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CMS Issues Rule on COVID-19 Vaccine and Therapeutic Coverage

The Centers for Medicare & Medicaid Services (CMS) announced policies to target costs associated with future COVID-19 vaccines, price transparency for COVID-19 tests, and enhanced Medicare payments for new COVID-19 treatments, among other provisions.

The agency’s fourth interim final rule during the COVID-19 public health emergency also seeks to implement provisions of the Coronavirus Aid, Relief, and Economic Security (CARES) Act on access to and payment for COVID-19 testing and treatments.

Specifically, the interim final rule:

  • requires that any future Food and Drug Administration–approved COVID-19 vaccine be provided at no cost to beneficiaries enrolled in Medicare, Medicare Advantage, Medicaid, and most private health plans;
  • provides Medicare add-on payments for hospitals treating COVID-19 patients with new products, under certain circumstances;
  • requires any provider who performs a COVID-19 diagnostic test to post online their cash prices, and establishes an enforcement process for this requirement; and
  • provides guidance and flexibility on maintaining Medicaid beneficiary enrollment as a condition of receiving the temporary increase in federal medical assistance percentage, as provided in the Families First Coronavirus Response Act.

The interim final rule also modifies policies of the Comprehensive Care for Joint Replacement model. The rule extends performance year five an additional six months and adds technical changes to accommodate these policy changes.

Additionally, CMS issued three toolkits for state Medicaid programs, providers, and issuers to help prepare for vaccine administration once it is available.

The interim final rule with comment period is effective upon publication in the Federal Register. Comments are due 60 days after publication.

America’s Essential Hospitals is analyzing the interim final rule for comment and will send members a detailed Action Update in the coming days.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Maryellen Guinan is a principal policy analyst at America's Essential Hospitals.

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