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HHS Issues Regulations Related to Coverage of COVID-19 Vaccines and Price Transparency for COVID-19 Testing

The Centers for Medicare and Medicaid Services (CMS) issued several provisions related to coverage of COVID-19 vaccines authorized or approved for use by the Food and Drug Administration (FDA).

Medicare will add coverage for COVID-19 vaccines and administration of the vaccine to the list of services covered under Medicare Part B without a coinsurance or deductible.

States are required to cover COVID-19 vaccines and administration of the vaccine without a copay for Medicaid beneficiaries during the Public Health Emergency (PHE). Upon conclusion of the PHE, coverage of COVID-19 vaccines and administration of the vaccine without a copay will be required for all Medicaid children under age 21.

CMS is also mandating coverage without cost sharing for all non-grandfathered group health plans and individual health insurance coverage providers. Plans must cover COVID-19 immunizations that are recommended by the United States Preventive Task Force Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention. During the public health emergency, plans must cover the service without a copay for both in-network and out-of-network providers.

Health Resources and Services Administration (HRSA) will cover the vaccine through the COVID-19 Claims Reimbursement program.

CMS also expanded price transparency requirements for facilities providing COVID-19 diagnostic tests. Any provider performing one or more COVID-19 diagnostic tests must make the cash price for the test available on their website. If the provider does not maintain a website, the provider must make the cash price available within two business days in writing upon request.  Non-compliant providers may be at risk of civil monetary penalties.

These changes are part of the fourth COVID-19 interim final rule with comment (IFC) period published by CMS. The IFC was released on October 28, 2020 and addressed multiple areas within Medicare and Medicaid. The IFC is effective immediately and is scheduled to be published on November 6 in the Federal Register with a 30 day public comment period.

A fact sheet regarding the IFC is available at here.

The full text of the IFC is available here.

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