HHS Launches New Reimbursement Program for COVID-19 Vaccine Administration Fees not Covered by Insurance

From HHS:

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.

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 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):

  1. Must administer the vaccines regardless of the recipient’s ability to pay COVID-19 vaccine administration fees or coverage status;
  2. Must administer COVID-19 vaccine at no out-of-pocket cost to the recipient; and
  3. 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.