparities and Fraud, Waste, & Abuse
    • Trends being seen
  • National Public Health Emergency
    • Short-term extension vs permanent extension of telehealth waivers
  • 50 State Review of the Public Health Emergency (PHE) Orders
    • High level review of which states have active PHEs and which states have terminated their PHEs
    • Trends being seen


Ben Steinhafel is the Director of Policy and External Affairs at the Center for Telehealth and e-Health Law (CTeL). Ben has been closely monitoring the telehealth flexibilities issued at the state and federal levels and proactively educates policymakers on the benefits of expanded telehealth and its potential to increase access to care for all Americans.

Prior to joining CTeL, Ben served in the Executive Branch at the U.S. Office of Personnel Management, where he oversaw the Federal Employee Health Benefits Program on the agency’s Congressional Affairs team. Ben also served in the U.S. House of Representatives as a health care advisory for Congressman Jim Sensenbrenner.

Webinar: The Continued Threat of Influenza and How to Sustain Influenza Vaccination Efforts

Date: September 9, 2021

Time: 12:00 PM CT


The Immunization Action Coalition (IAC) will be holding two interactive webinars in September to emphasize vigilance in preventing influenza in the midst of the COVID-19 pandemic.
The webinar will cover the following topics:

  • influenza surveillance in US and worldwide;
  • changes in circulation of other common respiratory pathogens, e.g., recent increases in RSV and other non-COVID-19 viruses;
  • changes in vaccine strains and changes in influenza ACIP recommendations;
  • the impact of influenza;
  • communications issues providers may face with regards to perceptions of the need for influenza vaccination; and
  • a public perspective on the importance of influenza vaccination and advocacy for vulnerable populations (chronic issues).

Following the presentations there will be time for an interactive discussion with our presenters (listed below) and other IAC experts.


  • Alicia Budd, MPH, Epidemiologist, Epidemiology and Prevention Branch of the Influenza Division in CDC’s National Center for Immunization and Respiratory Diseases
  • Robert Hopkins, Jr.,  MD, MACP, FAAP, Professor of Internal Medicine and Pediatrics and Chief of the Division of Internal Medicine, University of Arkansas for Medical Sciences
  • Gary Stein, MBA, Board Member, Families Fighting Flu

IAC Experts

  • Carolyn Bridges, MD, FACP, Director for Adult Immunization and Moderator for this webinar
  • Kelly L. Moore, MD, MPH, President and Chief Financial Officer
  • L.J Tan, MS, PhD, Chief Policy and Partnerships Officer and Co-chair, National Adult and Influenza Immunization Summit

This webinar is supported by IAC and a vaccine education grant from Seqirus, Inc.

Webinar: Missouri’s Public Health Response to COVID-19: Key Findings and Recommendations

Date: September 14, 2021

Time: 1:00 – 2:30 PM CT


As of August 2021, COVID-19 has tragically taken the lives of more than 10,000 Missourians and upended the social and economic fabric of all its residents. The pandemic continues to challenge public health in the state, highlighting the importance of a strong public health system at all levels of government.

In the summer of 2020, the Missouri Foundation for Health contracted the George Washington University to assess Missouri’s public health preparedness and response capacities to the pandemic and future public health crises.

The state now has a singular opportunity to build and modernize stronger public health agencies at the state and local levels. But how do we move forward?

 In this webinar we will discuss:

  • The preliminary assessment of state and local foundational public health capabilities;
  • Implications of the state’s governance and funding structure for public health;
  • Recommendations for strengthening the public health infrastructure in Missouri.

Federal Office of Rural Health Policy Announcements

August 19, 2021

More Federal Support for Rural Telehealth. The U.S. Department of Health & Human Services announced awards of more than $19 million to expand telehealth services in rural areas and underserved communities. In addition to projects that connect rural providers to specialists for complex conditions, the funding continues the work of HRSA-supported Telehealth Resource Centers that provide guidance for implementing telehealth in every part of the country. 

CDC Clinician Outreach: Additional mRNA COVID-19 Vaccines for Immunocompromised PeopleThe U.S. Food and Drug Administration has issued Emergency Use Authorizations for additional doses of vaccines for moderately to severely immunocompromised people who are at increased risk for severe COVID-19. Studies indicate that some immunocompromised people who have been vaccinated have a reduced immune response compared to vaccine recipients who are not immunocompromised. Studies have further demonstrated that an additional vaccine dose in some immunocompromised populations may enhance immune response. During this clinician outreach call that took place on August 17, presenters from the Centers for Disease Control and Prevention (CDC) discussed the current data and CDC’s guidance on additional COVID-19 doses in immunocompromised people.

“The Critical Role of Monoclonal Antibodies as the COVID-19 Pandemic Continues” Webinar Recording Available. The Health Resources and Services Administration recently held a webinar featuring Michael R. Anderson, MD, a Senior Advisor to the Department of Health and Human Services’ (HHS) Assistant Secretary for Preparedness and Response, who discussed how monoclonal antibody therapeutics can help prevent serious illness from COVID-19.  Dr. Anderson shared updates on available COVID-19 therapeutics including efficacy, new administration routes and novel treatments in the pipeline, reimbursement resources, and provider and patient tools and fact sheets. For further questions, contact Dr. Anderson and his team. 

Awards for the Rural Northern Border Region Planning Program. The Federal Office of Rural Health Policy recently announced four awards of approximately $760,000 each for a new program identifying health care challenges in rural counties served by the Northern Border Regional Commission. This eighteen-month project will support planning activities such as, but not limited to, community needs assessments, formal strategic planning processes, and infrastructure development.

New Insights on Maternity Care, Clinical Quality Measures, and Medication-Assisted Treatment. HRSA’s Health Centers Program published new research briefs exploring health center capacity in maternity care deserts, differences in clinical quality measures among Appalachian and non-Appalachian health centers, and the role of health centers in providing medication-assisted treatment. The briefs were developed through the UDS Mapper—a tool that helps evaluate the geographic reach, penetration, and growth of the Health Center Program and its relationship to other federally-linked health resources.

ERS: Rural Poverty Has Distinct Regional and Racial Patterns. A study from the Economic Research Service (ERS) at the U.S. Department of Agriculture found that, out of 310 counties with high and persistent poverty in 2019, 86 percent were rural. Nearly half of rural residents who identify as Black or African American and American Indian or Alaska Native lived in these persistent poverty counties; by comparison, 20 percent of poor Hispanics and 12 percent of rural non-Hispanic Whites resided in those counties. 

History of the Swing Bed.  The feature of the latest Rural Monitor reviews the history of the swing bed program, which provides continued care for patients after injury or illness in a rural hospital. The article describes how post-acute care for rural residents shifted from urban hospitals and aspects of the swing bed program that contributed to its success.

Webinar: Grants Management 101 for RHC Vaccine Confidence Grant Program

Date: August 25, 2021

Time: 1:00 PM CT


Starting up a new grant-funded program can be difficult for even a seasoned program manager. Join the National Organization of State Offices Rural Health (the Federal Office of Rural Health Policy designated technical assistance provider) to learn how to ensure your work on Vaccine Confidence grant efforts can be managed in order to meet all requirements and have a meaningful impact in your community. This webinar will be presented with a practical look at how you can be successful in a hectic environment.

At the conclusion of the webinar, participants will understand how to:

  • Implement 5 simple strategies for successful grants management
  • Utilize required websites and basic tools to manage, track and report on all aspects of the grant program
  • Tap the expertise of technical assistance who will help your organization be successful