FAQs for The HRSA COVID-19 Coverage Assistance Fund

The HRSA COVID-19 Coverage Assistance Fund (CAF) is a program established by and administered by the Health Resources and Services Administration (HRSA), using funds appropriated by Congress under the Provider Relief Fund (PRF).  Contractor support is provided by the SSI Group (SSI). The CAF reimburses eligible health care providers for claims associated with COVID-19 vaccine administration provided to underinsured individuals, who are defined for this purpose as having 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.

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 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.

Cost-sharing, for this purpose, means the share of costs not covered by insurance that a patient would pay out of pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but does not include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. See, e.g., Cost Sharing.

The HRSA COVID-19 Coverage Assistance Fund reimburses providers for claims for COVID-19 vaccine administration provided to individuals who have health insurance, but whose health plan either does not include COVID-19 vaccination as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing. In contrast, the HRSA COVID-19 Uninsured Program reimburses providers who have conducted COVID-19 testing, provided COVID-19 treatment and/or 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 who did not have any health care coverage at the time the service was rendered. Both programs work toward the goal of supporting providers in increasing access to COVID-19 vaccines for individuals living in the United States. Because claims for underinsured individuals require additional coordination with insurers, however, separate portals have been established for each patient population. More information about the HRSA Uninsured Program can be found at: COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured

The program is being administered by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) through its contractor, The SSI Group (SSI).

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.

Health care providers 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, can request claims reimbursement through the HRSA COVID-19 Coverage Assistance Fund electronically and will be reimbursed at the national Medicare rate (not geographically adjusted) for the vaccine administration fees, or for patient charges related to COVID-19 vaccination, including co-pays for vaccine administration, deductibles for vaccine administration, and co-insurance, subject to available funding. Steps will involve enrolling as a provider participant, submitting claims, and receiving payment via direct deposit. Prior to these steps, the provider must submit a claim for vaccine administration to the individual’s health plan for payment and have the claim denied or only partially paid.

Reimbursement pricing and policies under this program, as determined by HRSA are described below.

• Vaccine administration fees will be priced based on national Medicare rates for administering the COVID-19 vaccine (not geographically adjusted) and are outlined below:
  • For dates of service through March 14, 2021:
    • Administration of a single-dose COVID-19 vaccine - $28.39
    • Administration of the first dose of a COVID-19 vaccine requiring a series of two or more doses - $16.94
    • Administration of the final dose of a COVID-19 vaccine requiring a series of two or more doses - $28.39
  • For dates of service on or after March 15, 2021:
    • Administration (per dose) of a COVID-19 vaccine - $40.00
      • Effective August 12, 2021, this includes an additional (third) dose of a COVID-19 vaccine for certain immunocompromised individuals (refer to the CDC website for more information).
• For COVID-19 vaccinations administered in-home* with dates of service on or after June 8, 2021:
  • Administration (per dose) of a COVID-19 vaccine - $75.50
    • Effective August 12, 2021, this includes an additional (third) dose of a COVID-19 vaccine for certain immunocompromised individuals (refer to the CDC website for more information).
  • *Note: In-home vaccine administration claims must be submitted with two codes to be eligible for reimbursement:
    • The first code must be one of the following:
      • Pfizer: 0001A, 0002A, 0003A, 0071A, 0072A
      • Moderna: 0011A, 0012A, 0013A, 0064A
      • Janssen: 0031A, 0034A
    • The second code must be M0201 (COVID-19 vaccine home administration)
    • For a definition of what constitutes in-home administration, see this CMS fact sheet (PDF - 138 KB).
• These rates recognize the costs involved in administering the vaccine, including the additional resources involved with required public health reporting, conducting important outreach and patient education, and spending additional time with patients answering any questions they may have about the vaccine.
• Publication of new codes and updates to existing codes will be made in accordance with published CMS guidance.
• For any new codes where a CMS published rate does not exist, claims will be held until CMS publishes corresponding reimbursement information.

To enroll in the program, providers should visit the HRSA Coverage Assistance Fund site. Providers will click on the Provider Enrollment Link and navigate to the account creation page to begin enrollment.

