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

King & Spalding

On May 3, 2021, HHS announced a new program to cover the costs of COVID-19 vaccination for patients enrolled in health plans that either do not cover vaccinations generally, or cover them but with patient cost-sharing requirements. The new program, called the COVID-19 Coverage Assistance Fund, is designed specifically to address the gap for patients with health coverage but who may be hesitant to receive the vaccine due to the necessary cost-sharing requirements.

The new program focuses on patients with health insurance and pays providers for eligible claims at national Medicare rates, which were recently increased in March to better reflect the cost of administering the vaccines. The COVID-19 Coverage Assistance Fund also follows HHS’s COVID-19 uninsured program launched in April, which reimburses providers for administration of the vaccine to uninsured patients.

The CDC’s guidance – which covers any provider that administers COVID-19 vaccinations – requires that all organizations and providers participating in the program: (1) administer the vaccine regardless of the patient’s ability to pay; (2) administer the vaccine at no out-of-pocket cost to the patient; and (3) seek appropriate reimbursement from a program or plan that covers vaccine administration.

The Coverage Assistance Fund is funded through the Provider Relief Fund Program and will accept eligible claims from providers dated on or after December 14, 2020. Claims must be submitted electronically and are subject to eligible funding. To be eligible for payment, providers must have first submitted the claim to the individual’s health plan for payment and had the claim denied or only partially paid.
For dates of service through March 14, 2021, the reimbursement rate is as follows:

  • Administration of a single-dose COVID-19 vaccine is $28.39;
  • Administration of the first dose of a COVID-19 vaccine requiring a series of two or more doses is $16.94; and
  • Administration of the final dose of a COVID-19 vaccine requiring a series of two or more doses is $28.39

For dates of service on or after March 15, 2021, reimbursement has been increased to $40.00 for each administration.
More details about the program are available from the Health Resources & Services Administration here. The provider portal for submitting claims for reimbursement is accessible here.

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King & Spalding

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