The Centers for Medicare & Medicaid Services (CMS) is taking steps to ensure all Americans, including the nation’s seniors, have access to the COVID-19 vaccine. It will be at no cost when it becomes available.
Today, the agency released a comprehensive plan with proactive measures to remove regulatory barriers and ensure consistent coverage and payment to administer an eventual vaccine for millions of Americans.
CMS released a set of toolkits for providers, states, and insurers to help the health care system prepare to administer the vaccine once it is available swiftly. These resources are designed to increase the number of providers who can administer the vaccine and ensure adequate reimbursement for administering the vaccine.
The resources released by CMS make it clear to private insurers and Medicaid programs their responsibility to cover the vaccine at no charge to beneficiaries. Also, CMS is taking action to increase reimbursement for any new COVID-19 treatments approved or authorized by the FDA.
“Under President Trump’s leadership, we have developed a comprehensive plan to support the swift and successful distribution of a safe and effective vaccine for COVID-19,” said CMS Administrator Seema Verma. “As Operation Warp Speed nears its goal of delivering the vaccine in record time, CMS is acting now to remove bureaucratic barriers while ensuring that states, providers, and health plans have the information and direction they need to ensure broad vaccine access and coverage for all Americans.”
To ensure broad access to a vaccine for America’s seniors, CMS released an Interim Final Rule with Comment Period (IFC) that establishes that any vaccine that has met the requirements set out by the FDA will be covered under Medicare as a preventive vaccine at no cost.
In anticipation of the availability of new COVID-19 treatments, the IFC also establishes additional Medicare hospital payments to support Medicare patients’ access to these potentially life-saving COVID-19 therapies.
Under this IFC, hospitals would qualify for additional payments when they treat patients with innovative new products approved or authorized to treat COVID-19 to mitigate any losses they may experience from making these therapies available.
This rule also allows states to employ a broad range of strategies based on local needs to manage their Medicaid program costs appropriately. The guidance and flexibility provided to states in the IFC will help them maintain Medicaid beneficiary enrollment while receiving the temporary increase in federal funding in the Families First Coronavirus Response Act (FFCRA).
CMS is also issuing three toolkits aimed at state Medicaid agencies, providers who will administer the vaccine, and health insurance plans. Together, these toolkits will help ensure the health care system is prepared to successfully administer a safe and effective vaccine by addressing access, billing and payment, and coverage issues.
As a condition of receiving free COVID-19 vaccines from the federal government, providers will be prohibited from charging consumers to administer the vaccine.
CMS is encouraging state policymakers and other private insurance agencies to utilize the Medicare reimbursement strategy to develop their vaccine administration payment plan in the Medicaid program, CHIP, the Basic Health Program (BHP), and private plans. Using the Medicare strategy as a model would allow states to match federal efforts in successfully administering the full vaccine to the most vulnerable populations.
Additional information on this IFC can be found in the fact sheet here: https://www.cms.gov/newsroom/fact-sheets/fourth-covid-19-interim-final-rule-comment-period-ifc-4.
