Two new COVID vaccines were approved for use late last week, and experts continue to encourage seniors to get the booster, but payment issues for nursing homes and long-term care pharmacies complicate access for residents.
The US Food and Drug Administration approved vaccines from Pfizer and Moderna that should now be in transit to doctors’ offices and commercial pharmacies. But Chad Worz, chief executive of the American Society of Consultant Pharmacists, told McKnight’s Long-Term News Friday that the billing and reimbursement processes that nursing homes must utilize continues to cause problems.
“Payment issues in nursing home settings continue to be a barrier to implementing successful vaccinations for residents,” Worz said. “It also has a simple fix that was available during the COVID-19 emergency but stripped away after the official end of the emergency.”
He added that access to vaccines “should” be better than last year.
“Right now, it’s on the manufacturers to get it produced and distributed. It looks promising that we will have ample access to vaccines timely for this season,” he said.
Until the federal government declared an end to the COVID public health emergency on May 11, 2023, COVID vaccines were provided free of charge to anyone who wanted to get the shot. Since then, it has been commercially available to those with private insurance or through free- or low-cost clinics for those who qualified.
For nursing home residents, it’s complicated. For residents in their Medicare Part A stay, COVID, influenza, and pneumococcal vaccines are covered outside of the consolidated payment for Part through Medicare Part B but only if the nursing home roster bills those vaccines and administrations to Part B, Worz said. Long-term care pharmacies cannot bill Medicare Part B for these vaccines to Medicare Part A individuals.
For non-Part A individuals, residents in the long-stay part of the nursing home, pharmacies can bill Medicare Part B for vaccines and administration for COVID, influenza and pneumococcal, according to Worz. Nursing homes can bill Medicare Part B for long-stay residents for COVID, influenza, and pneumococcal, but they cannot bill for the other vaccines recommended by the Advisory Committee on Immunization Practices for older adult vaccines (Part D).
“This complicated system creates challenges to effectively and efficiently getting shots in arms to this vulnerable population,” Worz said. “Should the Secretary [of the US Department of Health and Human Service] or CMS return to allowing long-term care pharmacies to bill for the vaccine and administration of COVID-19, pneumococcal and influenza to individuals in their Part A stay, they could be responsible for the entire vaccination process for all ACIP-recommended vaccines to older adults in nursing homes, which would allow more efficient and effective vaccination partnerships between LTC pharmacies and nursing homes.”
Pressure still on
It remains critically important for seniors, particularly those in community living environments, to continue receiving at least annual COVID vaccinations, emphasized Rajeev Kumar, MD, president of the Post-Acute and Long-Term Care Medical Association, in an interview with McKnight’s Friday.
The newly approved shots from Pfizer and Moderna target the KP.2 strain, which the Centers for Disease Control and Prevention said accounts for approximately 3% of all current cases in the US.
“Most of our residents are high-risk individuals,” Kumar said. “We are seeing pretty significant infection rates even in people who have previously been vaccinated, so having this booster, especially if you didn’t catch COVID in the latest wave, is important.”
Kumar noted there are efforts to develop a combined vaccine for COVID and influenza that could also become a triple shot including RSV, but individual vaccines should remain available.
But he and Denise Winzeler, curriculum development specialist with the American Association of Post-Acute Care Nursing, both acknowledged that vaccine fatigue is becoming a larger issue throughout the country.
“Facilities need to be diligent and promote this vaccine just as we do other seasonal vaccines to ensure safety for residents and staff,” Winzeler told McKnight’s.
Uptake confusion
LeadingAge emphasized the same thing in a letter to the White House following the July 18 Long-Term Care Leadership Summit 3.0
“Sadly, it appears that efforts to provide the public with the most up-to-date information and tools for mitigating COVID have backfired,” wrote LeadingAge’s director of Nursing Home Quality & Policy Jodi Eyigor. “COVID mitigation strategies for healthcare settings changed frequently throughout the public health emergency, and while flu shots are recommended only once per season, COVID vaccine recommendations have also changed frequently over the years, with new variant vaccines introduced seemingly every few months and additional doses often required for high-risk populations.
“This has led residents/families and staff to subsequently conclude that COVID mitigation measures and COVID vaccines are ineffective, since recommendations have been updated so many times,” she added.
Still, Kumar said once-a-year vaccinations may not be enough for vulnerable seniors.
“COVID is now endemic in our country and across the world,” he said. “It’s almost become a flu-like illness for most of us, but there are still deaths happening among the very old and immuno-compromised patients. Yearly [shots] may not be enough. It depends on how protective it is and for how long.”
