CMS Bolsters Payments for At-Home COVID-19 Vaccines

From CMS on June 9, 2021

Biden Administration Continues Efforts to Increase Vaccinations by Bolstering Payments for At-Home COVID-19 Vaccinations for Medicare Beneficiaries

As part of President Biden’s commitment to increasing access to vaccinations, CMS announced an additional payment amount for administering in-home COVID-19 vaccinations to Medicare beneficiaries who have difficulty leaving their homes or are otherwise hard-to-reach. This announcement further demonstrates continued efforts of the Biden-Harris Administration to meet people where they are and make it as easy as possible for all Americans to get vaccinated. There are approximately 1.6 million adults 65 or older who may have trouble accessing COVID-19 vaccinations because they have difficulty leaving home.

While many Medicare beneficiaries can receive a COVID-19 vaccine at a retail pharmacy, their physician’s office, or a mass vaccination site, some beneficiaries have great difficulty leaving their homes or face a taxing effort getting around their communities easily to access vaccination in these settings. To better serve this group, Medicare is incentivizing providers and will pay an additional $35 per dose for COVID-19 vaccine administration in a beneficiary’s home, increasing the total payment amount for at-home vaccination from approximately $40 to approximately $75 per vaccine dose. For a two-dose vaccine, this results in a total payment of approximately $150 for the administration of both doses, or approximately $70 more than the current rate.

“CMS is committed to meeting the unique needs of Medicare consumers and their communities – particularly those who are home bound or who have trouble getting to a vaccination site. That’s why we’re acting today to expand the availability of the COVID-19 vaccine to people with Medicare at home,” said CMS Administrator Chiquita Brooks-Lasure. “We’re committed to taking action wherever barriers exist and bringing the fight against the COVID-19 pandemic to the door of older adults and other individuals covered by Medicare who still need protection.”

Delivering COVID-19 vaccination to access-challenged and hard-to-reach individuals poses some unique challenges, such as ensuring appropriate vaccine storage temperatures, handling, and administration. The CDC has outlined guidance to assist vaccinators in overcoming these challenges. This announcement now helps to address the financial burden associated with accommodating these complications.

The additional payment amount also accounts for the clinical time needed to monitor a beneficiary after the vaccine is administered, as well as the upfront costs associated with administering the vaccine safely and appropriately in a beneficiary’s home. The payment rate for administering each dose of a COVID-19 vaccine, as well as the additional in-home payment amount, will be geographically adjusted based on where the service is furnished.

How to Find a COVID-19 Vaccine:

As this action demonstrates, a person’s ability to leave their home should not be an obstacle to getting the COVID-19 vaccine. As states and the federal government continue to break down barriers – like where vaccines can be administered – resources for connecting communities to vaccination options remain key. Unvaccinated individuals and those looking to assist friends and family can:

  • Visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby
  • Text GETVAX (438829) for English or VACUNA (822862) for Spanish for near-instant access to details on three vaccine sites in the local area
  • Call the National COVID-19 Vaccination Assistance Hotline at 1-800-232-0233 (TTY: 1-888-720-7489) for assistance in English and Spanish

Coverage of COVID-19 Vaccines:

The federal government is providing the COVID-19 vaccine free of charge or with no cost-sharing for all people living in the United States. As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers cannot charge patients any amount for administering the vaccine.

Because no patient can be billed for COVID-19 vaccinations, CMS and its partners have provided a variety of information online for providers vaccinating all Americans regardless of their insurance status:

