CMS Increases Vaccine Reimbursement for Home Health Providers, Others

The U.S. Centers for Medicare & Medicaid Services (CMS) announced Monday that it is increasing the Medicare payment amount for administering the COVID-19 vaccine.

That could lift the home health organizations that have been able to play a role in vaccinating homebound seniors throughout their communities. Not all in-home care operators have been able to secure vaccines to deliver, but those that have are playing essential roles in getting the pandemic under control.

“This new and higher payment rate will support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day, including establishing new or growing existing vaccination sites, conducting patient outreach and education, and hiring additional staff,” CMS wrote in its announcement. “At a time when vaccine supply is growing, CMS is supporting provider efforts to expand capacity and ensure that all Americans can be vaccinated against COVID-19 as soon as possible.”


Aging services trade group LeadingAge recently touted multiple examples of in-home care organizations going above and beyond to vaccinate vulnerable, homebound populations.

In Syracuse, New York, for example, Nascentia Health is delivering vaccines to seniors who are unable to travel to vaccination sites. Not too far away, the Visiting Nurse Association Health Group’s program is bringing COVID-19 vaccines to homebound older adults in New Jersey.

In Pennsylvania, Geisinger Health — a large health system whose joint venture partners include LHC Group Inc. (Nasdaq: LHCG) — has identified 500 older homebound adults and is bringing vaccines to them.


Earlier this month, health care technology company Ro also revealed that it is among the innovative organizations now helping to vaccinate homebound older adults. Ro has been teaming up with the New York State Department of Health to administer in-home vaccinations.

“You have Americans today who are elderly, disabled and homebound, who are facing serious challenges when it comes to accessing vaccinations,” Saman Rahmanian, co-founder and chief product officer of Ro, previously told Home Health Care News. “In New York alone, you have 2.1 million folks who are over 65 and who live with chronic conditions for whom it’s too difficult, too unsafe and sometimes even impossible to travel to a vaccination site.”

Effective for COVID-19 vaccines administered on or after March 15, the national average payment rate for physicians, hospitals, pharmacies and other immunizers will be $40 for each dose, according to CMS. That represents an increase from about $28 to $40 for the administration of single-dose vaccines, and an increase from about $45 to $80 for the administration of two-dose vaccines.

“The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished,” the agency noted.

Beneficiaries with Medicare pay nothing for COVID-19 vaccines. There is no applicable copayment, coinsurance or deductible.

Under Medicare Advantage (MA), for calendar years 2020 and 2021, Medicare will pay providers directly for the COVID-19 vaccine and its administration for beneficiaries enrolled in MA plans. MA plans are not responsible for paying providers to administer the vaccine to MA enrollees during this time.

Like beneficiaries in traditional Medicare, MA enrollees also pay no cost-sharing for COVID-19 vaccines, according to CMS.

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