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Medicaid & Medicare Have New Regulations Governing Vaccinations
October 8, 2002

The US Department of Health and Human Services (HHS) announced a new policy designed to promote greater access to flu and pneumonia vaccinations, particularly among older Americans and others at high risk for illness. Nursing homes, hospitals, and home health agencies that serve persons with Medicare and Medicaid benefits are now permitted to remind patients when it is time for an annual vaccination and ask if they want to receive a shot. According to HHS, such "standing orders" can make sure that many high-risk Americans are informed about the benefits of these annual vaccinations and given an opportunity to receive them. Standing orders are permanent entries placed in medical charts directing that the patient be told when it is time to get a flu or pneumonia shot and asked if he or she wants the vaccination. If the patient chooses to be immunized, a shot can be administered on the spot by appropriate health care professionals, without the need for a doctor to write a new order each year.

The improvement is included in new Medicare regulations that modify the conditions of participation for hospitals, long-term care facilities, and home health agencies that serve Medicare and Medicaid beneficiaries. Those rules had required a physician's order for all treatments including immunizations in these particular care settings, although regulations allowed the vaccinations to be given without a physician's order in other settings, such as a clinic or a doctor's office. The new regulation was published in the October 3 Federal Register.

Each year, between 20,000 - 40,000 deaths in the United States are attributed to flu and pneumonia. More than 90% of these deaths occur in people age 65 and older. Senior citizens and others at risk generally should get a flu shot each year, while a single pneumonia immunization may remain effective for a lifetime. Medicaid and Medicare cover both types of vaccinations.

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