The Washington Report
May 5, 2021
Note to subscribers: Due to the current environment, information is changing at a rapid rate. While we do our best to provide timely updates, it is possible that the information shared in the newsletter may change or be revised after our publication deadline. Stay healthy and safe! ~The Washington Report team
HHS Announces Reimbursement Program for COVID-19 Vaccine Administration Fees Not Covered by Insurance
On May 3, 2021, the Department of Health and Human Services (HHS) announced a new program covering costs of administering COVID-19 vaccines to patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing. Since providers cannot bill patients for COVID-19 vaccination fees, this new program, the COVID-19 Coverage Assistance Fund (CAF), addresses an “outstanding compensation need for providers on the front lines vaccinating underinsured patients.”
The CAF is focusing on instances where individuals have insurance, but vaccines are either not covered or are but typically with patient cost-sharing. To address these gaps, the CAF will be compensating providers for eligible claims at national Medicare rates which increased in March. The CAF is funded through the Provider Relief Fund Program. The CAF program will accept eligible claims from providers dated on or after December 14, 2020. Additionally, claims must be submitted electronically and are subject to available funding.
A provider webinar will be hosted on May 6, 2021. Please visit the HHS website for additional details and information.
The news release is available here.
Information on the CAF is available here.
Information on the Provider Relief Fund Program is available here.
CMS Releases Final Regulations on 2022 Benefit and Payment Parameters; Lowers 2022 Health Care Costs in Marketplace Plans and Publishes Second Fact Sheet
On April 30, 2021, the Centers for Medicare and Medicaid Services (CMS) released final regulations on the Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards. The final regulations establish payment parameters and provisions related to the risk adjustment program and cost-sharing parameters. The regulations include changes related to special enrollment periods; direct enrollment entities; the administrative appeals processes with respect to health insurance issuers and non-federal governmental group health plans; the medical loss ratio program; income verification by the Federal Marketplace Exchanges; and other related topics. The regulations also revise the rule requiring the reporting of certain prescription drug information by qualified health plans or their pharmacy benefit managers. Additionally, as part of the latest guidance, CMS adopted new provisions to lower maximum out-of-pocket costs to consumers by $400.
This year, the CMS is finalizing the Payment Notice in multiple phases. The first 2022 Payment Notice final regulations were released on January 14, 2021, as outlined in the first Fact Sheet. This second 2022 Payment Notice continues “CMS's trend toward stabilizing the insurance market, promoting program integrity, and reducing regulatory burden.”
The final regulations become effective on July 6, 2021, with the exception of several amendments. Please refer to the final regulations for specific details.
The CMS anticipates additional rulemaking for the 2022 Payment Notice later this year.
The CMS news release is available here.
The first CMS Fact Sheet (January 14, 2021), is available here.
For further information on provisions in the second 2022 Payment Notice final regulations (April 30, 2021), please refer to the “Notice of Benefit and Payment Parameters for 2022 Final Rule Part Two Fact Sheet”, available here.
The final regulations are available here.
PBGC Publishes 2019 Data Tables
On April 30, 2021, the Pension Benefit Guaranty Corporation (PBGC) released the first installment of the 2019 Data Tables for the PBGC’s single-employer and multiemployer programs and the private defined benefit pension system. This installment includes various breakdowns of PBGC claims, guaranteed benefit payments, and summaries of PBGC operations.
The PBGC 2019 Data Tables are available here.
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