Medicare Compliance & Reimbursement

Non-compliance could result in revoked Medicare certification.

Long-term care providers need to be on the lookout for a final rule making flu and pneumonia shots mandatory in nursing homes.

That was the word from the feds during a Sept. 8 Web cast, which the Centers for Medicare and Medicaid Services called to get providers--and surveyors--on board for a new era in immunizations in nursing home.

CMS made another message clear at the session: A provider who fails to live up to the new standards will face the loss of Medicare and Medicaid certification.

"CMS takes immunizations extremely seriously--as a matter of life and death," emphasized Stephen Jencks, director of quality coordination for the agency, during the Web cast.

The agency published a proposed rule saying that nursing facilities must, as a condition of participation in Medicare and Medicaid, provide residents flu and pneumococcal vaccinations unless they refuse or the immunizations are contraindicated.

"That means that facilities will be surveyed for their compliance with the immunization requirements" once the rule goes into effect, attorney Carol Loepere, with Reed Smith in Washington, DC, tells MLR.

The Web cast also covered coding instructions for the new MDS Section W, which captures flu and pneumococcal vaccination rates in nursing homes.

Facilities must educate residents or their legal representatives about the risks and benefits of the immunizations, but "there are no federal requirements to obtain written consent for the resident" to receive the vaccination, said speaker Ray Strickas, MD, of the Centers for Disease Control and Prevention.

In fact, "obtaining written consent can present a barrier to timely administration of vaccines," Strickas stressed. Stellar Maris nursing home assesses residents' immunization status at admission or even as part of the preadmission process and obtains consent for the flu immunization for the entire facility stay, reported Web cast presenter Susan Levy, MD, medical director for the Timonium, MD facility. Nurses follow-up on instances where the facility didn't obtain consent.

Both CMS and the CDC also recommend facilities use standing orders for the vaccinations whenever possible.
Standing order programs authorize pharmacists and nurses to administer immunizations according to the physician or institution-approved protocol without a doctor exam.