The National Rural Health Association (NRHA) produced this summary of the rural health provisions in COVID-19 relief legislation and highlights NRHA’s priorities for COVID-19 relief for rural health care.

Vaccinating rural communities to mitigate the COVID-19 pandemic is no simple task and the National Rural Health Association (NRHA) understands the unique issues and viewpoints you face as a rural health stakeholder leading the way. Although many resources are currently available, we know materials focused for rural audiences will be most effective in reaching our communities. Because of this, NRHA has curated tools to assist you immediately and allow you to easily distribute and co-brand by adding your organization’s logo. Our resource library includes conversation starters and public service announcements developed in partnership with the COVID Collaborative, Health Action Alliance, and the Ad Council that can help rural employers, small business owners and public sector employers share vaccine facts and improve vaccination access for employees and families.

The Chartis Center for Rural Health released the results of the survey they conducted on vaccine hesitancy among rural hospital staff. Their survey found that 30% of the 160 rural hospital executives who responded said less than half of their employees had been vaccinated — even though health care workers had been eligible for months. Only about a third said that 70% or more of their staff were vaccinated. Additionally, the survey asked participants what the reasons were for those opting to not receive the vaccine, and Matter of Personal Opinion and Lack of Trust in Vaccines were the top two reasons. NRHA knows that health care personnel in rural communities tend to be leaders and examples for their patients, and we are communicating that message to Congress and the administration.

The White House has announced a goal of having a 70 percent vaccination rate among American adults by the Fourth of July holiday. To help achieve this goal, the House Energy and Commerce Committee held a hearing on vaccine hesitancy, discussing in detail the hesitancy facing rural communities. NRHA applauds the White House for this vaccination goal and is pleased to see Congress examining the reasons some communities have struggled to receive the vaccine in high numbers. We are committed to continuing working with both the Administration and Congress to ensure the vaccination rate continues to grow.

The House Appropriations Labor, Health and Human Services, Education and Related Agencies Subcommittee held a hearing on the FY 2022 budget request for the Centers for Disease Control and Prevention (CDC). During the hearing, Representative Cheri Bustos (D-IL) asked CDC Director Rochelle Walensky about what the agency is doing to increase rural vaccine access and uptake. Dr. Walensky responded by acknowledging the agencies efforts to increase grassroots education efforts, funding for community health workers, and telehealth utilization.

The Food and Drug Administration (FDA) updated its guidance for health care providers administering the vaccine and allows for undiluted, thawed Pfizer-BioNTech COVID-19 Vaccine vials to be stored in refrigeration for up to one month. The previous time span was up to five days.

Action Could Impact as many as 1.6 Million People with Medicare

As part of President Biden’s commitment to increasing access to vaccinations, the Centers for Medicare & Medicaid Services (CMS) today announced an additional payment amount for administering in-home COVID-19 vaccinations to Medicare beneficiaries who have difficulty leaving their homes or are otherwise hard-to-reach. This announcement further demonstrates continued efforts of the Biden-Harris Administration to meet people where they are and make it as easy as possible for all Americans to get vaccinated.  There are approximately 1.6 million adults 65 or older who may have trouble accessing COVID-19 vaccinations because they have difficulty leaving home.

While many Medicare beneficiaries can receive a COVID-19 vaccine at a retail pharmacy, their physician’s office, or a mass vaccination site, some beneficiaries have great difficulty leaving their homes or face a taxing effort getting around their communities easily to access vaccination in these settings. To better serve this group, Medicare is incentivizing providers and will pay an additional $35 per dose for COVID-19 vaccine administration in a beneficiary’s home, increasing the total payment amount for at-home vaccination from approximately $40 to approximately $75 per vaccine dose. For a two-dose vaccine, this results in a total payment of approximately $150 for the administration of both doses, or approximately $70 more than the current rate.

