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Nursing Homes Must Give Flu Shots: Medicare,
Medicaid Say
Aug. 12, 2005 - Nursing homes serving Medicare and
Medicaid patients would have to provide immunizations against influenza
and pneumococcal disease to all residents if they want to continue in
the programs, according to a proposed rule to be released by CMS in the
August 15 Federal Register.
Unless refused by the patient or patient’s family
or for medical reasons, nursing homes would be required to ensure that
each resident received the immunizations as a condition of participation
in the two programs.
About two million Americans, most senior citizens
age 65 years or older, live in long-term care facilities. People aged
65 years and older account for more than 90 percent of influenza-related
deaths in the United States and elderly nursing home residents are
particularly vulnerable to influenza-related complications. In addition,
the elderly are more likely than younger individuals to die from
pneumonia.
In light of these statistics and in line with the
agency’s Nursing Home Quality Initiative, CMS received input from the
Centers for Disease Control and Prevention (CDC) and two of the nation’s
largest nursing home industry trade groups, the American Association of
Homes and Services for the Aging and the American Health Care
Association, in developing the proposed rule.
“Improving immunization is a key element of our
quality improvement strategy—a strategy that is focused on preventing
illnesses and complications in the first place,” said Mark B. McClellan,
M.D., Ph.D., administrator of CMS. “The outstanding commitment of the
nursing home industry, caregivers and other stakeholders makes clear
that his commitment to better quality through more effective
immunization is shared and achievable.
“As a physician, I know the impact that influenza
and pneumococcal infections can have on the elderly, particularly those
in nursing homes,” he added. “Greater use of flu shots and pneumococcal
vaccine in nursing homes is a proven approach to better health and fewer
costly complications for one of our most vulnerable groups of
beneficiaries.”
In its collaborative effort to improve quality of
care, CMS is also encouraging nursing homes to provide influenza vaccine
to their healthcare workers. Although the vaccine for these workers
will not be required in the proposed regulation, immunizing nursing home
workers has been shown to reduce mortality rates among residents of
long-term care facilities. Research from last year’s flu season
revealed that only 36 percent of all healthcare workers were vaccinated
against the illness.
“Healthcare workers play a vital role in protecting
the health of one of our nation’s most vulnerable populations—the
elderly and disabled who live in nursing facilities,” said Julie
Gerberding, M.D., director of the Centers for Disease Control and
Prevention. “This initiative is critical to ensuring they receive the
best quality healthcare.”
A 1999 national nursing home survey showed that 65
percent of residents had documented influenza shots and only 38 percent
had been inoculated against bacterial pneumonia. A goal of this
proposed rule is to attain a target rate of 90 percent for both
vaccinations. As an added incentive to increase immunization rates, in
January, CMS increased the average Medicare payment rate for
administering each shot from $8 to $18, in addition to a separate
payment for the cost of the vaccine. Medicaid payment rates are set
independently by each state.
As a Medicare condition of participation, the rule
proposes that long-term care facilities ensure that each resident is:
offered influenza immunization annually;
immunized against influenza unless medically
contraindicated or when the resident or the resident’s legal
representative refuses immunization;
offered pneumococcal immunization once if there is
no history of immunization; and
immunized against pneumococcal disease unless
medically contraindicated or when the resident or the resident’s legal
representative refuses immunization.
In the case of a vaccine shortage as declared by
CDC, state survey agencies would have the discretion not cite facilities
for being out‑of‑compliance with this requirement.
“Vaccines against these diseases are effective in
preventing hospitalizations and death,” said Dr. McClellan. “However,
many at-risk people are not getting the vaccines they need. This
initiative will be critical to maintaining high-quality care in the
nation’s long-term care facilities.”
Because of the impending influenza season, this
expedited proposed rule will have a 15-day comment period. To review
the proposal, go to the Federal Register Web site at
www.gpo.gov.
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