On March 15, CMS increased the Medicare payment amount for administering the COVID-19 vaccine. This new and higher payment rate will support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day, including establishing new or growing existing vaccination sites, conducting patient outreach and education, and hiring additional staff. At a time when vaccine supply is growing, CMS is supporting provider efforts to expand capacity and ensure that all Americans can be vaccinated against COVID-19 as soon as possible.

Effective for COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies, and many other immunizers will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.

These updates to the Medicare payment rate for COVID-19 vaccine administration reflect new information about the costs involved in administering the vaccine for different types of providers and suppliers, and the additional resources necessary to ensure the vaccine is administered safely and appropriately.

CMS is updating the set of toolkits for providers, states, and insurers to help the health care system swiftly administer the vaccine with these new Medicare payment rates. These resources are designed to increase the number of providers that can administer the vaccine, ensure adequate payment for administering the vaccine to Medicare beneficiaries, and make it clear that no beneficiary, whether covered by private insurance, Medicare, or Medicaid, should pay cost-sharing for the administration of the COVID-19 vaccine.

Coverage of COVID-19 Vaccines:

As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers are prohibited from charging patients any amount for administration of the vaccine. To ensure broad and consistent coverage across programs and payers, the toolkits have specific information for several programs, including:

Medicare: Beneficiaries with Medicare pay nothing for COVID-19 vaccines and there is no applicable copayment, coinsurance, or deductible.

Medicare Advantage (MA): For calendar years 2020 and 2021, Medicare will pay providers directly for the COVID-19 vaccine (if they do not receive it for free) and its administration for beneficiaries enrolled in MA plans. MA plans are not responsible for paying providers to administer the vaccine to MA enrollees during this time. Like beneficiaries in Original Medicare, Medicare Advantage enrollees also pay no cost-sharing for COVID-19 vaccines.

Medicaid: State Medicaid and Children’s Health Insurance Program agencies must provide vaccine administration with no cost sharing for nearly all beneficiaries during the Public Health Emergency (PHE) and at least one year after it ends. Through the American Rescue Plan Act signed by President Biden on March 11, 2021, the COVID vaccine administration will be fully federally funded. The law also provides an expansion of individuals eligible for vaccine administration coverage. There will be more information provided in upcoming updates to the Medicaid toolkit.

Private Plans: CMS, along with the Departments of Labor and Treasury, is requiring that most private health plans and issuers cover the COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost sharing during the PHE. Current regulations provide that out-of-network rates must be reasonable, as compared to prevailing market rates, and reference the Medicare reimbursement rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect commercial carriers to continue to ensure that their rates are reasonable in comparison to prevailing market rates.

Uninsured: For individuals who are uninsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration (HRSA).

More Information:

• Medicare COVID-19 Vaccine Shot Payment webpage: Payment for COVID-19 vaccine administration, including a list of billing codes, payment allowances, and effective dates
• CDC COVID-19 Vaccination Program Provider Requirements and Support webpage: How the COVID-19 vaccine is provided at 100% no cost to recipients
• HRSA COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured webpage

The Biden-Harris Administration announced the American Rescue Plan Act of 2021 (ARP) will help to reduce health care costs, expand access to coverage, and ensure nearly everyone who buys their own individual or family health insurance through a Marketplace can receive a tax credit to reduce their premiums. The ARP not only provides the resources for America to beat this pandemic, but it also expands access to health insurance coverage, lowers costs, and ensures that health care truly is a right for all Americans.

The fact sheets cover more details on the provisions to be implemented April 1.  Look for more communication from CMS over the next week for training sessions that will provide more information.

To read the CMS fact sheet, visit: https://www.cms.gov/newsroom/fact-sheets/american-rescue-plan-and-marketplace

To read the HHS fact sheet, visit: https://www.hhs.gov/about/news/2021/03/12/fact-sheet-american-rescue-plan-reduces-health-care-costs-expands-access-insurance-coverage.html

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@POTUS signed the American Rescue Plan, which expands access to health care and financial assistance, and lowers premiums. Read the full announcement here: https://www.hhs.gov/about/news/2021/03/12/fact-sheet-american-rescue-plan-reduces-health-care-costs-expands-access-insurance-coverage.html

On March 11, 2021, President Biden signed into law a $1.9 trillion COVID-19 relief package. Thanks to the advocacy of NRHA and its members, the package includes a number of provisions to protect and promote rural health.

