CMS to Relax Medicare Billing Rules to Speed COVID-19 Vaccine Distribution in Nursing Homes
Skilled Nursing News
|
The federal government on Friday announced its intention to relax restrictions around billing Medicare for immunization in nursing homes, with the stated goal of speeding the eventual distribution of a COVID-19 vaccine.
Skilled nursing facilities are typically required to bill Medicare directly for immunizations under the terms of the Social Security Act, even if the vaccines are provided by a third-party firm such as an independent pharmacy.
Citing the ongoing federal coronavirus emergency, the Centers for Medicare & Medicaid Services (CMS) will use “enforcement discretion” to widen the group of providers that can be reimbursed for COVID-19 vaccinations.
“Through the exercise of that discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare SNF residents,” CMS announced in a Medicare Learning Network announcement.
The news came the same day that the Department of Health and Human Services (HHS) announced a partnership with retail pharmacy giants Walgreens and CVS to distribute vaccines to nursing homes and other congregate care settings across the country at no cost to operators or residents. Walgreens and CVS will bill Medicare, Medicaid, and private payers for the direct administration of the vaccine, federal officials indicated, with Washington already picking up the tab for acquisition and distribution.
The flexibility will last either until the end of the quarter in which the formal federal emergency is suspended, or “so long as CMS determines that there is a public health need for mass COVID-19 vaccinations in congregate care setting,” whichever comes last.
CMS positioned outside immunization providers as vital to facing the “unprecedented challenge” of distributing a COVID-19 vaccine to seniors in the long-term and post-acute setting.
“Unfortunately, many long-term care facilities may not have sufficient capacity to receive, store, and administer vaccines,” CMS noted in the announcement. “And some long-term care facility residents cannot safely leave the facility to receive vaccinations.”
CMS will provide 60 days’ notice of a change to the waived requirements, the agency indicated.
The COVID-19 vaccines currently under development come with unique logistical challenges, including the need for extremely low-temperature storage and management of multiple doses for each recipient.
“You can’t simply send 100 doses to a nursing home [in one] box, that everybody’s been administered the same drug in the same dose. They’re going to require booster shots. That’s going to be specific to the particular kind of vaccine,” Alan Rosenbloom, president and CEO of the Senior Care Pharmacy Coalition, told SNN in September. “There’s a hell of a lot of patient tracking that’s going to have to happen, and employee tracking is going to have to happen.”
To view the article at Skilled Nursing News click here.
Recent Posts
-
Rep. Beth Van Duyne: Congress can save seniors’ access to medications before it’s too late
Seniors in nursing homes across the country depend on round-the-clock care and medications, perhaps more than any other American patient population. In turn, the nursing homes and assisted living facilities that care for them depend on a small number of specialized long-term care (LTC) pharmacies to ensure their patients have access to the prescription meds they need.
-
Bill Aims to Offset Reimbursement Losses for Long-Term Care Pharmacies Catering to Nursing Homes
Starting in January, falling prices for costly drugs may strain long-term care pharmacies, but proposed legislation backed by advocacy groups aims to subsidize some of this loss. And nursing home advocacy groups are among those urging Congress to pass the Preserving Patient Access to Long-Term Care Pharmacies Act.
-
Drug pricing policy could jeopardize long-term care pharmacies, leaders contend
Senior living and care leaders have joined a coalition calling attention to a policy fix they say would address unintended consequences of Medicare Part D price negotiations that could shutter long-term care pharmacies.
Stay in the Know
Get the latest news and updates on issues impacting the long-term pharmacy community.