October 18, 2002 
Centers for Medicare and Medicaid Services
Influenza and Pneumonia Activities 
Immunization (Standing Orders Regulation): This new regulation was published in the 
Federal Register on October 2, 2002. The regulation allows hospitals, nursing homes and 
home health agencies to use Standing Orders to immunize their patients. Attached are two press releases (consumer and professional versions) from the Oklahoma 
Foundation for Medical Quality on the new Immunization Regulation. 
Centers for Medicare and Medicaid Services / Centers for Disease Control and Prevention Standing Orders Project 
Standing orders programs authorize nurses or pharmacists to administer vaccination 
according to an institution- or physician-approved protocol without a physicians 
examination. 
To date, the Standing Orders Project reveals that, after a review of 22,000 nursing home 
residents in 14 states, vaccine coverage rates fall far below the Healthy People 2010 goal of 
90 percent. Baseline data indicates only 58 percent and 33 percent of nursing home residents received the flu 
and pneumonia vaccines, respectively. Preliminary data also shows that standing orders are 
associated with the highest coverage rates in nursing homes for flu and pneumonia. 
Currently, less than 10 percent of nursing homes are using standing orders. However, the coverage 
rate for flu using standing orders is 71 percent vs. 56 percent for usual care. The coverage rate for 
pneumonia using standing orders is 75 percent vs. 4 percent for usual care. Standing orders have been 
proven more effective and are less costly. The cost of implementing a standing order is 
$7.00 per resident as compared to alternative interventions, which is $14.00 per resident 
(twice as expensive). 
Office of Clinical Standards and Quality  Quality Improvement Organizations 
Every Quality Improvement Organization is required to work on immunization (influenza and pneumococcal) projects: The 
projects include working with: 
 Immunization coalitions in their states to promote immunizations in ambulatory and institutional settings. 
 Hospitals to promote standing orders. 
 Physician on public health campaign messages and sending them directly to physician offices showing the percentage of patients being immunized. 
 Flu clinics, senior centers and health fairs. Some QIOs provide direct beneficiary education at these sites. 
 The Disparities project which focuses on increasing flu and pneumonia vaccination rates among diverse populations (African-American Hispanics and Native American Indians). 
 Historically Black Colleges and Universities.
 Physicians. Some Quality Improvement Organizations are providing direct mail and information to primary care 
physicians and encouraging them to vaccinate their population of patients. 
 Cable networks and producing public service announcements, and speaking on radio talk shows about the importance of being immunized against influenza and 
pneumococcal diseases. 
Centers for Medicare and Medicaid Services
National Influenza and Pneumococcal Campaign*: Funds are used to evaluate innovative health promotion campaigns and improve immunization rates among minority and 
other vulnerable populations (African-American, Hispanic and Native American Indians): In Fiscal Year 02, 
Centers for Medicare and Medicaid Services is contracting with the following organizations: 
 National Medical Association 
 CDC National Immunization Conference 
 National Conference on Immunization Coalitions 
 CMS Region-Specific Outreach Efforts 
 National Foundation for Infectious Diseases 
 Oklahoma Foundation for Medical Quality 
 Baltimore City Health Department 
 Dallas Area Agency on Aging 
 Rio Grande Area Agency on Aging in El Paso 
 Religious, Educational, Charitable and Development Projects, Inc. 
 Mille Lacs Band of Ojibwe Indians  Ne-Ia-Shing Clinic (Native American Indians) 
 Virginia Commonwealth University 
In Fiscal Year 03, Centers for Medicare and Medicaid Services will contract with organizations to improve the rate of immunizations among 
Asian-Pacific Islanders. 
Vaccine Supply Update (As of September 30, 3002): No delays are expected in the availability of influenza vaccine or shortages of vaccine supply. 
 Manufacturers now project 94.9 million doses to be produced this year, which greatly exceeds last years production of 87.7 million. 
 Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention and other groups represented must work to increase 
demand for the vaccine to make sure that all produced is used. 
 If all companies continue to proceed as planned, the bulk of the vaccine should be distributed by the end of October. 
Flu & Pneumonia Reimbursement Rates: Medicare pays: 
 8.02 dollars for influenza vaccine 
 13.10 dollars for pneumococcal vaccine. 
 3.00 dollars to 6.00 dollars for administration costs which varies in accordance with geographic location. 
*Quality Improvement Organizations support monies fund the Centers for Medicare and Medicaid Services Influenza and Pneumococcal Campaign.