Home Health & Hospice

Modifications to CMS’ pneumococcal vaccine policy to be implemented next week

Homecare Insider, January 26, 2015

Next Monday, CMS will implement reimbursement policy modifications to better align Medicare coverage with updated recommendations for administering pneumococcal vaccinations to elders.
The revisions—which were outlined in a change request (CR 9051) dated December 31, 2014, and became effective September 19, 2014—are based on new vaccination guidelines from the Advisory Committee on Immunization Practices (ACIP) that dictate the administration of a series of two different pneumococcal vaccinations for all adults 65 years of age and older.
Accordingly, CMS is updating coverage requirements to allow providers to administer an initial pneumococcal vaccine to all Medicare beneficiaries who have never received such a vaccination under Medicare Part B. The second type of recommended pneumococcal vaccine may be administered one year after the first vaccine was administered (i.e., when 11 full months have passed following the month in which the initial pneumococcal vaccine was administered).
Before these modifications, CMS would generally cover the pneumococcal vaccine once in a beneficiary’s lifetime. In addition, it would typically only cover revaccinations for those at highest risk if five years had passed since the last vaccination or if the beneficiary’s vaccination history was unknown.
To access the full change request, click here.
To view the APIC recommended pneumococcal vaccine schedule, click here.