  • Original Medicare and Medicare Advantage: Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance or deductible.
  • Medicaid and the Children’s Health Insurance Program (CHIP):State Medicaid and CHIP agencies must cover COVID-19 vaccine administration with no cost sharing for nearly all beneficiaries during the COVID-19 Public Health Emergency (PHE) and for over a year after it ends. For the very limited number of Medicaid beneficiaries who are not eligible for this coverage (and do not receive it through other coverage they might have), providers may submit claims for reimbursement for administering the COVID-19 vaccine to underinsured individuals through the COVID-19 Coverage Assistance Fund, administered by the Health Resources and Services Administration (HRSA), as discussed below. Under the American Rescue Plan Act of 2021 (ARP), signed by President Biden on March 11, 2021, the federal matching percentage for state Medicaid and CHIP expenditures on COVID-19 vaccine administration is currently 100% (as of April 1, 2021), and will remain 100% for more than a year after the COVID-19 PHE ends. The ARP also expands coverage of COVID-19 vaccine administration under Medicaid and CHIP to additional eligibility groups. CMS recently updated the Medicaid vaccine toolkit to reflect the enactment of the ARP at https://www.medicaid.gov/state-resource-center/downloads/covid-19-vaccine-toolkit.pdf.
  • Private Plans: The vaccine is free for people enrolled in private health plans and issuers COVID-19 vaccine and its administration is covered without cost sharing for most enrollees, and such coverage must be provided both in-network and out-of-network during the PHE. Current regulations provide that out-of-network rates must be reasonable as compared to prevailing market rates, and the rules reference using the Medicare payment rates as a potential guideline for insurance companies. In light of CMS’s increased Medicare payment rates, CMS will expect health insurance issuers and group health plans to continue to ensure their rates are reasonable when compared to prevailing market rates. Under the conditions of participation in the CDC COVID-19 Vaccination Program, providers cannot charge plan enrollees any administration fee or cost sharing, regardless of whether the COVID-19 vaccine is administered in-network or out-of-network.

The Biden-Harris Administration is providing free access to COVID-19 vaccines for every adult living in the United States. For individuals who are underinsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine through the COVID-19 Coverage Assistance Fund administered by HRSA after the claim to the individual’s health plan for payment has been denied or only partially paid. Information is available at https://www.hrsa.gov/covid19-coverage-assistance.

For individuals who are uninsured, providers may submit claims for reimbursement for administering the COVID-19 vaccine to individuals without insurance through the Provider Relief Fund, administered by HRSA. Information on the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program is available at https://www.hrsa.gov/CovidUninsuredClaim.

More information on Medicare payment for COVID-19 vaccine administration – including a list of billing codes, payment allowances and effective dates – is available at https://www.cms.gov/medicare/covid-19/medicare-covid-19-vaccine-shot-payment.

More information regarding the CDC COVID-19 Vaccination Program Provider Requirements and how the COVID-19 vaccine is provided through that program at no cost to recipients is available at https://www.cdc.gov/vaccines/covid-19/vaccination-provider-support.html.

Benefit | Credit Card Fee Class Action Settlement

Dear AAA Members:

As you may know, there is a class action lawsuit pending in the U.S. alleging Visa, MasterCard and their member banks engaged in anticompetitive practices. The case, Payment Card Interchange Fee Settlement, alleges activity that includes collusion which artificially inflated the interchange fee that all AAA members paid to accept Visa and MasterCard branded credit cards. The proposed settlement provides that any merchant that accepted Visa and MasterCard credit cards at any time between January 1, 2004 and January 25, 2019 will be entitled to participate in the $5.54 billion-dollar settlement

Sign Up Now

Class Action Refund has over 17 years of experience in managing complex claims and is an innovator of a niche service that specializes in the recovery of antitrust settlements for businesses, which includes large organizations like the AAA. Class Action Refund can ease the burden of self-filing. The life cycle of a claim can take several years to settle and may require various types of documentation and correspondence with the claims administrator in order to substantiate the claim. Class Action Refund will manage the entire filing process and inform you of milestones as necessary, so that you may stay focused on your core business. Additionally, there are NO OUT-OF-POCKET COSTS TO AAA MEMBERS. Class Action Refund will reduce its normal 33% contingency fee of funds recovered to 25% for AAA members.  If no recovery is made, then no fee is charged.

Any member interested in availing themselves of Class Action Refund’s recovery management services, for the Payment Card Interchange Fee Settlement can quickly and easily sign up below!

Sign Up Now

Questions? Contact:

Joe Grande
Senior Account Manager
914.630.5112
jgrande@classactionrefund.com

Sign Up Now

Disclaimer: No claim forms are available at this time, and no claim-filing deadline exists. No-cost assistance will be available from the Class Administrator and Class Counsel during any claims-filing period. No one is required to sign up with any third-party service in order to participate in any settlement. For additional information regarding the status of the litigation, interested persons may visit www.paymentcardsettlement.com, the Court-approved website for this case.

CMS | Repayment of COVID-19 Accelerated & Advance Payments Began 3/30

Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021

CMS issued information about repayment of COVID-19 accelerated and advance payments. If you requested these payments, learn how and when we’ll recoup them:

  • Identify payments we recovered
  • Prepare your billing staff

More Information:

New Benefit | Credit Card Fee Class Action Settlement

Dear AAA Members:

As you may know, there is a class action lawsuit pending in the U.S. alleging Visa, MasterCard and their member banks engaged in anticompetitive practices. The case, Payment Card Interchange Fee Settlement, alleges activity that includes collusion which artificially inflated the interchange fee that all AAA members paid to accept Visa and MasterCard branded credit cards. The proposed settlement provides that any merchant that accepted Visa and MasterCard credit cards at any time between January 1, 2004 and January 25, 2019 will be entitled to participate in the $5.54 billion-dollar settlement

Sign Up Now

Class Action Refund has over 17 years of experience in managing complex claims and is an innovator of a niche service that specializes in the recovery of antitrust settlements for businesses, which includes large organizations like the AAA. Class Action Refund can ease the burden of self-filing. The life cycle of a claim can take several years to settle and may require various types of documentation and correspondence with the claims administrator in order to substantiate the claim. Class Action Refund will manage the entire filing process and inform you of milestones as necessary, so that you may stay focused on your core business. Additionally, there are NO OUT-OF-POCKET COSTS TO AAA MEMBERS. Class Action Refund will reduce its normal 33% contingency fee of funds recovered to 25% for AAA members.  If no recovery is made, then no fee is charged.

Any member interested in availing themselves of Class Action Refund’s recovery management services, for the Payment Card Interchange Fee Settlement can quickly and easily sign up below!

Sign Up Now

Mr. Hugh Bellingreri, Senior Account Manager, is the contact person for members. Please call Hugh directly at 914-630-5116, or you can reach him by email at hbellingreri@classactionrefund.com with any questions. 

Sign Up Now

Disclaimer: No claim forms are available at this time, and no claim-filing deadline exists. No-cost assistance will be available from the Class Administrator and Class Counsel during any claims-filing period. No one is required to sign up with any third-party service in order to participate in any settlement. For additional information regarding the status of the litigation, interested persons may visit www.paymentcardsettlement.com, the Court-approved website for this case.

Credit Card Fee Class Action Settlement

Dear AAA Members:

As you may know, there is a class action lawsuit pending in the U.S. alleging Visa, MasterCard and their member banks engaged in anticompetitive practices. The case, Payment Card Interchange Fee Settlement, alleges activity that includes collusion which artificially inflated the interchange fee that all AAA members paid to accept Visa and MasterCard branded credit cards. The proposed settlement provides that any merchant that accepted Visa and MasterCard credit cards at any time between January 1, 2004 and January 25, 2019 will be entitled to participate in the $5.54 billion-dollar settlement

Sign Up Now

Class Action Refund has over 17 years of experience in managing complex claims and is an innovator of a niche service that specializes in the recovery of antitrust settlements for businesses, which includes large organizations like the AAA. Class Action Refund can ease the burden of self-filing. The life cycle of a claim can take several years to settle and may require various types of documentation and correspondence with the claims administrator in order to substantiate the claim. Class Action Refund will manage the entire filing process and inform you of milestones as necessary, so that you may stay focused on your core business. Additionally, there are NO OUT-OF-POCKET COSTS TO AAA MEMBERS. Class Action Refund will reduce its normal 33% contingency fee of funds recovered to 25% for AAA members.  If no recovery is made, then no fee is charged.

Any member interested in availing themselves of Class Action Refund’s recovery management services, for the Payment Card Interchange Fee Settlement can quickly and easily sign up below!

