CMS announced in an MLN Connects newsletter that it will exercise enforcement discretion on statutory consolidated billing provisions in skilled nursing facilities. This will allow Medicare-enrolled immunizers, including pharmacies, to bill directly and receive direct reimbursement from the Medicare program for administering COVID-19 vaccines to Medicare skilled nursing residents. CMS will exercise this enforcement discretion until the last day of the calendar quarter in which the COVID-19 public health emergency ends or as long as CMS determines that there is a public health need for mass COVID-19 vaccinations in congregate care settings, whichever is longer. During this period, compliance with SNF consolidated billing provisions is not material to CMS’ decision to reimburse for COVID-19 vaccine administration. CMS will provide advance public notice and at least 60 days for affected outside immunizers to modify their business practices once CMS decides to cease exercising this enforcement discretion. Join NCPA’s LTC Division for the latest news and resources on LTC.
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