“CMS is committed to meeting the unique needs of Medicare consumers and their communities – particularly those who are home bound or who have trouble getting to a vaccination site. That’s why we’re acting today to expand the availability of the COVID-19 vaccine to people with Medicare  at home,” said CMS Administrator Chiquita Brooks-Lasure. “We’re committed to taking action wherever barriers exist and bringing the fight against the COVID-19 pandemic to the door of older adults and other individuals covered by Medicare who still need protection.”

Delivering COVID-19 vaccination to access-challenged and hard-to-reach individuals poses some unique challenges, such as ensuring appropriate vaccine storage temperatures, handling, and administration. The Centers for Disease Control and Prevention (CDC) has outlined guidance to assist vaccinators in overcoming these challenges. Today’s announcement now helps to address the financial burden associated with accommodating these complications.

The additional payment amount also accounts for the clinical time needed to monitor a beneficiary after the vaccine is administered, as well as the upfront costs associated with administering the vaccine safely and appropriately in a beneficiary’s home. The payment rate for administering each dose of a COVID-19 vaccine, as well as the additional in-home payment amount, will be geographically adjusted based on where the service is furnished.

How to Find a COVID-19 Vaccine

As today’s action demonstrates, a person’s ability to leave their home should not be an obstacle to getting the COVID-19 vaccine. As states and the federal government continue to break down barriers – like where vaccines can be administered – resources for connecting communities to vaccination options remain key. Unvaccinated individuals and those looking to assist friends and family can:

1. Visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby.
2. Text GETVAX (438829) for English or VACUNA (822862) for Spanish for near-instant access to details on three vaccine sites in the local area.
3. Call the National COVID-19 Vaccination Assistance Hotline at 1-800-232-0233 (TTY: 1-888-720-7489) for assistance in English and Spanish.

Coverage of COVID-19 Vaccines

The federal government is providing the COVID-19 vaccine free of charge or with no cost-sharing for all people living in the United States. As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers cannot charge patients any amount for administering the vaccine.

Because no patient can be billed for COVID-19 vaccinations, CMS and its partners have provided a variety of information online for providers vaccinating all Americans regardless of their insurance status:

• Original Medicare and Medicare Advantage: Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance or deductible.
• Medicaid and the Children’s Health Insurance Program (CHIP):State Medicaid and CHIP agencies must cover COVID-19 vaccine administration with no cost sharing for nearly all beneficiaries during the COVID-19 public health emergency (PHE) and for over a year after it ends. For the very limited number of Medicaid beneficiaries who are not eligible for this coverage (and do not receive it through other coverage they might have), providers may submit claims for reimbursement for administering the COVID-19 vaccine to underinsured individuals through the COVID-19 Coverage Assistance Fund, administered by the Health Resources and Services Administration (HRSA), as discussed below. Under the American Rescue Plan Act of 2021 (ARP), signed by President Biden on March 11, 2021, the federal matching percentage for state Medicaid and CHIP expenditures on COVID-19 vaccine administration is currently 100% (as of April 1, 2021), and will remain 100% for more than a year after the COVID-19 PHE ends. The ARP also expands coverage of COVID-19 vaccine administration under Medicaid and CHIP to additional eligibility groups. CMS recently updated the Medicaid vaccine toolkit to reflect the enactment of the ARP at https://www.medicaid.gov/state-resource-center/downloads/covid-19-vaccine-toolkit.pdf.
• Private Plans: The vaccine is free for people enrolled in private health plans and issuers COVID-19 vaccine and its administration is covered without cost sharing for most enrollees, and such coverage must be provided both in-network and out-of-network during the PHE. Current regulations provide that out-of-network rates must be reasonable as compared to prevailing market rates, and the rules reference using the Medicare payment rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect health insurance issuers and group health plans to continue to ensure their rates are reasonable when compared to prevailing market rates. Under the conditions of participation in the CDC COVID-19 Vaccination Program, providers cannot charge plan enrollees any administration fee or cost sharing, regardless of whether the COVID-19 vaccine is administered in-network or out-of-network.

The Biden-Harris Administration is providing free access to COVID-19 vaccines for every adult living in the United States. For individuals who are underinsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine through the COVID-19 Coverage Assistance Fund administered by the Health Resources and Services Administration (HRSA) after the claim to the individual’s health plan for payment has been denied or only partially paid. Information is available at https://www.hrsa.gov/covid19-coverage-assistance.

