Medicare Reimbursement

Who Pays?

McKnight’s reported that CMS will pay for coronavirus treatments. The government’s decision to allow Medicare reimbursement for COVID-19 treatments should be extremely helpful for nursing homes care with symptomatic, positive residents. CMS announced that coverage for the treatment will be available to nursing homes at no cost during the public health emergency.

“Nursing home residents, just by their very nature, are the types of people who will benefit from this. They’re at high-risk for bad outcomes and hospitalization. It seems like a good fit,” Karl Steinberg, M.D., president-elect of AMDA — The Society for Post-Acute and Long-Term Care Medicine. 

CMS’ coverage will apply to bamlanivimab. The agency added Medicare will cover and pay for the infusions and vaccines. However, the program will not pay for products that providers receive for free. No double recovery is appropriate.

CMS explained in a memo that Medicare will establish guidelines, and codes and rates for the administration of the products.

Vaccine Issues

The federal government has agreements with CVS and Walgreens to send pharmacists and support staff to vaccinate residents and staff at thousands of long-term care facilities such as nursing homes and assisted-living communities.

Some residents and staff are balking at taking the vaccine. And there remains widespread confusion about a key element: how nursing homes will get consent to vaccinate residents who aren’t able to make their own medical decisions.

Employees at SavaSeniorCare, one of the largest for-profit nursing-home chains, are confused. The chain doesn’t believe they can start getting consent from residents and staff until they get the forms from CVS. Annaliese Impink is a SavaSeniorCare executive coordinating the vaccine rollout.

Consistently short-staffed facilities like the SavaSeniorCare chain are concerned about extra labor costs and workers sick with side effects. The National Association of Health Care Assistants disclosed that 72 percent of CNAs refuse to receive the vaccine.

With most nursing home employees work in shifts, will it be possible to vaccinate everyone over the course of just a few visits from CVS and Walgreens?  Will it take all of 2021 to get done?