HHS launches new vaccine reimbursement program for providers

(Photo by Alexandru Pavalache.EyeEm\Getty Images)

The Department of Health and Human Services, through the Health Resources and Services Administration, has announced a new program for providers to cover the cost 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. 

The COVID-19 Coverage Assistance Fund addresses a provider need to be reimbursed for uncompensated costs. Providers cannot bill patients for COVID-19 vaccination fees.

HHS Secretary Xavier Becerra said, "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."
 
The Coverage Assistance Fund focuses on instances in which individuals have insurance but vaccines are either not covered or are, but typically with patient cost-sharing. To address these gaps, the fund will  compensate providers for eligible claims, at national Medicare rates which, in March, the Centers for Medicare and Medicaid Services increased to reflect newer information on the true costs associated with administering the vaccines. 

The fund builds on the HRSA COVID-19 Uninsured Program, which has been reimbursing providers for vaccine administration fees associated with uninsured individuals, HHS said.
 
WHY THIS MATTERS

While the COVID-19 vaccines are free to all adults in the United States, providers incur other costs – from training to storage to staffing – when administering them, HHS said. 

Typically, providers would bill either insurance plans or patients for these expenses. 

But providers must administer the COVID-19 vaccine at no out-of-pocket cost to the recipient, according to a policy reiterated by HHS in April when reports surfaced of patients being charged.

For example, in April, a couple in Maineville, Ohio vaccinated at The Little Clinic inside of a Kroger store were asked to produce their insurance card, according to WCPO Cincinnati. They were later billed the difference between the $45 for the vaccine and the $33.30 paid by insurance, the report said.

Money to pay providers for the funding gap is coming through the Provider Relief Fund Program. The 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.  A provider webinar will also be hosted on Thursday, May 6.

THE LARGER TREND

In a Dec. 29, 2020 letter to CMS, the American Hospital Association recommended that CMS increase the payment rates for the administration of the COVID-19 vaccine to reflect the higher resource costs involved in administering the COVID-19 vaccine compared to other preventive vaccines.

In March, Medicare upped the payment for a single dose COVID-19 vaccine, from $28.39 to approximately $40 for its administration.

For COVID-19 vaccines requiring multiple doses, such as Pfizer and Moderna, Medicare increased payment to about $40 for each dose, from  $16.94 for the initial dose and $28.39 for the second.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com