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

Date: September 14, 2021

Time: 1:00 – 2:30 PM CT

REGISTER

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.

Webinar: Grants Management 101 for RHC Vaccine Confidence Grant Program

Date: August 25, 2021

Time: 1:00 PM CT

REGISTER

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

Webinar: What is the Rural Health Clinic COVID-19 Vaccine Distribution Program?

Date: August 31, 2021

Time: 2:00 PM CT

REGISTER

Join the Georgia Health Policy Center, Georgia State University, for a virtual learning session on the Health Resources and Services Administration’s (HRSA) Rural Health Clinic COVID-19 Vaccine Distribution Program.
In this one-hour webinar, you will learn:

  • What the Rural Health Clinic COVID-19 Vaccine Distribution Program is;
  • Why you should be a part of it;
  • How to enroll; and
  • The technical assistance resources available.

The Rural Health Clinic Vaccine Distribution Program (RHCVD) distributes COVID-19 vaccines directly to Rural Health Clinics to increase the availability of COVID-19 vaccines in rural communities.

Funding Opportunity: $500 Million in Emergency Rural Health Care Grant Funding Available

The Biden-Harris Administration announced that the United States Department of Agriculture (USDA) is making up to $500 million available in grants to help rural health care facilities, tribes, and communities expand access to COVID-19 vaccines, health care services, and nutrition assistance.

President Biden’s comprehensive plan to recover the economy and deliver relief to the American people is changing the course of the pandemic and providing immediate relief to millions of households; growing the economy; and addressing the stark, intergenerational inequities that have worsened in the wake of COVID-19.

Read the full news release here.

Webinar Recording: The Critical Role of Monoclonal Antibodies as the COVID-19 Pandemic Continues

The Health Resources and Services Administration (HRSA) held a webinar focused on how monoclonal antibody therapeutics can help prevent serious illness from COVID-19. It featured Michael R. Anderson, MD, a Senior Advisor to HHS’ Assistant Secretary for Preparedness and Response (ASPR). 

Watch the webinar recording.

More about the Webinar

In the continued fight against COVID-19, HRSA has seen how important monoclonal antibody therapeutics are in helping prevent serious illness. As viral variants arise and spread, it is increasingly critical that health care providers have the latest treatment information at their fingertips. 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. Dr. Anderson and HRSA representatives answered providers’ questions about these important COVID-19 therapies. Questions? Contact Dr. Anderson and his team

Resources

Learn more about monoclonal antibody therapeutics on ASPR’s website:

HHS Mask Distribution Program—Child-Size Masks Still Available

In partnership with the Department of Health and Human Services (HHS), the Department of Defense has distributed more than 26 million free masks to health centers and food banks across the country. These high-quality, washable cloth masks, manufactured consistent with mask guidance from the The Centers for Disease Control and Prevention (CDC), are intended to be distributed free of charge for use during the ongoing COVID-19 pandemic, as well as during future events such as flu season.

Child-Size Masks Are Still Available

Approximately 4,500 cases of child-size masks are still available for health centers. Each box contains 250 individually-wrapped pairs of masks (500 total masks per box).

Health centers may request additional cases of child-size masks on a first come, first served basis through the BPHC Contact Form by 5:00 p.m. ET on Thursday, August 19.

  • Select category “COVID-19 Mask Distribution” and sub-category “General Inquiry.”
  • You may request up to 50 cases. Please indicate the number of cases you would like to receive and include your H80 or LAL award number in your request.

The Defense Logistics Agency (DLA) will ship the masks to your administrative address on record in HRSA’s Electronic Handbooks (EHBs), unless you notify us otherwise by August 19. Your Project Director listed in the EHBs will receive an email from DLA with a FedEx tracking number 1-2 days prior to shipment.

Questions?

If you have questions about the HHS Mask Distribution Program or would like to provide feedback on the masks you received, please use the BPHC Contact Form. Additional information about the program is available on our COVID-19 FAQ webpage.

Free Transportation Available for COVID-19 Vaccination Appointments Now Available

The Missouri Rural Health Association (MRHA) with support of the National Rural Health Association (NRHA), is supporting COVID-19 vaccination transportation in Benton, Buchanan, Cedar, Crawford, Dent, Henry, Hickory, Howell, Johnson, Lafayette, Pettis, Phelps, St Clair, and Vernon Counties. No-cost transportation to COVID-19 vaccination appointments is now available. No-cost transportation includes youth 12 years and older with a parent or guardian present.

COVID-19 cases are rising. The new Delta variant, predicted to become the dominant variant worldwide, was first identified in Missouri in April 2021. The primary target for the Delta variant and other variants is unvaccinated individuals.

According to a news release issued by the Department of Health and Senior Services on July 2, 2021, mRNA vaccines developed for COVID-19 are nearly 90% effective against symptomatic disease and 96% effective against hospitalization. Some reports indicate the Delta variant’s viral load is 1000-times higher than other variants making it substantially more transmissible than in prior months. It is slated to be 60% more transmissible than the Alpha variant that was first discovered in the U.K. See local statistics (updated daily)..

“The Delta variant is also impacting young people in a way that previous variants have not,” said DHSS Acting Director Robert Knodell. “It is wrong to think that only the elderly and those with compromised immune systems need the vaccination. The virus has changed since the early days of the pandemic.”  

To safeguard and improve the health of rural Missourians, MRHA wants to eliminate the transportation barrier for COVID vaccinations. Using MRHA volunteer drivers and the HealthTran scheduling platform, rides can be scheduled 3 to 20 days in advance. Individuals living in the same household may be transported together.

How to Schedule a Ride

To find local vaccination sites and arrange an appointment explore www.vaccines.gov/search/

  • Select vaccines of choice.
  • Enter ZIP Code (25 miles or less Radius) and click “Search for Vaccines”.
  • Select a location close to you using the list and map feature.
  • Call to set an appointment date and time. Remember to schedule three or more working days in advance. This improves ride availability. Call 573-469-9117 to schedule a ride.
  • A mobility coordinator will be available Monday through Thursday, from 8 a.m. to 4:30 p.m., and Friday, 8 a.m. to 12 p.m.
  • Leave a voice message with a name, contact number, appointment date, time, and location. A mobility manager will call immediately to confirm your trip details.
  • Rides are not guaranteed and are based on driver availability. If possible, schedule your ride five or more days in advance.

If you live outside the listed counties above, find free and low-cost transportation options.

For more information, contact Mary Gordon at Mary@morha.org.

Biden-Harris Administration Provides $100 Million to Rural Health Clinics for COVID-19 Vaccine Outreach in Their Communities to Increase Vaccinations

July 22, 2021

The U.S. Department of Health and Human Services (HHS) provided nearly $100 million to Rural Health Clinics (RHCs) across the country to support outreach efforts to increase vaccinations in rural communities. The funds will go to more than 1,980 RHCs who will use these resources to develop and implement additional vaccine confidence and outreach efforts as many communities face the Delta variant and work to get more people vaccinated and protected from COVID-19 in medically underserved rural communities. The funding was made available by the American Rescue Plan and is being administered by the Health Resources and Services Administration (HRSA) through the Rural Health Clinic Vaccine Confidence (RHCVC) Program.

Read the release.