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Home Health & Hospice Week

COVID-19:

Medicare Nearly Doubles Pay Rate For At-Home COVID Shots

Published on Fri Jun 11, 2021

But pay increase only applies if there are no other Medicare-covered services during that visit.

Home health and hospice agencies now are getting more support for doing their part to boost vaccination rates for their patients and other seniors in the home.

Effective June 8, the Centers for Medicare & Medicaid Services has adopted “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,” according to a CMS release. “There are approximately 1.6 million adults 65 or older who may have trouble accessing COVID-19 vaccinations because they have difficulty leaving home,” CMS says.

“To better serve this group, Medicare is incentivizing providers and 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,” CMS explains. “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,” according to the release.

“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,” newly confirmed CMS Administrator Chiquita Brooks-Lasure says in the release. “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.”

The extra pay isn’t just to incentivize providers to furnish the shots. “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,” CMS details. The higher rate “now helps to address the financial burden associated with accommodating these complications.”

Plus: “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,” CMS adds.

The extra pay applies for shots administered in a private residence; temporary lodging including a hotel, motel, campground, hostel, or homeless shelter; an apartment in an apartment complex or a unit in an assisted living facility or group home; and “a Medicare patient’s home that’s made provider-based to a hospital during the COVID-19 public health emergency,” CMS says in an infographic on the change.

Administration sites that do not merit the extra pay include the communal space of a multi-unit living arrangement; hospitals and nursing facilities; outpatient or physician clinic settings; and assisted living facilities with residents vaccinated through the CDC’s Pharmacy Partnership for Long-Term Care Program.

“This is a very positive step forward,” NAHC President Bill Dombi praises in a release. “We look forward to continuing our partnership with [CMS and the White House] in getting vaccines to a very vulnerable group of individuals who cannot otherwise secure the life-saving COVID vaccines,” Dombi says.

The pay boost is “exciting,” cheers Sharon Litwin with 5 Star Consultants in Missouri, which was acquired by Healthcare Provider Solutions in Tennessee last fall. “This is so needed so that home health and hospice agencies can assist to get everyone vaccinated,” Litwin says. Tennessee and Missouri were 37th and 49th in state rank of percentage of population fully vaccinated as of June 8, according to Centers for Disease Control and Prevention data tracker information.

While the pay bump is helpful, barriers to vaccination remain, including:

1. Logistics. Many home health and hospice agencies are at a loss as to how to order doses, and are untrained in and/ or unequipped for the CDC protocol for refrigeration, Litwin points out.

2. Population limit. Home health and hospice agencies “don’t often see 30 years and younger [patients], and those are a big percentage of who aren’t getting the vaccines,” Litwin laments. It will be hard to push the needle forward signifi­cantly without access to that population.

3. Hesitancy. The pay boost and resulting availability also don’t address a major hurdle in inoculating home care patients — “lack of willingness to get vaccinated,” notes Cindy Krafft with Kornetti & Krafft Health Care Solutions in Atlanta. Georgia was 43rd in state rank of percentage of population fully vaccinated as of June 8.

4. Payment catch. HHAs should also take note of one rule that could reduce payment for patients. “Medicare only pays the additional amount for administering the COVID-19 vaccine in the home if the sole purpose of the visit is to administer a COVID-19 vaccine,” CMS says in an infographic about the change. “Medicare doesn’t pay the additional amount if you provide another Medicare service in the same home on the same date,” CMS explains.

Note: More details about the pay boost, including a link to the two-page infographic, are at www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment.

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