The Centers for Medicare & Medicaid Services (CMS) has released a rule to make COVID-19 vaccines available at no cost to Medicare, Medicaid, and CHIP patients.
Late on Wednesday, CMS released what it called “a comprehensive plan with proactive measures to remove regulatory barriers and ensure consistent coverage and payment for the administration of an eventual vaccine for millions of Americans.” The rule also establishes payment provisions that support Medicare patients’ access to other COVID-19 therapies in hospitals.
CMS released the plan along with three toolkits that it says will “help the health care system prepare to swiftly administer the vaccine once it is available,” and said it was working with the American Medical Association (AMA) on billing codes.
Under CMS’ interim final rule, which includes a 30-day comment period, any vaccine that receives Food and Drug Administration (FDA) approval through an emergency use authorization or under a biologics license application “will be covered under Medicare as a preventive vaccine at no cost to beneficiaries,” CMS said in a release.
State Medicaid and CHIP agencies will have to provide the vaccine with no-cost sharing “for most beneficiaries during the public health emergency.” (Texas Medicaid has no cost-sharing.)
The rule also addresses how private health plans will cover a COVID-19 vaccine. Practitioners who administer the vaccine to the uninsured will be able to receive payment through the Provider Relief Fund.
The toolkits are “aimed at state Medicaid agencies, providers who will administer the vaccine, and health insurance plans,” and “give health care providers not currently enrolled in Medicare the information needed to administer and bill vaccines to Medicare patients,” CMS said.
In an effort to boost the ranks of physicians and other health care workers who can administer COVID-19 vaccines, the rule gives practitioners not enrolled in Medicare an expedited 24-hour process to enroll as a Medicare “mass immunizer.”
“The ability to easily enroll as a mass immunizer is important for some pharmacies, schools, and other entities that may be non-traditional providers or otherwise not eligible for Medicare enrollment,” CMS said in its release. “To further increase the number of providers who can administer the COVID-19 vaccine, CMS will continue to share approved Medicare provider information with states to assist with Medicaid provider enrollment efforts. CMS is also making it easier for newly enrolled Medicare providers to also enroll in state Medicaid programs to support state administration of vaccines for Medicaid recipients.”
CMS added that it is working with AMA “on finalizing a new approach to report use of COVID-19 vaccines, which include separate vaccine-specific codes.”
“After the FDA either approves or authorizes a vaccine for COVID-19, CMS will identify the specific vaccine codes, by dose if necessary, and specific vaccine administration codes for each dose for Medicare payment,” the release said.
The new toolkits and more information are available on CMS’ COVID-19 resources page.
TMA and the Texas Department of State Health Services (DSHS) are urging physicians to enroll in the DSHS Immunization Program to administer the vaccine when it becomes available.
For the latest on COVID-19, visit TMA’s COVID-19 Resources page, which is continually updated.