Clinical Corner: Immunization in Long Term Care

News

• Medicare coverage and reimbursement rules for the H1N1 vaccine and seasonal flu coverage and reimbursement information.

  Note that Medicare will pay for seasonal flu vaccinations even if the vaccinations are rendered earlier in the year than normal.  We understand that such preparations are critical for the upcoming flu season, especially in planning for the influenza A (H1N1) vaccine.

  Though Medicare typically pays for one vaccination per year, if more than one vaccination per year is medically necessary (i.e., the number of doses of a vaccine and/or type of influenza vaccine), then Medicare will pay for those additional vaccinations.  Our Medicare claims processing contractors have been notified to expect and prepare for earlier-than-usual seasonal flu claims and there should not be a problem in getting those claims paid.  Furthermore, in the event that it is necessary for Medicare beneficiaries to receive both a seasonal flu vaccination and an influenza A (H1N1) vaccination, then Medicare will pay for both. 

  Please be advised that if either vaccine is provided free of charge to the health care provider, then Medicare will only pay for the vaccine’s administration (not for the vaccine itself). 

  All providers administering flu vaccine should review this article and be sure that their billing staffs are aware of this information. For more information, please read the article located at:
  http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0920.pdf 

• The Centers for Medicare & Medicaid Services has issued new MDS coding guidance for skilled nursing facilities for the upcoming flu season.  Nursing facilities should only code the MDS for the "Seasonal Influenza Vaccine," not for the "H1N1 Influenza Vaccine," according to CMS. For H1N1 influenza, nursing facilities should follow the specific guidance from the Centers for Disease Control and Prevention. H1N1 information and guidance can be found at www.cdc.gov/flu.

  http://www.amda.com/tools/clinical/pandemic.cfm

• H1N1 vaccine effective after one dose, not two doses as original predicted.
  • Pandemic Influenza Vaccine Policy — Considering the Early Evidence
  • Trial of Influenza A (H1N1) 2009 Monovalent MF59-Adjuvanted Vaccine — Preliminary Report
  • Response after One Dose of a Monovalent Influenza A (H1N1) 2009 Vaccine — Preliminary Report
  • Additional H1N1 Resources

Articles

Falsey A, Treanor  J, Tornieporth  N et al. Randomized, Double‐Blind Controlled Phase 3 Trial Comparing the Immunogenicity of High-Dose and Standard-Dose Influenza Vaccine in Adults 65 Years of Age and Older

Poland G, Mulligan M. The Imperative of Influenza Vaccines for Elderly Individuals—An Evolving Story

Cate TR, Rayford Y, Niño D, Winokur P, A high dosage influenza vaccine induced significantly more neuraminidase antibody than standard vaccine among elderly subjects.

Dean AS, Moffatt CR, Rosewell A, Et al. Incompletely matched influenza vaccine still provides protection in frail elderly.

Tools

• Patient Self-Screening Form for Inactivated Influenza Vaccine (from CDC)


• There will be an influenza vaccination record card that will be available next week on the Influenza Summit's web site (www.preventinfluenza.org) for download. This card is identical to the card that will be included in quantity with shipments of H1N1 influenza vaccine

Links

CDC National Immunization Information Hotline

CDC National Immunization Program

Immunization Action Coalition

Institute for Vaccine Safety

National Coalition for Adult Immunization

National Network for Immunization Information