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

Medicare payments will increase by $35 per dose for providers who administer at-home COVID-19 vaccinations for Medicare beneficiaries, CMS announced today. In alignment with President Biden’s goal of ensuring vaccine accessibility, this increase will incentivize providers and allow beneficiaries who cannot leave their homes the opportunity to receive the vaccine.

Prior to this announcement, at-home vaccine administration warranted a $40 reimbursement for providers per dose; providers will now receive $75 per dose, or $150 for a two-dose vaccine. The increase in payment covers any costs associated with at-home vaccinations and accounts for the time a provider needs to monitor the beneficiary after the shot. The payment rates will be adjusted geographically.

“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. That’s why we’re acting today to expand the availability of the COVID-19 vaccine to people with Medicare at home,” said Chiquita Brooks-Lasure, the recently confirmed CMS Administrator, in the announcement.

“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.”

Difficulty with vaccine storage temperatures and travel make administering at-home vaccines a significant challenge for many providers. In conjunction with CMS’ announcement, the Centers for Disease Control and Prevention (CDC) released guidelines for providers who are administering at-home vaccines.

“Vaccine administration involves a series of actions: assessing patient vaccination status and determining needed vaccines, screening for contraindications and precautions, educating patients, preparing and administering vaccines properly, and documenting the vaccines administered,” the CDC guidelines state.

Everywhere in the US, the vaccine is free, regardless of insurance status. Those with Medicare, Medicaid, and private health insurance plans can receive the vaccine without a copayment or deductible.

“In light of CMS’s increased Medicare payment rates, CMS will expect health insurance issuers and group health plans to continue to ensure their rates are reasonable when compared to prevailing market rates,” the CMS announcement stated.

“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.”

In addition, HHS Secretary Xavier Becerra sent a letter today to providers and insurers to emphasize that vaccines and testing should be free for all patients regardless of immigration or insurance status. Providers should bill the Health Resources and Services Administration COVID-19 Uninsured and COVID-19 Coverage Assistance Fund programs for vaccine costs relating to uninsured and underinsured patients. Becerra also emphasized that although vaccine and testing administration incur significant costs to providers, Medicare, Medicaid, and private insurance should be billed for these services, not the patients themselves.

“In light of recent reports of consumer cost concerns, I am reminding health care providers of their signed agreements to cover the administration of COVID-19 vaccines free-of-charge to patients, and group health plans and health insurers of their legal requirement to provide coverage of COVID-19 vaccinations and diagnostic testing without patients shouldering any cost,” the letter stated.

The letter also stressed that providers who fail to follow these policies can be reported to CMS or state insurance departments to be held accountable.