HHS sends letter to providers, insurers reinforcing requirements for COVID-19 vaccination and testing to be free for all recipients

Xavier Becerra, secretary of HHS, issued a letter emphasizing that out-of-pocket fees for COVID-19-related services are prohibited.

The U.S. Department of Health and Human Services recently reminded healthcare providers and health plans that recipients of the COVID-19 vaccine must not bear any of the cost and that health plans must fully cover testing.

In a letter, Xavier Becerra, secretary of HHS, pointed to a New York Times report that some unvaccinated adults cited wariness about potential costs as a reason for their reluctance to get vaccinated.

Becerra noted that as a condition of offering the vaccine, providers must sign the CDC’s COVID-19 Vaccination Program Provider Agreement, which states that the vaccine must be offered at no out-of-pocket cost or fee to patients. Providers also are barred from requiring that patients be seen for additional medical services when they get vaccinated.

“We recognize that there are costs associated with administering the vaccines — from staff trainings to vaccine storage,” Becerra wrote. “For these expenses, providers may not bill patients but can seek reimbursement through Medicare, Medicaid, private insurance or other applicable coverage.”

Payment options for providers

Becerra added that “most” group health plans and health insurers are statutorily required to cover the full cost of vaccines recommended by the CDC’s Advisory Committee on Immunization Practices.

For uninsured patients who receive testing, treatment or vaccination related to the disease, providers can be reimbursed by the COVID-19 Uninsured Fund. For patients whose health plans don’t cover the cost of vaccination or require cost sharing, providers can file claims with the COVID-19 Coverage Assistance Fund.

“If providers accidentally billed and received payments for patients for COVID-19 vaccine-related fees, those payments should be immediately returned to their patients,” Becerra wrote.

“Providers who fail to abide by CDC vaccine 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 noncompliance with the CDC Provider Agreement,” he added.

Health plans must fully cover testing

Becerra also referred to February 2021 regulations, issued by the U.S. Departments of Labor and Treasury, requiring group health plans and health insurers to cover the full cost of COVID-19 testing.

Payers are “prohibited from delaying COVID-19 diagnostic testing or making COVID-19 diagnostic testing more cumbersome and costly through prior authorization or other medical management,” he said. Violations may be reported to state insurance departments, CMS or Labor.