The Biden-Harris Administration is providing free access to COVID-19 vaccines for every adult living in the United States. Accordingly, the Health Resources and Services Administration’s (HRSA) COVID-19 Coverage Assistance Fund (CAF) will cover the costs of administering COVID-19 vaccines to patients whose health insurance doesn’t cover vaccine administration fees, or does but typically has patient cost-sharing. While patients cannot be billed directly for COVID-19 vaccine fees, costs to health care providers on the front lines for administering COVID-19 vaccines to underinsured patients will now be fully covered through CAF, subject to available funding. As vaccination efforts accelerate, patients will increasingly gain access to COVID-19 vaccines at locations near where they live with providers they trust.
Providers who have administered Food and Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA) to underinsured individuals, on or after December 14, 2020 (the first date of vaccine distribution in the United States), may now submit their COVID-19 vaccine administration fee claims for reimbursement consideration to the CAF. To be eligible for reimbursement, the provider must have first submitted the claim to the individual’s health plan for payment and had the claim denied or only partially paid.
Providers can access the CAF Portal
View Frequently Asked Questions
Note that providers who have administered COVID-19 vaccines to uninsured patients on or after December 14, 2020 are eligible to submit claims for reimbursement to the HRSA COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration for the Uninsured HRSA Uninsured Program).
About the Program
HRSA will provide claims reimbursement to eligible health care providers at the national Medicare rate for administering Food and Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA) to underinsured individuals.
Section 3203 of the CARES Act and its implementing regulations generally require non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to cover any qualifying coronavirus preventive service, including recommended COVID-19 vaccines and their administration, without imposing any cost-sharing requirements, such as a copayment for vaccine administration, co-insurance, or deductible for vaccine administration, during the COVID-19 public health emergency.
However, certain health plans are not subject to this requirement. Examples include grandfathered health plans, excepted benefits, or short-term limited duration insurance plans. The Centers for Medicare & Medicaid Services (CMS) is encouraging, but cannot require, such plans to cover vaccine administration without cost-sharing. Some states may require these plans to cover vaccine administration.
Currently, all organizations and providers participating in the Centers for Disease Control and Prevention’s (CDC) COVID-19 Vaccination Program (which currently includes any providers who may be administering vaccine to individuals) must administer the COVID-19 vaccine, regardless of the vaccine recipient’s ability to pay. Providers are not allowed to seek any reimbursement from vaccine recipients, but may seek reimbursement from a program or plan that covers COVID-19 vaccine administration fees. Vaccine administration fees for uninsured individuals are currently covered through HRSA’s Uninsured Program. The Coverage Assistance Fund extends the same level of support to providers who administer vaccines to underinsured individuals.
How it Works
Health care providers can request claims reimbursement, through the COVID-19 Coverage Assistance Fund electronically and will be reimbursed at the national Medicare rate for vaccine administration, and for patient charges related to COVID-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance, subject to available funding.
Before submitting a claim to the COVID-19 Coverage Assistance Fund, the provider must submit a claim for vaccine administration to the individual’s health plan for payment and have the claim denied or only partially paid. Providers are not required to ascertain a patient’s immigration status in order to receive reimbursement from the fund.
To participate, providers must attest to the following at registration:
- They have submitted a vaccine administration claim to the patient’s health care plan and confirmed that the patient has a health plan that either does not include COVID-19 vaccine administration as a covered benefit or covers COVID-19 vaccination but with cost-sharing. (Certain health plans are not required to provide coverage of qualifying coronavirus preventive services, including recommended COVID-19 vaccines and their administration, without cost-sharing under section 3203 of the CARES Act. Examples include grandfathered health plans, excepted benefits, or short-term limited duration insurance plans.)
- They have verified that no other payer will reimburse them for COVID-19 vaccine administration fees for that patient, or other patient charges related to COVID-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance.
- They will accept defined program reimbursement as payment in full.
- They will agree not to balance bill the patient.
- They will agree to program terms and conditions and may be subject to post-reimbursement audit review.
What’s Covered
There is no cost to health care providers for COVID-19 vaccines received from the federal government, therefore, providers are expected to submit a claim for only vaccine administration to the individual’s health plan for payment. Only those claims denied or for which a patient’s health plan assesses charges to the patient related to COVID-19 vaccine administration are eligible for reimbursement and may be submitted to the Coverage Assistance Fund. Those claims include co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance. Claims will be subject to Medicare timely filing requirements, thus must be submitted within 365 calendar days from the date of service. All claims submitted must be complete and final. Providers who receive reimbursement from the COVID-19 Coverage Assistance Fund cannot also receive reimbursement for such vaccine administration from the individual or other source.
Claims Submission
- Create an account: Coverage Assistance Fund Portal
- Once enrolled, eligible providers and pharmacies can submit claims through their current clearinghouse or submit a claim electronically or manually through the Portal.
Claims Reimbursement Rate
Claims for reimbursement will be priced as described below for eligible services:
- Vaccine administration fees will be priced based on national Medicare rates for administering the COVID-19 vaccine (not geographically adjusted) and are outlined below:
- For dates of service through March 14, 2021:
- Administration of a single-dose COVID-19 vaccine - $28.39
- Administration of the first dose of a COVID-19 vaccine requiring a series of two or more doses - $16.94
- Administration of the final dose of a COVID-19 vaccine requiring a series of two or more doses - $28.39
- For dates of service on or after March 15, 2021:
- Administration (per dose) of a COVID-19 vaccine - $40.00
- Effective August 12, 2021, this includes an additional (third) dose of a COVID-19 vaccine for certain immunocompromised individuals (refer to the CDC website for more information).
- For COVID-19 vaccinations administered in-home* with dates of service on or after June 8, 2021:
- Administration (per dose) of a COVID-19 vaccine - $75.50
- Effective August 12, 2021, this includes an additional (third) dose of a COVID-19 vaccine for certain immunocompromised individuals (refer to the CDC website for more information).
- For a definition of what constitutes in-home administration, see this Centers for Medicare & Medicaid Services fact sheet (PDF - 138 KB)
- Reimbursement will be based on incurred date of service.
- Publication of new codes and updates to existing codes will be made in accordance with CMS.
- For any new codes where a CMS published rate does not exist, claims will be held until CMS publishes corresponding reimbursement information.
Resources
Informational resources are available for providers interested in learning more about the HRSA COVID-19 Coverage Assistance Fund:
- May 12, 2021 Webcast: HRSA COVID-19 Coverage Assistance Fund
For more information about the program, access: