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COVID-19: Revised Booster Guidance, Supreme Court Vaccine Mandate Arguments

The Centers for Disease Control and Prevention (CDC) made several alterations to its COVID-19 booster shot eligibility recommendations.

The agency on Jan. 4 updated its recommendation for when people who received the Pfizer vaccine can receive a booster shot, shortening the interval from six to five months. One day later, CDC endorsed its Advisory Committee on Immunization Practices (ACIP) recommendation to expand Pfizer COVID-19 booster shot eligibility to adolescents ages 12–15. The agency now recommends that everyone 12 years and older should receive a booster dose five months after completing their primary series of the Pfizer vaccine.

On Jan. 7, CDC adjusted its guidance for the Moderna COVID-19 vaccine to recommend a booster shot five months after completing the primary dose series, shortened from a previous recommendation of six months. This comes after the Food and Drug Administration (FDA) amended its emergency use authorization for the Moderna vaccine to shorten the period between primary dose and booster shot to five months.

Individuals who received a Janssen COVID-19 vaccine are urged to receive a booster shot of a messenger RNA vaccine — Pfizer or Moderna — two months after receiving the Janssen vaccine.

In a comprehensive chart, CDC outlines all three COVID-19 vaccines authorized or approved for use in the U.S., as well as recommendations for who should receive a booster, when to get a booster, and which booster to get.

Supreme Court Hears Oral Arguments in Vaccine Mandate Cases

The U.S. Supreme Court on Jan. 7 heard oral arguments about whether to allow the Centers for Medicare & Medicaid Services (CMS) and Occupational Safety and Health Administration (OSHA) COVID-19 vaccine mandates to proceed.

Justices were clear to distinguish between the two mandates, framing the CMS mandate as a method of protecting the marginalized groups — low-income and older patients — served by Medicaid and Medicare.

“With respect to these two vulnerable populations and especially vulnerable when it comes to COVID, how can it not be the principal, prime responsibility of the CMS head and the Secretary of [Health and Human Services] to look out for their health and safety?” asked Justice Elena Kagan.

Deputy Solicitor General Brian Fletcher stressed that CMS will enforce the mandate flexibly, and hospitals with vaccine policies that are working in good faith to vaccinate their staff will not be penalized if they do not technically meet the mandate’s standards.

Justices had more questions about OSHA’s mandate, which some justices viewed as beyond the agency’s jurisdiction to protect against workplace hazards by infringing on states’ and Congress’ role to promote general welfare.

“This is, in effect, an effort to cover the waterfront,” said Chief Justice John Roberts.

Justices did signal a willingness to adopt a more tailored OSHA mandate that would apply to workers in close confines, such as those at a meat-packing plant.

After the Supreme Court rules, the cases will proceed on the merits in the lower courts of appeals; the Supreme Court ruling likely will influence the outcomes in those courts.

HHS Requires Insurance Plans to Cover At-Home Tests

The Department of Health and Human Services (HHS) announced that private health insurance plans and group health plans must completely cover eight over-the-counter, at-home COVID-19 tests per individual per month, effective Jan. 15.

HHS is incenting insurers and group health plans to create programs that would allow people to get over-the-counter tests directly from preferred pharmacies or retailers without having to submit a reimbursement claim. Under this incentive, if an individual buys a test outside the insurer’s network of preferred pharmacies, the plan would still be required to reimburse $12 per test, or the cost of the test if it is less than $12.

Currently, state Medicaid and Children’s Health Insurance Program entities are required to cover FDA-authorized at-home COVID-19 tests without cost-sharing. The agency has released FAQs on the new policy.

New Code for Outpatient Remdesivir Administration

CMS has created a new Healthcare Common Procedure Coding System (HCPCS) code for remdesivir antiviral medication administered in an outpatient setting.

HCPCS code J0248 is available for use by all payers, effective Dec. 23, 2021. The long descriptor for this code is “Injection, remdesivir, 1 mg,” and the short descriptor is “Inj, remdesivir, 1 mg.”

Visit the America’s Essential Hospitals coronavirus resource page for more information about the pandemic.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Emily Schweich is a communications manager at America's Essential Hospitals.

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