COVID-19 Vaccination Update: Reimbursement Rate Change

COVID-19 Vaccination Update: Reimbursement Rate Change 

On December 31, 2020 we announced that providers of Sections 5, 14, 45, and 90 who have entered into a CDC COVID-19 Vaccination Program Provider Agreement can begin submitting claims for COVID-19 vaccine administration and product, with the intent to update our system in the near future so that providers of Sections 3, 9, 31, 40, 80, and 103 services who are approved as vaccinators can also submit claims.  

As communicated, we set reimbursement for vaccine administration at 100% of Medicare, which at the time the Centers for Medicare and Medicaid Services (CMS) had set as national rates. Soon after our announcement, CMS released regional rates. As a result, we have updated our rates to reflect that, effective January 1, 2021, we will reimburse based on Medicare’s regional rates for Maine, per our standard practice. The reimbursement rate will be set at 100% of the regional rate. This information can be found in the table below.  

Providers will need to adjust any claims they have submitted for dates of service January 1, 2021 through January 13, 2021. We apologize for any inconvenience this has caused.  

For more information on the rates that were in effect through December 31, 2020, please see our previous message.   

Providers who administer a licensed or authorized COVID-19 vaccine to uninsured individuals or those enrolled in MaineCare with certain limited benefits (family planning services, family planning presumptive eligibility, emergency MaineCare, and prisoner inpatient) should request reimbursement through the federal Health Resources & Services Administration (HRSA). For more information on the process and the availability of funds, please visit HRSA’s website. For more guidance about vaccine coverage for uninsured individuals or those with limited benefits, please see CMS’ website.  

Federal Public Health Emergency (PHE) is Extended       

As previously communicated, many of MaineCare’s temporary policy changes related to our COVID-19 response are approved for the duration of the federal Public Health Emergency (PHE), which is declared by U.S. Health and Human Services Secretary Azar.   

The federal PHE that was set to expire on January 20, 2021 has been renewed for an additional 90 days, effective January 21, 2021 through April 20, 2021.       

As a reminder, a federal PHE declaration lasts until the Secretary declares that the PHE no longer exists or upon the expiration of the 90-day period beginning on the date the Secretary declared a PHE exists, whichever occurs first. The Secretary may extend the PHE declaration for subsequent 90-day periods for as long as the PHE continues to exist, and may terminate the declaration whenever he determines that the PHE has ceased to exist.        

In regard to our temporary policy changes and guidance related to the COVID-19 pandemic, we are working on guidance to help prepare providers for the end of the federal PHE, whenever that may occur, and will keep you updated on the status of the declaration.       

For more information on MaineCare’s COVID-19 policy changes and guidance, please visit our COVID-19 webpage. For more information about the federal PHE, please visit the HHS website.