MCN Healthcare: Policy Management and Compliance Tools

The Centers for Medicare and Medicaid Services (CMS) has released their annual immunizers guide Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations.  The document addresses immunizers' commonly asked questions about the administration of influenza and pneumococcal vaccines to Medicare, Medicaid and CHIP patients. It also includes questions and answers that are particularly relevant to the 2012-2013 influenza immunization season. The guide contains sections covering current recommendations of the Advisory Committee on Immunization Practices (ACIP) as they relate to immunization; Medicare, Medicaid and CHIP coverage and payment policy; requirements for mass immunizers and centralized billing; and a brief discussion of managed care. In addition, a list of definitions is included.

Influenza causes an estimated 226,000 hospitalizations and 3000-49,000 deaths annually in the United States. An estimated ninety percent of seasonal influenza-related deaths occur among those aged 65 or older. Invasive pneumococcal infection (e.g., sepsis, meningitis) causes an estimated 40,000 cases and over 4,000 deaths annually in the U.S. Almost half of deaths due to pneumococcal disease occur in persons aged 65 and older.  The Department of Health and Human Services' Healthy People 2020 target vaccination rate for both vaccines is 90 percent for persons aged 65 years and older.  According to the Centers for Disease Control and Prevention (CDC), in 2008 the pneumococcal vaccination rate for persons aged 65 years and older was 60.1 percent.  In 2009, the influenza immunization rate for this group was 65.0 percent.

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