|
Trump
Administration Acts to Ensure Coverage of Life-Saving COVID-19 Vaccines &
Therapeutics Under President Trump’s leadership, the Centers for Medicare
& Medicaid Services (CMS) is taking steps to ensure all Americans,
including the nation’s seniors, have access to the coronavirus disease 2019
(COVID-19) vaccine at no cost when it becomes available. Today, the agency
released a comprehensive plan with proactive measures to remove regulatory
barriers and ensure consistent coverage and payment for the administration of
an eventual vaccine for millions of Americans. CMS released a set of toolkits
for providers, states and insurers to help the health care system prepare to
swiftly administer the vaccine once it is available. These resources
are designed to increase the number of providers that can administer the
vaccine, ensure adequate reimbursement for administering the vaccine in
Medicare, while making it clear to private insurers and Medicaid programs
their responsibility to cover the vaccine at no charge to beneficiaries. In
addition, CMS is taking action to increase reimbursement for any new COVID-19
treatments that are approved or authorized by the FDA. “Under President Trump’s leadership, we have developed a
comprehensive plan to support the swift and successful distribution of a safe
and effective vaccine for COVID-19,” said CMS Administrator Seema Verma. “As
Operation Warp Speed nears its goal of delivering the vaccine in record time,
CMS is acting now to remove bureaucratic barriers while ensuring that states,
providers and health plans have the information and direction they need to
ensure broad vaccine access and coverage for all Americans.” To ensure broad access to a vaccine for America’s seniors, CMS
released an Interim Final Rule with Comment Period (IFC) today that
establishes that any vaccine that receives Food and Drug Administration (FDA)
authorization, either through an Emergency Use Authorization (EUA) or
licensed under a Biologics License Application (BLA), will be covered under
Medicare as a preventive vaccine at no cost to beneficiaries. The IFC
also implements provisions of the CARES Act that ensure swift coverage of a
COVID-19 vaccine by most private health insurance plans without cost sharing
from both in and out-of-network providers during the course of the public
health emergency (PHE). In anticipation of the availability of new COVID-19 treatments,
the IFC also establishes additional Medicare hospital payment to support
Medicare patients’ access to these potentially life-saving COVID-19
therapies. In Medicare, hospitals are generally reimbursed a fixed
payment amount for the services they provide during an inpatient stay, even
if their costs exceed that amount. Under current rules, hospitals may qualify
for additional “outlier payments,” but only when their costs for a particular
patient exceed a certain threshold. Under this IFC, hospitals would qualify
for additional payments when they treat patients with innovative new products
approved or authorized to treat COVID-19 to mitigate any losses they may experience
from making these therapies available, even if they do not reach the current
outlier threshold. The IFC also makes changes to reimbursement for outpatient
hospital services to ensure payment for certain innovative treatments for
COVID-19 that occur outside of bundled arrangements and are paid separately.
In addition, CMS released information to prepare hospitals to bill for the
outpatient administration of a monoclonal antibody product in the event one
is approved under an emergency use authorization (EUA). This rule also allows states to employ a broad range of
strategies - based on local needs - to appropriately manage their Medicaid
program costs. The guidance and flexibility provided to states in the IFC
will help them maintain Medicaid beneficiary enrollment while receiving the
temporary increase in federal funding in the Families First Coronavirus
Response Act (FFCRA). CMS is also taking continued steps to ensure that price
transparency extends to COVID-19 testing during the PHE. Provisions in
the IFC require that any provider who performs a COVID-19 diagnostic test
post their cash prices online. Providers that are non-compliant may face
civil monetary penalties. In addition to these provisions, the IFC:
Along with these regulatory changes, CMS is issuing three
toolkits aimed at state Medicaid agencies, providers who will administer the
vaccine, and health insurance plans. Together, these toolkits will help
ensure the health care system is prepared to successfully administer a safe and
effective vaccine by addressing issues related to access, billing and
payment, and coverage. Increasing Access to Vaccines for Medicare
& Medicaid Beneficiaries The toolkits issued today give health care providers not
currently enrolled in Medicare the information needed to administer and bill
vaccines to Medicare patients. CMS is working to increase the number of
providers that will administer a COVID-19 vaccine to Medicare beneficiaries
when it becomes available, to make it as convenient as possible for America’s
seniors. New providers are now able to enroll as a “Medicare mass immunizers”
through an expedited 24-hour process. The ability to easily enroll as a mass
immunizer is important for some pharmacies, schools, and other entities that
may be non-traditional providers or otherwise not eligible for Medicare
enrollment. To further increase the number of providers who can administer
the COVID -19 vaccine, CMS will continue to share approved Medicare provider
information with states to assist with Medicaid provider enrollment efforts.
