HHS Launches New Reimbursement Program for COVID-19 Vaccine Administration Fees not Covered by Insurance
Today, the US Department of Health and Human Services, through the Health Resources and Services Administration (HRSA) is announcing a new program covering costs of administering COVID-19 vaccines to patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing. Since providers cannot bill patients for COVID-19 vaccination fees, this new program, the COVID-19 Coverage Assistance Fund (CAF), addresses an outstanding compensation need for providers on the front lines vaccinating underinsured patients.
“After securing enough COVID-19 vaccines for all adults, the Biden-Harris Administration is elevating work to boost access to them,” said HHS Secretary Becerra. “We listened to our healthcare providers on the frontlines of the pandemic. On top of increasing reimbursement rates tied to administering the shots, we are closing the final payment gap that resulted as vaccines were administered to underinsured individuals. No healthcare provider should hesitate to deliver these critical vaccines to patients over reimbursement cost concerns.”
CAF is focusing on instances where individuals have insurance, but vaccines are either not covered or are but typically with patient cost-sharing. To address these gaps, the CAF will be compensating providers for eligible claims, at national Medicare rates which increased in March to reflect newer information on the true costs associated with administering the vaccines. CAF also builds on the HRSA COVID-19 Uninsured Program, which has been reimbursing providers for vaccine administration fees associated with uninsured individuals.
The availability of COVID-19 vaccines have fundamentally changed and strengthened our battle against this pandemic. While the COVID-19 vaccines themselves are free to all adults in the US, providers incur other costs – from training to storage to staffing – when administering them. Typically, providers would bill either insurance plans or patients for these expenses. The Centers for Disease Control and Prevention (CDC) issued guidance in February, that all organizations and providers participating in the CDC COVID-19 Vaccination Program (which currently includes any provider administering COVID-19 vaccines):
- Must administer the vaccines regardless of the recipient’s ability to pay COVID-19 vaccine administration fees or coverage status;
- Must administer COVID-19 vaccine at no out-of-pocket cost to the recipient; and
- May seek appropriate reimbursement from a program or plan that covers COVID-19 vaccine administration fees for the vaccine recipient.
The CAF is funded through the Provider Relief Fund Program. The CAF program will accept eligible claims from providers dated on or after December 14, 2020. Additionally, claims must be submitted electronically and are subject to available funding.
Learn more about the CAF program here. A provider webinar will also be hosted on May 6th.
Learn more about the Provider Relief Fund Program here.
Special Enrollment Period
The American Rescue Plan increased the tax credits available to millions of consumers to buy insurance on the Health Insurance Marketplace® or state-based Marketplace. This means reduced premiums and better access to affordable, quality health care coverage. Through the Special Enrollment Period (SEP) which began on February 15,2021, consumers are being encouraged to shop and find plans that may provide better quality coverage including coverage for vaccine administration fees. Consumers who want to view their options and check whether they qualify for more affordable premiums can visit HealthCare.gov or CuidadoDeSalud.gov for 2021 plans and prices. Additionally, consumers can call the Marketplace Call Center at 1-800-318-2596, which provides assistance in over 150 languages. TTY users can call 1-855-889-4325. Consumers can also find a local assister or agent/broker in their area by visiting: https://localhelp.healthcare.gov. SEP runs through August 15, 2021.