Most notably, NRHA has secured the infusion of $8.5 billion for rural providers, a key provision which NRHA worked closely with Senator Manchin’s office on. The $8.5 billion for rural providers will be provided through a fund called the Health Care Heroes Sustainability Fund (HCHSF), which will be similar to the Provider Relief Fund (PRF) but specific to rural providers. After months of advocacy, NRHA and its members are proud to have secured this much-needed relief on behalf of rural providers. 

Additional rural health provisions of note include:  

• Additional funding for the Paycheck Protection Program (PPP) with language increasing eligibility for rural providers. Previously, rural hospitals affiliated with a larger health system were deemed ineligible for the PPP if their affiliation brought them above the program’s 500-employee threshold, even if the rural hospital itself only had 100 or so employees. The new bill will waive the affiliation provision, which will enable many more rural providers to participate in the program. NRHA has advocated for this change since the PPP was created last March.  
• $500 million for the creation of an ‘Emergency Grants for Rural Health Care’ program through the United States Department of Agriculture. This program will support rural hospitals’ efforts around COVID-19 response and vaccine administration, as well as telehealth services. 
• $7.66 billion in funding for the public health workforce to carry out activities related to establishing, expanding, and sustaining public health at the state, local, and territorial levels. 
• Supplemental appropriation allocation for the National Health Service Corps ($800 million) and the Nurse Corps Loan Repayment Program ($200 million), bringing $1 billion dollars of additional funding to health care workforce programs. NRHA has advocated for additional funding for the health care workforce in each COVID-19 relief bill, and we are pleased that Congress has decided to provide resources to rural and underserved communities. 
• An additional $55 billion in funding for COVID-19 vaccine deployment, vaccine awareness programs, testing, tracing, and mitigation programs. 
• $1 billion in funding to support vaccine confidence activities throughout the country. 
• Additional funds for mental health support for rural and underserved areas, including $80 million towards Mental Health training, and $40 million in funding to support the Mental Health professional workforce.

The COVID-19 pandemic has disproportionately impacted minority and vulnerable populations. The COVID-19 vaccine can reduce the spread of the virus and help end the public health emergency. Community partners working with racial and ethnic minorities, people with disabilities, people with limited English proficiency, sexual and gender minorities, and rural populations are critical in helping consumers understand how and when they can receive the vaccine, vaccine safety and confidence, and the important ongoing precautions to slow the spread of COVID-19.

To assist our partners, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) has developed a COVID-19 Vaccine Resources website of the many Federal resources and organized them for health care professionals, partners, consumers, and for assistance in additional languages.

To view the page, visit: go.cms.gov/omhcovid19vaccine.

We encourage you to visit the website regularly, as we will continue to update the page with new resources. You can also share this page within your networks to prepare others to get the vaccine as soon as it’s available to them.

For additional COVID-19 information, visit our general COVID-19 website for Federal resources focusing on vulnerable populations: go.cms.gov/omhcovid19 and From Coverage to Care COVID-19: go.cms.gov/c2ccovid19 webpage.

On March 10, CMS, in collaboration with the CDC, issued updated guidance for nursing homes to safely expand visitation options during the COVID-19 pandemic public health emergency.

This latest guidance comes as more than 3 million doses of vaccines have been administered within nursing homes, thanks in part to the CDC’s Pharmacy Partnership for Long-Term Care Program, following the FDA authorization for emergency use of COVID-19 vaccines.

According to the updated guidance, facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the resident, or visitor, unless certain scenarios arise that would limit visitation for:

• Unvaccinated residents, if the COVID-19 county positivity rate is greater than 10 percent and less than 70 percent of residents in the facility are fully vaccinated,
• Residents with confirmed COVID-19 infection, whether vaccinated or unvaccinated, until they have met the criteria to discontinue transmission-based precautions, or
• Residents in quarantine, whether vaccinated or unvaccinated, until they have met criteria for release from quarantine

The updated guidance also emphasizes that “compassionate care” visits should be allowed at all times, regardless of a resident’s vaccination status, the county’s COVID-19 positivity rate, or an outbreak. Compassionate care visits include visits for a resident whose health has sharply declined or is experiencing a significant change in circumstances.