Sign Up Now

Mr. Hugh Bellingreri, Senior Account Manager, is the contact person for members. Please call Hugh directly at 914-630-5116, or you can reach him by email at hbellingreri@classactionrefund.com with any questions. 

Sign Up Now

Disclaimer: No claim forms are available at this time, and no claim-filing deadline exists. No-cost assistance will be available from the Class Administrator and Class Counsel during any claims-filing period. No one is required to sign up with any third-party service in order to participate in any settlement. For additional information regarding the status of the litigation, interested persons may visit www.paymentcardsettlement.com, the Court-approved website for this case.

CHART Model Community Transformation Track App Deadline Extended

From CMS on December 29, 2020

CHART Model Community Transformation Track Application Deadline Extension

The Centers for Medicare & Medicaid Services (CMS) will extend the Community Health Access and Rural Transformation (CHART) Model Community Transformation Track application deadline by one month to March 16, 2021.

This extension is in response to feedback received from stakeholders, including comments about the challenges of preparing an application during the coronavirus disease 2019 (COVID-19) public health emergency. Extending the application deadline will allow interested applicants additional time to prepare their applications.

The Community Transformation Track will provide up-front funding to up to 15 rural communities across the country. The rural communities will be awarded seed money to work with health care providers and payers across the community to design systems of care that improve access to high quality care that is sustainable and value-based.

WaPo | Pandemic is pushing America’s 911 system to ‘breaking point’

From the Washington Post by William Wan on December 3, 2020

Pandemic is pushing America’s 911 system to ‘breaking point,’ ambulance operators say
Surging demand, financial strain are leaving ambulance teams exhausted and running out of funds

The coronavirus pandemic has pushed America’s 911 system and emergency responders to a “breaking point,” with ambulance operators exhausted and their services financially strained, according to the group that represents them.

The situation since the novel coronavirus struck last winter has grown so dire that the American Ambulance Association recently begged the Department of Health and Human Services for $2.6 billion in emergency funding.

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Ambulance Cost Collection DELAYED

Due to the Public Health Emergency declared for the COVID-19 pandemic, CMS issued a blanket waiver in May 2020 to delay the data collection and reporting for those ground ambulance organizations selected to report in year 1 by one year. They were concerned that the unpredictability of the winter influenza season when combined with the COVID-19 pandemic would further strain the capacity of ground ambulance organizations in 2021.

As a result, CMS hissued a revised blanket waiver yesterday to delay the Medicare Ground Ambulance Data Collection System. Please see page 31 of this document.

CMS is delaying the data collection and reporting period for ground ambulance organizations selected to participate in year 1 for two years and for one year for ground ambulance organizations selected to participate in year 2. With this modification, the data collection period for year 1 and year 2 selected ground ambulance organizations will begin between January 1, 2022 and December 31, 2022.

AAA will send out a more detailed member advisory to assess the impact of the delay on the other requirements imposed in the legislation that mandated cost data collection for ambulance services.

JEMS | Ambulance Market Growth

From JEMS

Ambulance Services Market to Grow by $7.77 Billion amid COVID-19 Spread

Market research firm Technavio says the ambulance services market is poised to grow by $7.77 billion during 2020-2024. The report offers an up-to-date analysis regarding the current market scenario, latest trends and drivers and the overall market environment.

Impact of COVID-19

The COVID-19 pandemic continues to transform the growth of various industries, however, the immediate impact of the outbreak is varied. While a few industries will register a drop in demand, numerous others will continue to remain unscathed and show promising growth opportunities. COVID-19 will have a low impact on the ambulance services market. The market growth in 2020 is likely to increase compared to the market growth in 2019.

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KFF 2020 Employer Health Benefits Survey

From the Kaiser Family Foundation on October 8

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. The 2020 survey included 1,765 interviews with non-federal public and private firms.

Annual premiums for employer-sponsored family health coverage reached $21,342 this year, up 4% from last year, with workers on average paying $5,588 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,644 for single coverage. Fifty-five percent of small firms and 99% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 56%.

Survey results are released in several formats, including a full report with downloadable tables on a variety of topics, a summary of findings, and an article published in the journal Health Affairs.