For individuals who are uninsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA). Information on the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program is available at https://www.hrsa.gov/CovidUninsuredClaim.

More information on Medicare payment for COVID-19 vaccine administration – including a list of billing codes, payment allowances and effective dates – is available at https://www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment.

More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients is available at https://www.cdc.gov/vaccines/covid-19/vaccination-provider-support.html.

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Rural Health Clinic COVID-19 Vaccine Distribution (RHCVD) Program. The Rural Health Clinic Vaccine Distribution Program (RHCVD) will distribute COVID-19 vaccines directly to RHCs to increase the availability of COVID-19 vaccines in rural communities. This is a way to directly provide vaccines in your RHC while the patient is in your clinic. Studies have shown that a trusted-source for COVID-19 vaccine advice is the patient’s health care provider.  This supply is in addition to your state allocation and allows for a choice from all three vaccines.

Important Changes to Pfizer Vaccine Shipment Sizes and Storage Requirements. Through RHCVD program, HRSA is now able to ship 450 doses of the Pfizer vaccine, rather than the previous minimum of 1,170. Also, the storage requirements of the Pfizer vaccine have been updated to a longer shelf life without ultra-cold storage. Here is the link for detailed storage advice from the CDC on each vaccine product. Concerns about wasting unused doses in a small-volume environment is secondary to the imperative to get “shots in the arms” according to this CDC resource.

Rural Health Clinic Vaccine Confidence (RHCVC) Program. Remember to apply for the RHCVC program. All RHCs that apply will be funded, but you must first apply. Here is a link to the NRHA webinar featuring FORHP speakers describing the RHCVC program. For information pertaining to Rewards and Incentives as part of you RHCVC application, please review this HHS OIG guidance on COVID-19 vaccination incentives. The deadline for application is June 23, 2021.

Rural Vaccine Toolkit and Resource Guide. To assist you in your vaccine administration efforts, and provide material for your RHCVC application, NRHA developed resources for your use.  COVID-19 vaccination talking points for rural community leaders includes key facts and messages derived from NRHA research on common questions, concerns, and attitudes shared by rural Americans.  COVID-19 vaccine resources is a compendium of useful information to help you navigate the many regional and national resources most relevant to rural leaders.

The U.S. Department of Health and Human Services (HHS) announced the launch of a first-of-its-kind national hotline to connect people with disabilities to information and services to improve access to COVID-19 vaccines.

The Disability Information and Access Line (DIAL) is now available to help people with disabilities find vaccination locations in their communities, assist callers with making vaccination appointments, and connect callers to local services – such as accessible transportation – to overcome barriers to vaccination. The hotline also can provide information and resources to answer questions and address concerns about the vaccines and can connect callers to information and services that promote independent living and address fundamental needs, such as food, housing, and transportation.

DIAL is operated as a collaboration between a consortium of organizations serving people with disabilities and the National Association of Area Agencies on Aging (n4a). The consortium includes:

• Association of Programs for Rural Independent Living (APRIL),
• Association of University Centers on Disabilities (AUCD),
• Independent Living Research Utilization (ILRU),
• National Association of Councils on Developmental Disabilities (NACDD),
• National Council on Independent Living (NCIL),
• National Disabilities Rights Network (NDRN), and
• The Partnership for Inclusive Disaster Strategies.

This collaboration benefits from the disability networks’ extensive knowledge and expertise in meeting the needs of people with disabilities across the U.S. and n4a’s decades of experience operating the Eldercare Locator, the only federally funded national information and referral resource that supports consumers across the spectrum of issues affecting older Americans. By leveraging these capabilities, ACL was able to launch this critical tool in less than six weeks.

