HRSA COVID-19 Coverage Assistance Fund and Rural Health Clinic (RHC) Payment Limits

HRSA COVID-19 Coverage Assistance Fund 

The Biden-Harris Administration is providing free access to COVID-19 vaccines for every adult living in the United States. 

Accordingly, the Health Resources and Services Administration’s (HRSA) COVID-19 Coverage Assistance Fund (CAF) will cover the costs of administering COVID-19 vaccines to patients whose health insurance doesn’t cover vaccine administration fees, or does but typically has patient cost-sharing. 

While patients cannot be billed directly for the COVID-19 vaccine fees, costs to health care providers on the front lines for administering COVID-19 vaccines to underinsured patients will now be fully covered through CAF, subject to available funding. 

As vaccination efforts accelerate, patients will increasingly gain access to COVID-19 vaccines at locations near where they live with providers they trust.

Providers are eligible for claims reimbursement if they 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 individuals whose health plan does not cover vaccine administration fees, or does but typically has patient cost-sharing.

The eligible providers will be reimbursed at national Medicare rates for vaccine administration fees, and for any patient cost-sharing related to vaccination, including,

• Co-pays
• Deductibles,
• Co-insurance

Rural Health Clinic (RHC) Payment Limits

Effective January 1, 2021, the RHC payment limit per visit for Calendar Year (CY) 2021 is $87.52. This payment limit applies to independent RHCs and RHCs that are provider-based to a hospital with 50 or more beds.

Beginning April 1, 2021, the RHCs will begin to receive an increase in their payment limit per visit over an 8-year period, with a prescribed amount for each year from 2021, through 2028. 

Then, in subsequent years, the limit is updated by the percentage increase in MEI applicable to primary care services furnished as of the first day of that year.

The RHC payment limit per visit over an 8-year period is as follows,

• In 2021, after March 31, at $100 per visit
• In 2022, at $113 per visit
• In 2023, at $126 per visit
• In 2024, at $139 per visit
• In 2025, at $152 per visit
• In 2026, at $165 per visit
• In 2027, at $178 per visit
• In 2028, at $190 per visit