FAQs for The HRSA COVID-19 Coverage Assistance Fund

No. Individuals with plans purchased on the Marketplace/Exchange who are in the grace period do not meet the definition of underinsured for the purpose of the CAF.

Indian Health Service clinics which administer authorized or licensed COVID-19 vaccines to underinsured individuals are eligible to submit claims for reimbursement through the CAF.  These individuals would not include IT/U beneficiaries, as vaccine administration is a covered benefit for such individuals.

Health care providers that have administered Food and Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA) to underinsured individuals can request claims reimbursement through the program.  Reimbursement may be requested electronically and, subject to available funding, will be reimbursed at the national Medicare rate for the vaccine administration fee or for patient cost-sharing related to COVID-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance.

Any provider that is on the Office of the Inspector General U.S. Department of Health and Human Services List of Excluded Individuals/Entities and/or any provider who has had their Medicare enrollment revoked by the Centers for Medicare & Medicaid Services (CMS) is ineligible to receive funding from the COVID-19 Coverage Assistance Fund.  In addition, providers who are reimbursed for vaccine administration fees (and other patient charges related to COVID-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance, if applicable) by another source may not submit a claim to the CAF.

The HRSA COVID-19 Coverage Assistance Fund reimburses providers for COVID-19 vaccine administration services provided to an individual who has a health plan that either does not include COVID-19 vaccine administration as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing. Section 3203 of the CARES Act generally requires non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage to cover any qualifying coronavirus preventive service, including recommended COVID-19 vaccines and their administration, without imposing any cost-sharing requirements, such as a copayment for vaccine administration, co-insurance, or deductible for vaccine administration. However, these coverage requirements do not apply to a plan or coverage that is not required to provide coverage of preventive services without cost-sharing under section 2713 of the Public Health Service Act, such as grandfathered group health plans, excepted benefits, and short-term limited duration insurance.

The fee for COVID-19 vaccine administration is eligible for reimbursement. Additionally, any patient cost-sharing requirements, such as a copayment for vaccine administration, co-insurance, or deductible for vaccine administration, are eligible for reimbursement. For more details, see the vaccine administration codes at: COVID-19 Vaccines and Monoclonal Antibodies.

Yes. All health care providers, including non-profit organizations or FQHCs, who have administered Food and Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA) to underinsured individuals may be eligible for claims reimbursement through the program, as long as the service(s) provided meet(s) the coverage and billing requirements established as part of the program. Non-profit organizations and FQHCs are eligible, in addition to for-profit entities.

Yes. Pharmacies/pharmacists and those operating under their supervision who are legally authorized to administer COVID-19 vaccinations, including under the Public Readiness and Emergency Preparedness Act, are eligible to request reimbursement under this program.

Health Center Program requirements include an obligation under section 330(k)(3)(F) of the Public Health Service Act for health centers to make “every reasonable effort to collect appropriate reimbursement for its costs in providing health services” from potential payers (see also [Chapter 16: Billings and Collection, Health Center Compliance Manual]). Health Centers are also required to provide financial and budget information relating to program income received by non-HRSA sources (e.g., reimbursement from private insurers, Medicare, Medicaid, etc.) These requirements do not impact a health center’s eligibility to submit reimbursement claims for administering Food and Drug Administration (FDA) authorized COVID-19 vaccines under an Emergency Use Authorization (EUA) or FDA-licensed COVID-19 vaccines under a Biologics License Application (BLA)to underinsured individuals to the HRSA COVID-19 Coverage Assistance Fund.

If a health center also receives Ryan White HIV/AIDS Program grant funds under title XXVI of the Public Health Service (PHS) Act, please refer to the HRSA HIV/AIDS Bureau website for further information.

In addition, please continue to ensure that you are appropriately allocating and tracking grant funds.

In accordance with the terms and conditions of the HRSA COVID-19 Coverage Assistance Fund, in order to seek reimbursement, a health center must agree to the following as attested at registration:

• You will accept HRSA COVID-19 Coverage Assistance Fund program reimbursement as payment in full.
• You agree not to balance bill the patient.

If a health center accepts reimbursement from the Coverage Assistance Fund, it may not balance bill/charge the patient.

For questions about Health Center Program billing and collections, sliding fee discount program, and other requirements please contact Health Center Program Support. More information about the Health Center Program is also available, including FAQs related to COVID-19 and health centers.

Providers should check with the entity sponsoring the vaccination site prior to submitting a claim to ensure there is no duplication of claims or payment. Providers who are reimbursed for vaccine administration fees (and other patient charges related to COVID-19 vaccination, including co-payments for vaccine administration, deductibles for vaccine administration, and co-insurance, if applicable) by another source may not submit a claim to the CAF.

Yes, the HRSA COVID-19 Coverage Assistance Fund accepts claims for patients with only Medicare Part A coverage, but who do not have Part B coverage.  Part A does not cover COVID-19 vaccine administration fees.