CMS expands Medicare payments for at-home COVID-19 vaccinations

Aug. 25, 2021

The Centers for Medicare & Medicaid Services (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, healthcare providers can now receive additional payments for administering vaccines to multiple residents in one home setting or communal setting of a home.  

The move is intended to further boost administration of COVID-19 vaccination – including second and third doses – in smaller group homes, assisted living facilities and other group living situations. It would allow vaccine providers to receive the increased payment up to five times when fewer than ten 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.

While many Medicare beneficiaries are able to receive a COVID-19 vaccine at a retail pharmacy or from a health care provider, some people 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 for at-home vaccination from approximately $40 to approximately $75 per vaccine dose, in certain circumstances.

Delivering COVID-19 vaccination to hard-to-reach individuals poses some unique challenges, such as ensuring appropriate vaccine storage temperatures, handling and administration. Along with the Centers for Disease Control and Prevention’s (CDC) guidance, today’s 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 a vaccine is administered, and upfront costs associated with administering the vaccine. Payment rates for administering each dose of vaccine, as well as the additional in-home payment cost, is geographically adjusted based on where the service is furnished.

The federal government provides 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.

CMS release

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