HHS program reimburses healthcare providers and facilities for testing, treatment, and vaccine administration fees associated with insured patients.
On May 3, 2021, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the new COVID-19 Coverage Assistance Fund (CAF) program that covers 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 may not bill patients for COVID-19 vaccination fees, this program addresses the compensation shortfall.
Closing the Gap
COVID-19 vaccines themselves are free to everyone 12 years and older in the United States, but providers incur costs associated with administering them, training staff, and storing the vaccine. If these services are not covered by a patient’s health plan or only partially covered, providers are not allowed to balance bill the patient. Certain health plans are not required to provide coverage of qualifying coronavirus preventive services, including recommended COVID-19 vaccines and their administration, without cost-sharing under section 3203 of the CARES Act. Examples include grandfathered health plans, excepted benefits, or short-term limited duration insurance plans.
To address cost gaps, the CAF will compensate providers for eligible claims at national Medicare rates, which increased in March. The CAF builds on the HRSA COVID-19 Uninsured Program, which has been reimbursing providers for vaccine administration fees associated with uninsured individuals. The CAF program will accept eligible claims from providers dated on or after Dec. 14, 2020.
How it Works
Healthcare providers that request claims reimbursement electronically will be reimbursed at the national Medicare rate for vaccine administration and for patient charges related to COVID-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance, subject to available funding.
To participate, providers must attest to the following at registration:
- You have submitted a vaccine administration claim to the patient’s healthcare plan and confirmed that the patient has a health plan that either does not include COVID-19 vaccine administration as a covered benefit or covers COVID-19 vaccination but with cost-sharing.
- You have verified that no other payer will reimburse them for COVID-19 vaccine administration fees for that patient, or other patient charges related to COVID-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance.
- You will accept defined program reimbursement as payment in full.
- You will agree not to balance bill the patient.
- You will agree to program terms and conditions and may be subject to post-reimbursement audit review.
Learn more about the CAF program here.
Find new 2021 HRSA informational resources here.
What is Covered?
Reimbursement under this program will be made for qualifying testing for COVID-19, treatment services with a primary COVID-19 diagnosis, and qualifying COVID-19 vaccine administration fees, as determined by the HRSA (subject to adjustment as may be necessary), which include the following:
- Specimen collection; diagnostic and antibody testing
- Testing-related visits in the following settings: office, urgent care or emergency room, telehealth
- Treatment: office visit (including telehealth), emergency room, inpatient, outpatient/observation, skilled nursing facility, long-term acute care, rehabilitation care, home health, durable medical equipment (e.g., oxygen, ventilator), emergency ambulance transportation, non-emergent patient transfers via ambulance, and FDA-licensed, authorized, or approved treatments as they become available for COVID-19 treatment
- Administration fees related to FDA-licensed or authorized vaccines
Claims will be subject to Medicare timely filing requirements.
Services not covered by traditional Medicare will also not be covered under this program. In addition, the following services are excluded:
- Any treatment without a COVID-19 primary diagnosis (U07.1), except for pregnancy when the COVID-19 code may be listed as secondary
- Hospice services
- Outpatient prescription drugs
All claims submitted must be complete and final.