Press release



             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 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‑of­â€‘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