Ensuring Access To COVID-19 Vaccines

posted by AHIP

on May 10, 2021

Health Insurance Provider Actions

FAQs AHIP Resources

Additional Resources and Regulations


The health and well-being of Americans remains our highest priority. Ensuring access to safe, effective COVID-19 vaccines is a public health imperative because vaccines save lives.  Health insurance providers are working with national, state, and local leaders so that every American can quickly access vaccines when they’re available.


AHIP Resources



Additional Resources and Regulations on COVID-19 Vaccines


Regulations and Legislation

CMS Fourth COVID Interim Final Rule, Overview Coronavirus Aid, Relief, and Economic Security (CARES) Act
Provides guidance on how to implement COVID-19 vaccine rules under the CARES Act, which established a vaccine as a preventive service when recommended by ACIP Section 3203 requires health insurance providers to cover any vaccines recommended by ACIP as a preventive service available without cost sharing within 15 business days or recommendation.
ACIP Interim Recommendation for Allocation of COVID-19 Vaccine
Advisory Committee on Immunization Practices (ACIP) recommendations of who should receive the vaccine and when, given limited supply.

FDA

EUA for Pfizer Vaccine (FDA) DailyMed: Library of Medicine Pfizer-BioNTech COVID-19 Vaccine (NIH)
Official Emergency Use Authorization granted for the Pfizer-BioNTech COVID-19 vaccine. Drug Labeling information for the Pfizer-BioNTech COVID-19 vaccine.
EUA for Moderna Vaccine (FDA) DailyMed: Library of Medicine Moderna COVID-19 Vaccine (NIH)
Official Emergency Use Authorization granted for the Moderna COVID-19 vaccine. Drug Labeling information for the Moderna COVID-19 vaccine.
Moderna COVID-19 Vaccine FAQs
The FDA has posted questions covering specific issues, such as what data the FDA used when it decided on whether to authorize the vaccine for emergency use.

Payer Toolkits and Guidance

COVID-19 Webpage (CMS) CMS Toolkit on COVID-19 Vaccine—Health Insurance Issuers and Medicare Advantage Plans
CMS landing page with policies, guidance, and links to toolkits for providers, health insurance providers, issuers, state Medicaid programs, and CHIP programs.
CMS Memo Regarding Access to COVID-19 Vaccine Data for Parts C & D Enrollees Tri-Agencies FAQs on Cost-Sharing Waivers
CMS will allow plans to request certain COVAX data2 from CMS regarding their enrollees, subject to CMS approval, if that data is the minimum necessary and is requested for the plans’ health care operations such as case management, care coordination, or population-based activities to improve the health of their enrollees.
Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)

CMS Toolkits

Medicare Fee-For-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) Tri-Agencies FAQs on cost-sharing waivers
The Centers for Medicare & Medicaid Services (CMS) is issuing blanket waivers consistent with those issued for past PHE declarations. These waivers prevent gaps in access to care for beneficiaries impacted by the emergency. You do not need to apply for an individual waiver if a blanket waiver is issued. Set out below are frequently asked questions (FAQs) regarding implementation of the Families First Coronavirus Response Act (the FFCRA), the Coronavirus Aid, Relief, and Economic Security Act (the CARES Act), and other health coverage issues related to Coronavirus Disease 2019 (COVID-19).
CDC’s COVID-19 Data Tracker CMS Toolkits
This site tracks national and local rates for COVID-19 cases and death. CMS released a set of toolkits to describe how health care providers can enroll in Medicare to bill for administering vaccines when available, vaccine Medicare coding structure, Medicare reimbursement strategy for COVID-19 vaccine administration, and how health care providers can bill correctly for administering vaccines, including roster and centralized billing.
CMS Toolkit on COVID-19 Vaccine—Health Insurance Issuers and Medicare Advantage Plans Interim Operational Guidance for Jurisdictions Playbook and State Plan Executive Summaries (CDC)
The Centers for Medicare & Medicaid Services (CMS) released a set of toolkits for providers, states and issuers to help the health care system prepare to swiftly administer the vaccine once it is available. Interim playbook serves as a playbook for state, territorial, and local public health programs and their partners on how to plan and operationalize a vaccination response to COVID-19 within their jurisdictions.

Coding and Billing Guidance

COVID-19 CPT Coding and Guidance EUA for Pfizer Vaccine (FDA)
New Current Procedural Terminology (CPT®) codes have been created that streamline the novel coronavirus testing currently available on the United States market. Official Emergency Use Authorization granted for the Pfizer-BioNTech COVID-19 vaccine.
DailyMed: Library of Medicine Pfizer-BioNTech COVID-19 Vaccine (NIH) EUA for Moderna Vaccine (FDA)
Drug Labeling information for the Pfizer-BioNTech COVID-19 vaccine. Official Emergency Use Authorization granted for the Moderna COVID-19 vaccine.
DailyMed: Library of Medicine Moderna COVID-19 Vaccine (NIH) Moderna COVID-19 Vaccine FAQs
Drug Labeling information for the Moderna COVID-19 vaccine. The FDA has posted questions covering specific issues, such as what data the FDA used when it decided on whether to authorize the vaccine for emergency use.
Medicare Part B Payment for COVID-19 Vaccines and Monoclonal Antibodies During PHE HRSA FAQs for Claims Reimbursement for Testing, Treatment and Vaccine Administration
CMS guidance on payment allowances and other related information under Medicare Part B. Also includes information on payment allowances for certain monoclonal antibodies. HRSA FAQs on claims for COVID-19 testing, treatment, and vaccine administration, including information about the Uninsured Program.

Toolkits for Providers and Consumers

COVID-19 Webpage (CMS) FAQ for Providers on COVID-19 Vaccine (CDC)
CMS landing page with policies, guidance, and links to toolkits for providers, health insurance providers, issuers, state Medicaid programs, and CHIP programs. CDC website with 8 things that the public needs to know about the COVID-19 vaccine program and vaccines, including safety, effectiveness, allocation, and who can administer the vaccine. It also has information on side effects, costs, FDA approval and authorization, and how a COVID-19 fits into the tools available to combat the pandemic.
Long-Term Care Facility Toolkit: Preparing for COVID-19 Vaccination at Your Facility (cdc.gov) CMS Memo Regarding Access to COVID-19 Vaccine Data for Parts C & D Enrollees
This toolkit provides long-term care facility (LTCF) administrators and clinical leadership with information and resources to help build vaccine confidence among healthcare personnel (HCP) and residents. CMS will allow plans to request certain COVAX data2 from CMS regarding their enrollees, subject to CMS approval, if that data is the minimum necessary and is requested for the plans’ health care operations such as case management, care coordination, or population-based activities to improve the health of their enrollees.
Phased Allocation of COVID-19 Vaccines: State and Territorial Approaches COVID-19 Vaccine FAQs in Correctional and Detention Centers
This table provides information on how states and territories are planning to allocate the COVID-19 vaccines. CDC released frequently asked questions about COVID-19 vaccination in correctional and detention centers.
COVID-19 Vaccine: Helps protect you from getting COVID-19 COVID-19 Vaccine Communications Resources 
Information from the CDC on getting ready for the COVID-19 vaccine.

Maps that provide state-specific vaccination data.

 

 

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