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HHS to reimburse providers who administer COVID-19 vaccines to underinsured patients

New program addresses compensation gaps caused by health plans that do not cover vaccination fees

May 17, 2021 Health care providers who administer COVID-19 vaccines to underinsured individuals have the opportunity to be reimbursed for claims not covered by their patients' insurance.

The U.S. Department of Health and Human Services' Health Resources and Services Administration announced a new program May 3 that would cover the 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.

To address these gaps, the COVID-19 Coverage Assistance Fund, supported by the Provider Relief Fund program, will compensate providers for eligible claims at national Medicare rates, according to an HHS news release. This new program builds on the Health Resources and Services Administration's COVID-19 Uninsured Program, which reimburses providers for vaccine administration fees associated with uninsured individuals.

While the COVID-19 vaccines themselves are free to all U.S. adults, providers incur other costs when administering them related to training, storage and staffing.

Providers would typically bill either insurance plans or patients for these expenses, but the Centers for Disease Control and Prevention issued guidance in February stating that all organizations and providers participating in the CDC COVID-19 Vaccination Program — which currently includes any provider administering COVID-19 vaccines — must provide the vaccines regardless of a recipient's coverage status or ability to pay the vaccine administration fees. While the vaccine must come at no out-of-pocket cost to the recipient, providers may seek appropriate reimbursement from a program or plan that covers administration fees for the recipient, according to the CDC.

The COVID-19 Coverage Assistance Fund program will accept eligible claims from providers dated on or after Dec. 14, 2020. Claims must be submitted electronically, and they are subject to available funding.

For more information on the assistance fund, visit hrsa.gov.