The U.S. Centers for Medicare & Medicaid Services (CMS) has authorized an additional $35 payment to incentivize health care providers to bring COVID-19 vaccines to patients who cannot easily leave their homes, including many hospice patients. This amount is in addition to the approximately $40 payment that Medicare currently pays for administration of a vaccine dose.
For vaccines that require two doses, the total payment would be close to $150, about $70 higher than the current rate. Nearly 1.6 million Medicare beneficiaries are considered homebound, which complicates their ability to secure vaccination, according to CMS.
“CMS is committed to meeting the unique needs of Medicare consumers and their communities – particularly those who are homebound 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 CMS Administrator Chiquita Brooks-Lasure. “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.”
The U.S. Centers for Disease Control & Prevention has developed guidance to help providers navigate the unique considerations of providing these vaccines in the home. This includes ensuring proper vaccine storage temperatures in transit, as well as guidelines for handling and administering the vaccine.
The CMS action is designed to help relieve the financial burden of providing this service safely and effectively and accounts for the clinical time necessary to monitor the patient post-vaccination. Similar to the per diems paid through the Medicare Hospice Benefit, vaccination payments will be geographically adjusted. With Medicare ensuring payment, providers are prohibited from charging the patient or family any additional fees related to the vaccination.
Some hospice providers and other stakeholders have taken the initiative to reach homebound patients prior to this move by CMS. South Carolina-based Agape Care Group launched a program to vaccinate homebound patients, including those in rural or remote areas. Agape collaborated with the South Carolina Department of Health and Environmental Control (DHEC) to ensure that its clinical teams were briefed and trained on vaccine protocols.
Hospice Savannah in Georgia earlier this year established its own mass vaccination sites, and Medicare Advantage payer SCAN Health Plan also took big steps to get the vaccines to patients who could not leave their homes.
If a patient is uninsured or if their health plan denies payment, providers may submit claims through the COVID-19 Coverage Assistance Fund administered by the Health Resources and Services Administration (HRSA).
“This is a very positive step forward. We thank the White House and CMS for the productive discussions on vaccinating homebound patients in the past few weeks,” said William A. Dombi, president of the National Association for Home Care & Hospice (NAHC). “We look forward to continuing our partnership with them in getting vaccines to a very vulnerable group of individuals who cannot otherwise secure the life-saving COVID vaccines.”