Expanded Billing Discretion When Vaccinating SNF Residents

Centers for Medicare and Medicaid Services (CMS) announced that effective September 20, 2021, it will allow Medicare-enrolled immunizers, including pharmacies, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare skilled nursing facility (SNF) residents. Social Security Act §§ 1862(a)(18), 1842(b)(6)(E) requires SNFs to bill for certain services, including vaccine administration, even when SNFs rely on outside vendors to perform the service. However, CMS cited several reasons justifying the exercise of its enforcement discretion to allow Medicare-enrolled immunizers to bill Medicare directly when vaccinating Medicare SNF residents.  These justifications include the urgent need to quickly, safely and effectively vaccinate residents in long-term care facilities who are particularly vulnerable and cannot safely leave the facility to receive vaccinations and the insufficient capacity of most SNFs to receive, store and administer vaccines. This exercise of discretion encompasses the seasonal influenza vaccine and pneumococcal vaccine, in addition to the COVID-19 vaccine.