New Data Highlight on Z Codes Now Available

The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) released a new data highlight: Utilization of Z Codes for Social Determinants of Health among Medicare Fee-for-Service Beneficiaries, 2019

Z codes are a set of ICD-10-CM codes used to report social, economic, and environmental determinants known to affect health and health-related outcomes. Nine broad categories of Z codes represent various hazardous social, economic, and environmental conditions. Z codes can be used in any health setting and by any provider as a tool for identifying a range of issues related to education and literacy, employment, housing, ability to obtain adequate amounts of food or safe drinking water, and occupational exposure to toxic agents, dust, or radiation.

The data highlight found that among the 33.1 million continuously enrolled Medicare fee-for-service (FFS) beneficiaries in 2019, 1.59% had claims with Z codes, an increase as compared to 1.31% in 2016.

Findings include:

  • The 5 most-utilized Z codes included those for homelessness, disappearance and death of family member, problems related to living alone, problems related to living in a residential institution, and problems in relationship with spouse or partner.
  • Beneficiaries who are dually eligible for Medicare and full-benefit Medicaid were overrepresented among the top 5 Z code claims.
  • Beneficiaries in rural areas were overrepresented (39.7%) among those coded as having problems related to living in a residential institution claim.
  • Male beneficiaries who accounted for 45.4% of the overall FFS population represented 67.1% of those with a homelessness claim.
  • Black and Hispanic beneficiaries accounted for 8.8% and 5.9% of the overall FFS population, respectively, but represented 24.8% and 9.2%, respectively, of those with a homelessness claim.
  • The top 5 provider types representing the largest proportions of those assigning Z codes to claims were family practice physicians, internal medicine physicians, nurse practitioners, psychiatry physicians, and licensed clinical social workers.

Using social determinants of health Z codes can enhance quality improvement activities, track factors that influence people’s health, and provide further insight into existing health inequities.

Looking for more information on Z Codes? Review the guide Using Z Codes: The Social Determinants of Health (SDOH) Data Journey to Better Outcomes, which provides step-by-step instructions for healthcare professionals on how to use Z codes.

For more CMS OMH health equity-focused resources, visit:

Nominations are now being accepted for 2021 Missouri Rural Health Champions – Due September 7, 2021

The Missouri Department of Health and Senior Services, Office of Rural Health and Primary Care is seeking nominations for 2021 Missouri Rural Health Champions. Awards will be presented on November 18, 2021, during the Missouri Rural Health Day celebration. This award is designed to honor a minimum of one individual and one group, depending on the number and type of nominations received. The person or group honored should demonstrate how their contributions are making a difference in Missouri rural health care through collaboration, education, innovation and communication. The nomination deadline is September 7, 2021.

Click here to submit your nomination. Feel free to share this link as you deem appropriate.


Webinar: Social Determinants of Health: Where Do Care Managers Start?

Date: September 15, 2021

Time: 1:00 PM CT


Social determinants of health (SDOH) are non-health related factors that account for up to 80% of health outcomes. SDOH significantly affect the work of care managers and social workers, all too often resulting in challenging barriers to the delivery of end-to-end care. It is essential for care teams to address SDOH in order to improve health outcomes and disparities in care.

In this webinar, we’re going back to basics to deliver an informative overview on:

  • Steps for identifying complex populations;
  • Utilizing relevant patient assessments;
  • Sourcing and securing appropriate resources to connect patients with community providers;
  • And highlighting recommended patient engagement strategies.

Following this overview, the team at MorCare will explore a case study scenario to demonstrate the effectiveness of using an automated solution to help facilitate success in screening, managing and engaging with your SDOH patients.

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.