# Presentation: 047909

## STRENGTHENING THE SUPPLY OF VACCINES IN THE UNITED STATESThe CMS PerspectiveNVAC Conference James Randolph Farris, M.D.Regional Administrator,CMS Region VIJanuary 25,2005     Washington, D.C.

## MEDICARE COVERAGE OF ADULT IMMUNIZATIONS

- 1981 - Coverage of Pneumococcal Immunizations
- 1993 - Coverage of Influenza Immunizations

## CREATING VACCINE DEMAND

- Among Medicare Beneficiaries And Their Caregivers
- Among Physicians And Providers

## CREATING VACCINE DEMAND

- Medicare Summary Notice Messages To Beneficiaries
- National Marketing Materials
- Provider Reminder Postcards And Posters
- Public Service Announcements

## CREATING VACCINE DEMAND

- Physician And Provider Notices
- Messages On Carrier Web Sites
- Annual Distribution Of Updated _Immunizer’s Question And Answer Guide To Medicare Coverage Of Influenza And Pneumococcal Immunizations_

## CREATING VACCINE DEMAND

- _Medicare Preventive Services: Adult Immunizations_ Booklet
- _Flu Billing Made Easier _Video And CD ROM
- Roster Billing
- Standing Orders

**Notes:**
CMS annually produces and distributes the Medicare Immunizer’s Question and Answer Guide to Medicare Coverage of Influenza and Pneumococcal Vaccinations package which responds to commonly asked questions regarding coverage policy, claims processing, mass immunization, roster billing and managed care.

Currently being updated

## HIPAA AND ROSTER BILLING

- The CMS Published a Rule That Waived the Electronic Submission of Roster Billed Medicare Claims for Influenza and Pneumococcal Immunizations.

## “...The Final Rule Will Remove the Federal Barrier Related to the Requirement for a Physician to Order Influenza and Pneumococcal Immunizations in Medicare and Medicaid Participating Hospitals, Long-term Care Facilities, and Home Health Agencies...”

- Federal Register/Volume 67 No. 191, October 2, 2002    

***- Federal Register/Volume 67 No. 191, October 2, 2002******    ***

**STANDING ORDERS REGULATION**

## Standing Orders Programs Authorize Nurses or Pharmacists, Where Allowed by State Law, to Administer Immunizations According to an Institution- or Physician-Approved Protocol Without the Need for a Physician’s Order or Signature.

**STANDING ORDERS PROGRAMS**

## CMS REGIONAL OFFICE IMMUNIZATION COORDINATORS

- Region - Specific Outreach Activities
- Projects With Immunization Coalitions
- Projects With QIOs

## Activities of CMS’s Quality Improvement Organizations

- Influence Behavior Related to Health Care
- Identify Opportunities to Improve the Health Care Delivered to Medicare Beneficiaries
- Design and Implement Culturally Sensitive and Appropriate Interventions

**Notes:**
 CMS works with its Quality Improvement Organizations (QIOs) on the individual state level to influence beneficiary and provider behavior related to immunization practices. By using Medicare claims data, CMS and the QIOs can identify those areas or populations where there is an opportunity to improve the immunization rates among Medicare beneficiaries. Through their quality improvement activities, QIOs design and implement culturally sensitive and appropriate interventions to address those areas of need, with the ultimate goal being to increase the rate of immunizations among the Medicare population. 

## QUALITY IMPROVEMENTORGANIZATION (QIO) PROJECTS

- Every Quality  Improvement Organization Is Required to Increase Immunization Rates in Its State for Influenza and Pneumococcal Disease

## SPECIAL PROJECTS

- Oklahoma Foundation for Medical Quality
- Supports CMS by Developing and Implementing Strategies for Systems Changes to Promote Influenza and Pneumococcal Immunizations

## SPECIAL PROJECTS(CONTINUED)

- Racial and Ethnic Adult Disparities in Immunization Initiative (READII)
- USDHHS Project (CDC, CMS, OMH)
- Rochester, New York
- Chicago, Illinois
- Milwaukee, Wisconsin
- San Antonio, Texas
- Rural Counties in Mississippi

## ELIMINATION OF RACIAL AND ETHNIC HEALTH DISPARITIES

- Part of CMS’s Contribution to This Effort Is the Elimination of Racial and Ethnic Disparities in Immunization of Medicare Beneficiaries for Influenza and Pneumococcal Disease

## CMS IMMUNIZATIONPARTNERSHIPS

- Centers for Disease Control and Prevention
- American Medical Association
- National Influenza Vaccine Summit
- National Foundation for Infectious Diseases/National Coalition for Adult Immunization

## CMS IMMUNIZATIONPARTNERSHIPS(CONTINUED)

- National Medical Association
- National Hispanic Medical Association
- Co-Sponsorship of National Conference of Immunization Coalitions

## VACCINE ORDER REMINDER NOTICE

- CMS Instructed Medicare Carriers to Publish Notices in Their Newsletters and on Their Web Sites Reminding Physicians and Providers to Order Influenza Vaccine Early.

## HEALTH PROFESSIONAL IMMUNIZATION RATE

- Data From the National Health Interview Survey (NHIS) Indicate That Only 36% of Health Professionals in the United States Are Immunized Against Influenza Annually.

## REIMBURSEMENT INCREASES

- Since 2000, CMS Has Progressively Increased Reimbursement Rates for Influenza and Pneumococcal Vaccine.
- Influenza		$10.10
- Pneumococcal	$23.28
- Administration Fee Increased to an Average of $18.00 on January 1, 2005

## MEDICARE MODERNIZATION ACT

- “Welcome To Medicare” Physical Examination
- Introduction To Preventive Benefits
- Influenza And Pneumococcal Immunizations
- Cardiovascular Screening
- Diabetes Screening

## THANK YOUJames Randolph Farris, M.D.214.767.6427rfarris@cms.hhs.gov