CMS Ups Medicare Payment for At-Home COVID-19 Vaccinations, Again

To increase the rate of COVID-19 vaccinations among vulnerable patients, CMS is once again increasing the Medicare reimbursement rate it pays to providers who immunize patients in their homes.

Medicare will pay an additional reimbursement of about $35 per dose administered for up to a maximum of five vaccine administration services per home unit or communal living space, as long as it is in a single group living location, CMS posted on its website earlier today.

The payment boost means that Medicare will reimburse immunizers approximately $150 if they administer a dose of a COVID-19 vaccine on the same date to two beneficiaries who live in the same residence. It is a bump from the previous rate of $115 for the two beneficiaries in the same residence.

The additional Medicare payment applies to at-home vaccinations administered to Medicare beneficiaries on and after August 24, 2021.

“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,” CMS Administrator Chiquita Brooks-LaSure said publicly.

“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.”

CMS also aims for the increased Medicare payment rate to boost vaccinations among beneficiaries living in smaller group homes and assisted living facilities. These group living settings do not always have the same opportunities to receive the vaccines, the federal agency stated.

For providers, the higher Medicare payment rate for at-home COVID-19 vaccinations will address the challenges of vaccine storage, handling, and administration, according to the announcement. It also accounts for upfront costs of vaccine administration in patient homes and the clinical time need to monitor patients after a vaccine has been administered.

The additional Medicare payment requires immunizers to document in the patient’s medical record the clinical status or barriers they face with accessing a COVID-19 vaccine outside of their home. However, the immunizer or another allowed practitioner does not need to certify that the Medicare patient is homebound.

Immunizers are eligible for the increased rate when patients have a condition that restricts their ability to leave the home unsupported, have a condition that puts them at increased risk of contracting COVID-19, and/or are generally unable to leave their homes or if it is taxing to do so.

Hard-to-reach patients because of disability or clinical, socioeconomic, or geographical barriers are also eligible for at-home COVID-19 vaccinations with an increased Medicare payment rate.

Under the new Medicare payment policy, communal spaces or multi-unit living arrangements and assisted living facilities participating in the CDC’s Pharmacy Partnership for Long-Term Care Program are also qualifying locations.

Other qualifying locations include private residences, temporary lodging (e.g., hotels, campgrounds), apartment complexes, and patient homes made into provider-based to a hospital during the COVID-19 public health emergency.

The new Medicare payment rate accounts for about $40 for the administration of each dose of the COVID-19 vaccine and approximately $35 per dose in additional payments. The rate will be geographically adjusted based on where the vaccine is administered, CMS clarified.