CMS Issues Rule on COVID-19 Vaccine Coverage, Cost and other Health Emergency Provisions

Situation Report | November 2, 2020

On October 28, the U.S. Centers for Medicare and Medicaid (CMS) issued an interim rule, open for comment, regarding COVID-19 vaccine coverage, cost and other public health emergency provisions.

The rule: 

  • Creates flexibilities for states maintaining Medicaid enrollment during the COVID‑19 PHE.
  • Establishes enhanced Medicare payments for new COVID-19 treatments.
  • Addresses price transparency for COVID-19.
  • Extends Performance Year 5 for the Comprehensive Care for Joint Replacement (CJR) model to provide “relief and stability in model operation” amid the PHE.
  • Creates flexibilities in the public notice requirements and post-award public participation requirements for a State Innovation Waiver under Section 1332 of the Patient Protection and Affordable Care Act during the COVID-19 PHE.

CMS is also issuing three toolkits aimed at state Medicaid agencies, providers who will administer the vaccine, and health insurance plans to address issues related to access, billing and payment, and coverage. 

The toolkits give health care providers not currently enrolled in Medicare the information needed to administer and bill vaccines to Medicare patients. New providers are now able to enroll as “Medicare mass immunizers” through an expedited 24-hour process. 

More information is here.