Below is a letter sent by U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra to insurers and providers following recent reports of ongoing concerns about Americans facing costs associated with COVID-19 vaccinations or testing.
To COVID-19 vaccination and testing providers and insurers:
Since we took office, the Biden-Harris administration has made combatting the COVID-19 pandemic our top priority. Central to our national plan to protect Americans and end the pandemic has been increasing testing and vaccinations. In light of recent reports of consumer cost concerns, I am reminding health care providers of their signed agreements to cover the administration of COVID-19 vaccines free-of-charge to patients, and group health plans and health insurers of their legal requirement to provide coverage of COVID-19 vaccinations and diagnostic testing without patients shouldering any cost.
COVID-19 vaccines and their administration are free for any individual living in the United States, regardless of their insurance or immigration status. Currently, all providers administering COVID-19 vaccines are required to sign the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program Provider Agreement. Among other requirements, this agreement states that providers must administer COVID-19 vaccines at no out-of-pocket cost to patients. Furthermore, to ensure no surprise billing, providers may not require that patients have additional medical services to receive their COVID-19 vaccination – nor can they charge any type of fee if COVID-19 vaccination is the sole medical service provided.
We recognize that there are costs associated with administering the vaccines – from staff trainings to vaccine storage. For these expenses, providers may not bill patients but can seek reimbursement through Medicare, Medicaid, private insurance, or other applicable coverage. Most group health plans and health insurers are statutorily required to cover COVID-19 vaccines recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention without cost-sharing.
For uninsured and underinsured patients, providers may bill the Health Resources and Services Administration COVID-19 Uninsured and COVID-19 Coverage Assistance Fund programs for vaccine-related fees. If providers accidentally billed and received payments from patients for COVID-19 vaccine-related fees, those payments should immediately be returned to their patients. Providers who fail to abide by CDC vaccine program requirements are reminded that they may be reported to the HHS Office of the Inspector General for possible enforcement action, in addition to remedies for non-compliance with the CDC Provider Agreement.
And, this past February, HHS with the Department of Labor and the Department of the Treasury issued updated guidance addressing the requirement that group health plans and health insurers cover COVID-19 diagnostic testing without cost-sharing. This requirement removes cost concerns as a barrier for Americans as they decide whether to get tested – a key priority as we try to catch COVID-19 cases early and prevent their spread. Group health plans and health insurers are also prohibited from delaying COVID-19 diagnostic testing or making COVID-19 diagnostic testing more cumbersome and costly through prior authorization or other medical management. The full guidance can be found here.
Health plans and health insurers failing to comply with these legal requirements may be reported to appropriate state insurance departments or to the Centers for Medicare & Medicaid Services for possible enforcement action. The Department of Labor will also address any complaints regarding coverage offered in connection with private, employer-sponsored group health plans.
Protecting the health and well-being of our nation is my primary priority as HHS Secretary, and it is core to our policymaking decisions. We will remain vigilant in holding providers accountable for vaccinating the public without charging patients and holding issuers accountable for covering COVID-19 diagnostic testing without cost-sharing.
I encourage providers and issuers to join our fight, if they haven’t already, and spread the word far-and-wide across communities about the importance of getting vaccinated against COVID-19. It’s free for patients, convenient, and available to everyone in the United States. And it’s how we end this pandemic, protect ourselves and each other, and begin to return to a more normal lifestyle.
This communication was printed, published, or produced and disseminated at U.S. taxpayer expense.
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Author: HHS Press Office