Biden Administration Recommits to COVID-19 Reimbursement

The Biden administration will provide COVID-19 reimbursement to clinicians vaccinating uninsured patients, according to new CMS guidance.

The guidance released on Feb. 26, 2021, stated that providers can still seek reimbursement from the FFCRA Relief Fund and the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA), as well as the Provider Relief Fund, for the vaccination and testing of any uninsured patients.

The FFCRA Relief Fund and PPPHCEA collectively appropriated $2 billion to reimburse providers for COVID-19 testing for individuals, while an unnamed portion of the $178 billion Provider Relief Fund has been designated for pandemic-related treatment of the uninsured under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act).

The Biden administration announced on Friday that $3 billion from the Provider Relief Fund has gone to COVID-19 reimbursement to providers testing and treating uninsured patients.

A Kaiser Family Foundation (KFF) analysis from October 2020, however, found that the program designed to reimburse providers for uninsured COVID-19 care as paid out limited funds, citing the requirement of a primary diagnosis of COVID-19.

“In some cases, patients with COVID-19 who are being treated for symptoms brought on by the virus may not have a primary diagnosis of COVID-19,” KFF stated.

The administration expects to pay out more in COVID-19 reimbursements soon as states scale vaccination efforts.

“This guidance also reinforces existing policy regarding coverage for the administration of the COVID-19 vaccine and highlights avenues for providers to seek federal reimbursement for costs incurred when administering COVID-19 diagnostic testing or a COVID-19 vaccine to those who are uninsured,” the Biden administration said Friday’s announcement.

“To further build awareness about the availability of this program, this announcement seeks comment on strategies to connect those without insurance to care from providers participating in this fund,” the administration continued.

The guidance also banned private health plans and issuers from denying coverage for COVID-19 diagnostic tests for individuals who are asymptomatic and who have no known or suspected exposure to the novel coronavirus.

“Such testing must be covered without cost sharing, prior authorization, or other medical management requirements imposed by the plan or issuer,” the administration clarified in the announcement.

The guidance also clarified that group health plans and issuers offering group or individual healthcare coverage must cover point-of-care COVID-19 tests and tests administered at state or locally administered testing sites.

Under the Families First Coronavirus Response Act (FFCRA) and CARES Act, private health plans and issuers are required to provide benefits for certain items and services related to COVID-19 testing. This included grandfathered health plans, the laws stated.

More specifically, the CARES Act broadened the list items and services that must be covered by private health plans and issuers and required that the plans reimburse providers administering the testing the negotiated rate or the cash price for the service as listed by the provider on a public website.

The new guidance aims to dispel the “many questions about plan and issuer responsibility to cover COVID-19 diagnostic testing for individuals who are asymptomatic and have no known or suspected recent exposure to COVID-19,” the Biden administration stated.

The guidance follows an executive order signed by President Biden on Jan. 21, 2021, that addressed the nation’s strategy for combatting the ongoing COVID-19 pandemic.

The executive order stated that, to improve access to quality and affordable healthcare, the administration will evaluate the COVID-19 Uninsured Program (via the Provider Relief Fund) and “take any available steps to promote access to treatments and clinical care for those without adequate coverage, to support safety-net providers in delivering such treatments and clinical care, and to make the Program easy to use and accessible for patients and providers, with information about the Program widely disseminated.”

The executive order also said the administration will assess Medicare, Medicaid, and group health plan coverage of “safe and effective COVID-19 treatments and clinical care.”