HHS Paying Providers for Underinsured Vaccine Administration

HHS has announced a new program designed to reimburse providers for administering COVID-19 vaccines to underinsured patients.

The COVID-19 Coverage Assistance Fund (CAF), launched Monday through the Health Resources and Services Administration (HRSA), will cover the costs of vaccine administration for providers treating patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing.

The program was designed by HHS to close the reimbursement gap since providers are prohibited by federal law from charging or balance billing patients for COVID-19 vaccine administration, a regulation HHS had to reiterate to providers last month after reports of patients being charged by their providers for vaccine administration.

“No healthcare provider should hesitate to deliver these critical vaccines to patients over reimbursement cost concerns,” HHS Secretary Xavier Becerra stated in the latest announcement.

Providers will get reimbursed at the national Medicare rates for vaccine administration. Medicare currently reimburses providers $40 for administration of single-dose vaccines and $80 for administration of vaccines requiring two doses.

HHS increased the rates in March from $28 for administration of a single-dose vaccine and $45 for administration of two-dose vaccines in an effort to boost access to vaccines.

Reimbursements will pull from the Provider Relief Fund established by the CARES Act and will accept eligible claims from providers dated on or after December 14, 2020. Claims must be submitted electronically and are subject to available funding, HHS stated.

Additionally, claims will only be eligible for reimbursement through CAF after they have been denied or only partially paid by the patients' health plan. The reimbursement will then cover the vaccination fee and patient charges, including co-payments, deductibles, and co-insurance for vaccine administration.

Providers must enroll in CAF to qualify for reimbursement.

The CAF builds on the COVID-19 Uninsured Program that reimburses providers for administering vaccines, as well as approved treatments, to COVID-19 patients who are uninsured. The program also run by HRSA also pays providers based on Medicare rates for vaccination fees and treatment prices.

“The Coverage Assistance Fund extends the same level of support to providers who administer vaccines to underinsured individuals,” HRSA states on the program’s website.

Together, HHS intends for the two programs to incent providers to get more shots in arms.

“After securing enough COVID-19 vaccines for all adults, the Biden-Harris Administration is elevating work to boost access to them,” Becerra said in the announcement.

Since the start of the COVID-19 vaccine rollout, over 247 million doses have been administered to Americans, fully vaccinating more than 105 million people or 31.8 percent of the population, according to data from the Centers for Disease Control and Prevention (CDC).

The number of daily doses has decreased from late March when more than 3 million shots were being administered per day. Now, about 2.45 million doses are administered per day, the CDC reports.

The US is reaching the point where supply is greater than demand as vaccine hesitancy remains high among certain patient populations and unvaccinated populations are hard to reach. Both have slowed the administration of approved vaccines.

In light of the data, many states are now shifting their vaccine rollouts to more local sites, such as physician practices and pharmacies, from regional sites established for the purposes of vaccine rollout.

More primary care practices, for example, have been administering vaccines compared to previous weeks, according to a recent survey of clinicians. But still, most practices are facing increased strain from the pandemic and many—though fewer compared to last year—continue to struggle financially in the face of the public health crisis.

To access the CAF portal for reimbursement, click here. HSRA is also hosting a webcast on May 6th and May 12th with additional information on the new program.