DIAL was created through a partnership between the Administration for Community Living and the Centers for Disease Control and Prevention to help older adults and people with disabilities get COVID-19 vaccines. With support from CDC, ACL also:

• Increased the capacity of the Eldercare Locator to connect older adults, including those who are unable to leave their homes and those who live in underserved communities, to local COVID-19 vaccination resources.
• Issued nearly $93 million in grants to the aging and disability networks in every state and territory to provide critical services to overcome barriers that are preventing millions of those most at-risk for serious illness and death from COVID-19 from receiving vaccines.

About the Disability Information and Access Line (DIAL)

The Disability Information and Access Line (DIAL) connects callers to information about how to access the COVID-19 vaccine and related supports for people with disabilities. DIAL connects callers to vaccine sites and provides information related to barriers to vaccination by referring callers to local and national disability resources.

acl.gov/dial | 888-677-1199 from 9:00 AM to 8:00 PM ET | DIAL@n4a.org

About the Eldercare Locator

Launched in 1991, the Eldercare Locator is the only national information and referral resource to provide support to consumers across the spectrum of issues affecting older Americans. The Locator was established and is funded by the U.S. Administration for Community Living and is administered by the National Association of Area Agencies on Aging (n4a).

eldercare.acl.gov | 800-677-1116 from 9:00 AM to 8:00 PM ET | eldercarelocator@n4a.org

About the Administration for Community Living

The Administration for Community Living was created around the fundamental principle that older adults and people of all ages with disabilities should be able to live where they choose, with the people they choose, and with the ability to participate fully in their communities. By funding services and supports provided by networks of community-based organizations, and with investments in research, education, and innovation, ACL helps make this principle a reality for millions of Americans.

About the CDC’s National Center on Birth Defects and Developmental Disabilities

The National Center on Birth Defects and Developmental Disabilities strives to advance the health and well-being of our nation’s most vulnerable populations. NCBDDD’s work is broad and far-reaching, and includes four areas of focus: saving babies through surveillance, research, and prevention of birth defects and infant disorders; helping children live to the fullest by understanding developmental disabilities; protecting people by preventing the complications of blood disorders; improving the health of people living with disabilities.

As COVID-19 vaccines continue rolling out across the country, CMS is taking action to protect the health and safety of our nation’s patients and providers and keeping you updated on the latest COVID-19 resources from the Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS).

With information coming from many different sources, CMS has summarized resources and materials to help you communicate with the people that you serve. You can find these and more resources on the COVID-19 Partner Resources Page and the HHS COVID Education Campaign page. We look forward to working with you to encourage our beneficiaries and consumers to get vaccinated. For more information, visit the CMS COVID-19 Policies and Guidance page.

June is National COVID-19 Vaccine Month of Action

The HHS “We Can Do This” COVID-19 Community Corps has kicked off a month-long mobilization effort to get our communities vaccinated by July 4th!  The National Vaccine Month of Action is a collaborative effort with thousands of national organizations, community-based partners, and everyday people, serving as trusted messengers, listening to people’s concerns, and helping them make informed decisions about COVID-19 vaccinations.

There are plenty of ways to take action near you or virtually. You can find more opportunities to participate here. 

“Back to School” Vaccinations

The Connecting Kids to Coverage National Campaign aims to get children and teens vaccinated so they are protected when they go back to in-person learning. Whether your organization is looking to catch children up on missed vaccines or promoting the COVID-19 vaccine to adolescents, you can find the Campaign’s many resources to promote well-child visits and vaccines on InsureKidsNow.gov.

Vaccines.gov – Making it Easier to Find Vaccines

Visit vaccines.gov, text GETVAX (438829), or call the National COVID-19 Vaccination Assistance Hotline at 1-800-232-0233 to search and find a vaccine near you.

Visit vacunas.gov (Spanish), VACUNA (822862) for Spanish to receive three vaccine sites on your phone within seconds.

STAY CONNECTED

Join the We Can Do This Community Corps: Help in the fight against COVID-19 by encouraging family, friends, and your community to get vaccinated. Join the Community Corps to get tips, tools and resources to share. See https://wecandothis.hhs.gov/covidcommunitycorps

For more information on CMS COVID-19 Partner Updates, please contact us: Partnership@cms.hhs.gov