COVID-19 Vaccine Payment

On June 9, 2021, the Centers for Medicare & Medicaid Services (CMS) announced an increase in the total payment amount for at-home vaccination for administering the COVID-19 vaccine to Medicare beneficiaries who would encounter difficulty in being vaccinated otherwise.

While the COVID-19 vaccine is readily available to most people at their pharmacy, doctor’s office, or special vaccination site, some have difficulty leaving their homes or have situations that make it challenging to get to any of these locations. The increase in payment is part of the effort to make it as easy as possible for all Americans to get vaccinated.

CMS estimates that approximately 1.6 million people aged 65 or older may have difficulty leaving home.

Additional In-Home Payment Qualifying Locations

For purposes of the additional payment, the patient’s home may be a private residence, apartment, or hotel/motel room. Other temporary lodgings including campgrounds, hostels, and homeless shelters also qualify. A unit in a group home or assisted living facility qualifies as in-home, but communal spaces of multi-unit facilities do not qualify for the additional payment.

If a patient’s home is “made provider-based to a hospital during the COVID-19 public health emergency” it qualifies, but the additional payment does not apply for vaccines given in Medicaid nursing facilities and Medicare skilled nursing facilities or hospitals, even if they are the patient’s permanent residence.

Challenges of In-Home Vaccination

Several factors resulted in the increased payment for in-home vaccination. One is simply the additional time required for personnel to get to the home and get set up. Extra time is required for monitoring beneficiaries after receiving their shots. In other settings, multiple recipients can be monitored at one time and personnel can starting the next patient, whereas, in the home setting, they have to stay on-site and wait.

Ensuring proper storage and handling of the vaccine, particularly maintaining the required temperature is another challenge for in-home administration. Because the vaccines are provided in vials containing multiple doses, careful planning is needed to determine how many people can be reached in one trip and to determine the number of doses/vials needed in order to minimize waste. Prep time for each shot and post-vaccination observation time must be factored into the estimates for planning.

The guidance on vaccinating homebound persons specifies that in order to avoid wasting vaccine doses, vaccinations may be given to caretakers and family members “as appropriate and approved by jurisdictions.” However, the payment guidance specifies that “If you administer the COVID-19 vaccine to more than 1 Medicare patient in a single home on the same day, Medicare pays: The additional payment amount of approximately $35 only once per date of service in that home, (and) Approximately $40 to administer each dose of the COVID-19 vaccine.”

Vaccine temperatures must be monitored, maintained, and reported when they are taken from storage, during transport, and at the time they are administered. Keeping the vials at the correct temperature requires careful management of equipment as well as proper handling. The responsible person must be trained on handling procedures for the vaccine in these remote locations.

CDC’s Guidance Vaccinating Homebound Persons With COVID-19 Vaccine also notes the importance of providing “training on accessibility-specific issues, such as working with people who are blind or have limited vision; those who are deaf or hard of hearing; those who work with service animals; and those with various language, physical, social, or sensory needs.”

Vaccine Payment Almost Doubles

The additional payment for giving a dose of the vaccine to a beneficiary in their home is $35. This makes the total per dose approximately $75, so completing a two-dose vaccine will result in a payment of about $150.

Like the basic payment rate for administering the vaccine, the additional in-home payment amount will be geographically adjusted according to the service location.

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