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Politics, Policy & Law

CMS announces rule to cover costs of COVID-19 vaccines, therapeutics 

Oct 30, 2020 | 12:48 AM GMT

CMS issued an interim final rule on Wednesday stating that any COVID-19 vaccine that receives emergency use authorization or a BLA from FDA will be covered under Medicare at no cost to beneficiaries, and be covered for most Medicaid beneficiaries during the public health emergency.

The rule would also implement provisions of the CARES Act that will require most private health plans to cover COVID-19 vaccines administered by in and out-of-network providers during the public health emergency, and enable providers to be reimbursed for administering a COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by the Health Resources and Services Administration.

CMS’s rule would establish increased reimbursement payments from Medicare to hospitals administering FDA-approved or authorized COVID-19 therapies in an in-patient setting, and ensure Medicare reimbursement for these therapies in the outpatient setting.

Normally, a hospital receives a fixed payment from Medicare for inpatient services, and may apply for additional “outlier payments” when its costs for a patient exceed a certain threshold. Under the interim final rule, hospitals will qualify for additional payments when they administer approved or authorized COVID-19 therapies, even if they do not reach the outlier threshold. 

The agency also released resources designed to increase the number of providers that can administer a COVID-19 vaccine to Medicare and Medicaid beneficiaries. 

The comment period for the CMS rule is open until Nov. 27. 

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