CMS continues to recommend facilities, residents, and families adhere to the core principles of COVID-19 infection control, including maintaining physical distancing and conducting visits outdoors whenever possible. This continues to be the safest way to prevent the spread of COVID-19, particularly if either party has not been fully vaccinated.

“CMS recognizes the psychological, emotional, and physical toll that prolonged isolation and separation from family have taken on nursing home residents and their families,” said Dr. Lee Fleisher, MD, CMS Chief Medical Officer and Director of CMS’ Center for Clinical Standards and Quality. “That is why, now that millions of vaccines have been administered to nursing home residents and staff, and the number of COVID cases in nursing homes has dropped significantly, CMS is updating its visitation guidance to bring more families together safely. This is an important step that we are taking, as we continue to emphasize the importance of maintaining infection prevention practices, given the continued risk of transmission of COVID-19.”

High vaccination rates among nursing home residents, and the diligence of committed nursing home staff to adhere to infection control protocols, which are enforced by CMS, have helped significantly reduce COVID-19 positivity rates and the risk of transmission in nursing homes.

Although outbreaks increase the risk of COVID-19 transmission, as long as there is evidence that the outbreak is contained to a single unit or separate area of the facility, visitation can still occur.

More Information:

• Nursing Home Visitation – COVID-19 webpage
• Fact sheet

From the U.S. Department of Health and Human Services (HHS) Office of Minority Health

As part of President Biden’s National Strategy for the COVID-19 Response and Pandemic Preparedness today, the Administration is announcing an effort to invest $250 million to encourage COVID-19 safety and vaccination among underserved populations. The U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) will offer the funding as health literacy grants to localities, who will partner with community-based organizations, to reach racial and ethnic minority, rural and other vulnerable populations. The new initiative – Advancing Health Literacy to Enhance Equitable Community Responses to COVID-19 – is expected to fund approximately 30 projects in urban communities and 43 projects in rural communities for two years. Cities, counties, parishes or other similar subdivisions may apply for the funding.

Recipients are expected to develop a disparity impact statement using local data to identify racial and ethnic minority populations at highest risk for health disparities, low health literacy, and not being engaged or reached through existing public health messages and approaches for promoting COVID-19 public health recommendations. Then they will create and operationalize a health literacy plan, partnering with community-based organizations and adhering to culturally and linguistically appropriate standards, to increase the availability, acceptability and use of COVID-19 public health information and services by racial and ethnic minority populations and others considered vulnerable for not receiving and using COVID-19 public health information.

“Information is power, especially the ability to understand and use information to support better health. Whether it helps us understand where to get tested or the benefits of the COVID-19 vaccine, information is a crucial part of keeping families and communities safe,” said Acting Assistant Secretary for Health RADM Felicia Collins, MD.  “Nowhere is this more important than in communities hit hardest by the pandemic, especially racial and ethnic minority communities and other vulnerable populations.”

Racial and ethnic minority populations experience higher rates of cases, hospitalizations and deaths related to SARS-CoV-2 infection. Social determinants of health, such as housing, education and work conditions, contribute to these disparities. Underlying chronic conditions, such as kidney disease, diabetes and obesity, are more prevalent among minority populations and increase the risk of severe COVID-19 illness.

HHS OMH will be accepting applications for this new initiative through April 20, 2021.

Click here to access the notice of funding opportunity.

A technical assistance webinar for potential applicants will be held March 17, 2021 at 5:00 PM ET. Click here to register for the webinar.

Visit our Promotional Resources Page for resources to help you share this notice of funding opportunity.

The Office of the Assistant Secretary for Health (OASH), a division of the U.S. Department of Health and Human Services, provides public health and science advice to the Secretary, and oversees the Department’s broad-ranging public health offices, whose missions include minority health, HIV policy, women’s health, disease prevention, human research protections and others. OASH also includes the Office of the Surgeon General and the U.S. Public Health Service Commissioned Corps.

The HHS Office of Minority Health is dedicated to improving the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities.

For more information about the HHS Office of Minority Health, visit: www.minorityhealth.hhs.gov.