CMS is also making it easier for newly enrolled Medicare providers to also
enroll in state Medicaid programs to support state administration of vaccines
for Medicaid recipients. Coverage As a condition of receiving free COVID-19 vaccines from the
federal government, providers will be prohibited from charging consumers for
administration of the vaccine. To ensure broad and consistent coverage across
programs and payers, the toolkits have specific information for several programs,
including: Medicare: Beneficiaries
with Medicare pay nothing for COVID-19 vaccines and their
copayment/coinsurance and deductible are waived. Medicare Advantage (MA): For
calendar years 2020 and 2021, Medicare will pay directly for the COVID-19
vaccine and its administration for beneficiaries enrolled in MA plans. MA
plans would not be responsible for reimbursing providers to administer the
vaccine during this time. Medicare Advantage beneficiaries also
pay nothing for COVID-19 vaccines and their copayment/coinsurance and
deductible are waived. Medicaid: State
Medicaid and CHIP agencies must provide vaccine administration with no cost
sharing for most beneficiaries during the public health emergency.
Following the public health emergency, depending on the population, states
may have to evaluate cost sharing policies and may have to submit state plan
amendments if updates are needed. Private Plans: CMS,
along with the Departments of Labor and the Treasury, is requiring that most
private health plans and issuers cover a recommended COVID-19 vaccine and its
administration, both in-network and out-of-network, with no cost sharing. The
rule also provides that out-of-network rates cannot be unreasonably low, and
references CMS’s reimbursement rates as a potential guideline for insurance
companies. Uninsured: For
individuals who are uninsured, providers will be able to be reimbursed for
administering the COVID-19 vaccine to individuals without insurance through
the Provider Relief Fund, administered by the Health Resources and Services
Administration (HRSA). Billing and Payment The toolkits also address issues related to billing and payment.
After the FDA either approves or authorizes a vaccine for COVID-19, CMS will
identify the specific vaccine codes, by dose if necessary, and specific
vaccine administration codes for each dose for Medicare payment. CMS
and the American Medical Association (AMA) are working collaboratively
on finalizing a new approach to report use of COVID-19 vaccines, which include
separate vaccine-specific codes. Providers and insurance companies will
be able to use these to bill for and track vaccinations for the different
vaccines that are provided to their enrollees. Medicare Payment CMS also released new Medicare payment rates for COVID-19
vaccine administration. The Medicare payment rates will be $28.39 to
administer single-dose vaccines. For a COVID-19 vaccine requiring a series of
two or more doses, the initial dose(s) administration payment rate will be
$16.94, and $28.39 for the administration of the final dose in the
series. These rates will be geographically adjusted and recognize the
costs involved in administering the vaccine, including the additional
resources involved with required public health reporting, conducting
important outreach and patient education, and spending additional time with
patients answering any questions they may have about the
vaccine. Medicare beneficiaries, those in Original Medicare or enrolled in
Medicare Advantage, will be able to get the vaccine at no cost. CMS is encouraging state policymakers and other private
insurance agencies to utilize the information on the Medicare reimbursement
strategy to develop their vaccine administration payment plan in the Medicaid
program, CHIP, the Basic Health Program (BHP), and private plans. Using the
Medicare strategy as a model would allow states to match federal efforts in
successfully administering the full vaccine to the most vulnerable
populations. The IFC (CMS-9912-IFC) is scheduled to display at the Federal
Register as soon as possible with an immediate effective date, and a 30-day
comment period. It can be downloaded from the Federal Register at: https://www.cms.gov/files/document/covid-vax-ifc-4.pdf Additional information on this IFC can be found in the fact
sheet here: https://www.cms.gov/newsroom/fact-sheets/fourth-covid-19-interim-final-rule-comment-period-ifc-4 The COVID-19 vaccine resources for providers, health plans and
State Medicaid programs can be found here: https://www.cms.gov/covidvax The FAQs on billing for therapeutics can be found here: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf ### Contact:
CMS Media Relations: CMS Media Inquiries Get CMS
news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS
Administrator @SeemaCMS and @CMSgov |
|
To be a Medicare Agent's source of information on topics affecting the agent and their business, and most importantly, their clientele, is the intention of this site. Sourced from various means rooted in the health insurance industry - insurance carriers, governmental agencies, and industry news agencies, this is aimed as a resource of varying viewpoints to spark critical thought and discussion. We welcome your contributions.
Wednesday, October 28, 2020
Trump Administration Acts to Ensure Coverage of Life-Saving COVID-19 Vaccines & Therapeutics
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment