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CMS Makes It Easier for Community Health Centers to Vaccinate Seniors

Contact: Amy Simmons Farber 202 309 0338

The  Biden Administration has announced a new policy that will support Community Health Centers in their efforts to vaccinate Americaโ€™s seniors against COVID-19. The Centers for Medicare and Medicaid Services (CMS) is permitting health centers to immediately request and receive lump sum payments that pay at 100% of reasonable cost for COVID-19 vaccine administration.

The Biden Administration has asked the nationโ€™s health centers, also known as Federally Qualified Health Centers, to play a leading role in delivering the COVID-19 vaccine to our most vulnerable communities. However, health centers need the tools and resources to do their part and this recent action by the Biden Administration to improve Medicare COVID-19 vaccine reimbursement will enable health centers to more effectively vaccinate Americaโ€™s seniors.

Serving nearly 3 million Medicare beneficiaries a year, health centers are positioned to meet the goal of vaccinating the 65 and older population as quickly as possible. Unfortunately, existing Medicare vaccine reimbursement policies have, up until now, left health centers severely challenged at the worst possible time. Typically, health centers are reimbursed at the end of the fiscal year for flu vaccine administration, and recent Medicare policy requires the COVID-19 vaccine to be similarly reimbursed. Since health centers are redirecting finite resources to fulfill urgent vaccination needs in their communities, year-end reimbursement without any interim payment is not sustainable.

Receiving after-the-fact reimbursement โ€“ in some cases more than a year after vaccinating the patient โ€“ would impose unique hardships on health centers. Health centers are being tasked with vaccinating large swaths of the population in their service areas in a short timeframe, and administering the COVID-19 vaccine poses several challenges for health centers that increase their costs:

  • The vaccine has a short shelf life
  • Many vaccines require two doses, meaning staff must double outreach efforts
  • The volume of appointments creates intense scheduling demands
  • Dedicated staff are necessary for patient monitoring

The National Association of Community Health Centers (NACHC) and other advocates have asked Medicare to modify its COVID-19 vaccine administration reimbursement policies. In response to this problem, CMS is permitting health centers to immediately request and receive lump sum payments that pay at 100% of reasonable cost for COVID-19 vaccine administration.

โ€œThis is great news for Americaโ€™s seniors. Health centers and providers are working to deliver the vaccine to every person that walks through our doors, including our Medicare patients, but success is only possible if we have the resources to do the job,โ€ said NACHC Chief Medical Officer Ron Yee, MD. โ€œThe Biden Administration and CMS deserve tremendous credit for adapting and ensuring health centers can continue focusing on delivering the vaccine in their communities and not how to keep their doors open.โ€