HRSA Reimbursement Available for Vaccine Administration to “Underinsured” Individuals
HRSA is now reimbursing providers for vaccine administrations to underinsured individuals through the “Coverage Assistance Fund.” This reimbursement is separate from the uninsured coverage through other HRSA programs. The fund will reimburse providers via the PRF for vaccine administration services provided to an individual who has a health plan that either does not include COVID-19 vaccine administration as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing.
Simply put, the fee for COVID-19 vaccine administration is eligible for reimbursement. Any patient cost-sharing requirements, such as a copayment for vaccine administration, co-insurance, or a deductible for vaccine administration, are eligible for reimbursement. Payment rates follow:
- 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
Providers may enroll here. Claims must be submitted within 1 year of the service.
Once enrolled, providers (including eligible pharmacies) can submit claims through their current clearinghouse or submit a claim electronically or manually through the provider portal at the prior link. Payments received from the program are claim reimbursements and should be treated in the same manner as reimbursements received from commercial insurance, Medicaid, and/or Medicare, etc., as opposed to, say, a grant award. Significant detail is available on the HRSA website (news release here, FAQs here).
Advis is available to answer any questions and to assist with the reimbursement process through the Coverage Assistance Fund. Contact us online or at (708) 478-7030.