On Oct. 7, 2005, a new Federal Medicare rule became effective that required all long-term care facilities to offer annual vaccination for influenza and one-time vaccination for pneumococcal disease to all residents as a condition of participation in Medicare.

As a condition of participation in the two programs, nursing homes will be required to ensure that residents received the immunizations.  The resident or the resident’s family can refuse the shots.  Residents who cannot receive the vaccines for medical reasons are exempt. Under the final rule, nursing homes will also be required to educate the resident and/or the resident’s family about the advantages and possible disadvantages of receiving the vaccines.

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. 

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 final 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.

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.

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.