The Centers for Medicare and Medicaid Services (CMS) said it’s taking steps to ensure all U.S. citizens, including the nation’s seniors, have access to a COVID-19 vaccine at no cost when it becomes available.

The agency’s actions lift regulatory barriers for administering an approved vaccine, along with toolkits for providers, states and insurers to help the health care system prepare to swiftly administer a virus vaccine when one is ready for the public.

The CMS said Oct. 28 that its action is designed to increase the number of providers that can administer the vaccine and to ensure adequate reimbursement of the cost for administering the vaccine in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover the vaccine at no charge to beneficiaries says CMS.

“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,” the agency said.

The CMS action last week establishes that any vaccine that receives Food and Drug Administration [FDA] authorization for COVID-19 will be covered under Medicare as a preventive vaccine at no cost to beneficiaries.

The agency action also implements provisions of the CARES Act to ensure swift coverage of a COVID-19 vaccine by most private health insurance plans without cost-sharing from both in and out-of-network providers during the course of the public health emergency.

As a condition of receiving free COVID-19 vaccines from the federal government, providers will be prohibited from charging consumers for administration of the vaccine.

CMS’ toolkits specific information for several programs include:

Medicare: Beneficiaries with Medicare pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.

Medicare Advantage (MA): For calendar years 2020 and 2021, Medicare will pay directly for the COVID-19 vaccine and its administration for beneficiaries enrolled in MA plans. MA plans would not be responsible for reimbursing providers to administer the vaccine during this time.

Medicare Advantage beneficiaries also pay nothing for COVID-19 vaccines and their copayment/coinsurance and deductible are waived.

Medicaid: State Medicaid and CHIP agencies must provide vaccine administration with no cost-sharing for most beneficiaries during the public health emergency.

Following the public health emergency, depending on the population, states may have to evaluate cost-sharing policies and may have to submit state plan amendments if updates are needed.

Private Plans: CMS, along with the Departments of Labor and the Treasury, is requiring that most private health plans and issuers cover a recommended COVID-19 vaccine and its administration, both in-network and out-of-network, with no cost-sharing.

The rule also provides that out-of-network rates cannot be unreasonably low, and references CMS’s reimbursement rates as a potential guideline for insurance companies.

Uninsured: For individuals who are uninsured, providers will be able to be reimbursed for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration.

Additionally, CMS says it’s taking action to increase reimbursement for any new COVID-19 treatments that are approved or authorized by the FDA.

Sarafina Wright –Washington Informer Staff Writer

Sarafina Wright is a staff writer at the Washington Informer where she covers business, community events, education, health and politics. She also serves as the editor-in-chief of the WI Bridge, the Informer’s...

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