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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 and providers may register here.
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.
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