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  3. What is the difference between the funds available to reimburse providers for COVID-19 testing, treatment, and vaccine administration services furnished to uninsured individuals through the Health Resources and Services Administration (HRSA) and the funds available through the Families First Coronavirus Response Act (FFCRA) to provide Medicaid coverage of COVID-19 testing services for uninsured individuals?

What is the difference between the funds available to reimburse providers for COVID-19 testing, treatment, and vaccine administration services furnished to uninsured individuals through the Health Resources and Services Administration (HRSA) and the funds available through the Families First Coronavirus Response Act (FFCRA) to provide Medicaid coverage of COVID-19 testing services for uninsured individuals?

What is the difference between the funds available to reimburse providers for COVID-19 testing, treatment, and vaccine administration services furnished to uninsured individuals through the Health Resources and Services Administration (HRSA) and the funds available through the Families First Coronavirus Response Act (FFCRA) to provide Medicaid coverage of COVID-19 testing services for uninsured individuals?

The optional COVID-19 testing eligibility group, added by section 6004(a)(3) of the FFCRA at section 1902(a)(10)(A)(ii)(XXIII) of the Act, is similar to other optional eligibility groups under which states can elect to furnish a targeted set of benefits to eligible individuals. To reimburse providers for the covered services, a state must elect to adopt this group under its state plan.

States that do so can then reimburse providers enrolled in their Medicaid program for in vitro diagnostic testing and other COVID-19 testing-related services furnished to individuals whom the agency has determined are eligible under the new group. For more information on the eligibility requirements for the optional COVID-19 testing eligibility group, covered benefits, the availability of hospital presumptive eligibility for the new group, and the availability of 100 percent Federal Medical Assistance Percentage (FMAP) for the testing services provided to individuals eligible under the optional COVID-19 testing eligibility group, see these FAQs (PDF - 94 KB). For more information on strategies to assist states in operationalizing this group, see this guidance (PDF - 244 KB).

HRSA is administering a separate program, referred to as the COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured Program (HRSA COVID-19 Uninsured Program). This program provides reimbursement directly to eligible providers and has two components:

  1. Reimbursement for COVID-19 testing services. This component, which reimburses providers for conducting COVID-19 testing for uninsured individuals, was authorized and initially funded via the FFCRA and the Paycheck Protection Program and Health Care Enhancement Act (PPPHCA). The FFCRA and the PPPHCA each appropriated $1 billion (for a total of $2 billion) for this purpose. With the initial $2 billion fully disbursed, the HRSA COVID-19 Uninsured Program currently reimburses providers for COVID-19 testing claims using funding allocated through the American Rescue Plan Act (ARPA) and a portion of the funding that comprises the Provider Relief Fund.
  2. Reimbursement for COVID-19 treatment services and vaccine administration. This component is authorized via the CARES Act, which provides $100 billion in relief funds for hospitals and other health care providers, including those on the front lines of the COVID-19 response. The PPPHCEA appropriated an additional $75 billion; and the Coronavirus Response and Relief Supplemental Appropriations Act (CRRSA) appropriated an additional $3 billion in relief funds. A portion of the Provider Relief Fund supports health care-related expenses attributable to the treatment of uninsured individuals with COVID-19 and COVID-19 vaccine administration to the uninsured in addition to COVID-19 testing of the uninsured, as explained above.

To access these funds, health care providers must enroll in the program as a provider participant. Once they have done so, they can submit claims for direct reimbursement for COVID-19 testing and treatment services furnished to uninsured individuals on or after February 4, 2020, and for COVID-19 vaccine administration fees for the uninsured.

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