Providers will be prompted to, and must, attest to the following at the time of enrollment:

• They have submitted a claim to the patient’s primary health insurance plan and there is a remaining balance from that health insurance plan that either does not include COVID-19 vaccination as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing.
• They have verified that no other third party payer will reimburse them for COVID-19 vaccine administration fees for that patient encounter, or other patient charges related to that COVID-19 vaccination, including co-pays for vaccine administration, deductibles for vaccine administration, and co-insurance.
• They will accept defined program reimbursement as payment in full.
• They agree not to balance bill the patient.
• They agree to program terms and conditions and may be subject to post-reimbursement audit review.

Once enrolled in the HRSA COVID-19 Coverage Assistance Fund, eligible providers (including eligible pharmacies) can submit claims through their current clearinghouse or submit a claim electronically or manually through the provider portal.

All claims submitted must be complete and final and no interim bills or corrected claims will be accepted. There will be no adjustments to payment once claims reimbursements are made.

• First and last name
• Date of birth
• Gender
• Date of service
• Primary insurance information and policy number
• Address*
• Middle initial (optional)
• Patient account number (optional)

*If the individual is unable or unwilling to provide their address, please add the address of the facility where the care was provided or other location that may be appropriate (e.g., shelter).

No. A provider does not need an individual’s Social Security Number to submit a claim for reimbursement to the CAF.

Yes, for the HRSA COVID-19 Coverage Assistance Fund, claims must be submitted within 365 calendar days from the date of service. All claims are subject to available funding.

If a claim was submitted to the HRSA COVID-19 Uninsured Program and the patient was actually insured, the provider should receive a notice that the claim was not eligible for reimbursement.

Prior to submitting a claim to the Coverage Assistance Fund, the provider should submit a claim for vaccine administration to the individual’s health insurance plan for payment.  The provider can submit the claims to the HRSA COVID-19 Coverage Assistance Fund for claims for COVID-19 vaccine administration provided to individuals who have health insurance, but whose health plan either does not include COVID-19 vaccination as a covered benefit or covers COVID-19 vaccine administration but with cost-sharing. Only those COVID-19 vaccine administration claims denied or not fully paid by a patient’s health insurance plan, including those insurance plans with patient co-pays for vaccine administration, deductibles for vaccine administration, and co-insurance related to the Covid-19 vaccination, are eligible for reimbursement.

COVID-19 vaccines are free to all individuals living in the US. No patient should be billed directly for fees associated with administering COVID-19 vaccines. Patients may be asked for their insurance information at the time they complete their paperwork to receive the COVID-19 vaccine. During this time, patients may confirm that their provider will be billing their insurance company or the federal government (Medicare, Medicaid, the HRSA CAF or HRSA COVID-19 Uninsured Program) for any associated vaccine administration fee.

Patients should note that currently, all providers and facilities participating in the CDC COVID-19 Vaccination Program (which currently includes any providers who may be administering vaccine to them) :

• must administer COVID-19 Vaccine regardless of the vaccine recipient’s ability to pay COVID-19 vaccine administration fees or insurance coverage status;
• may seek appropriate reimbursement from a program or plan that covers COVID-19 vaccine administration fees for the vaccine recipient; and
• may not seek any reimbursement, including through balance billing, from the vaccine recipient.

If a patient was previously billed for COVID-19 vaccine administration fees and the provider then received reimbursement from either the HRSA COVID-19 Uninsured Program or the HRSA COVID-19 Coverage Assistance Fund program, that provider must refund amounts paid by the patient.

Yes. Health care providers are not required to confirm immigration status prior to submitting claims for reimbursement to the CAF. Health care providers 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 an underinsured individual for dates of service or admittance on or after December 14, 2020, are eligible for claims reimbursement through the program as long as the service(s) provided meet the coverage and billing requirements established as part of the program.

Payments received from the program are claims reimbursements and should be treated in the same manner as reimbursements received from commercial insurance, Medicaid, and/or Medicare, including in how revenue or losses are determined. See guidance issued by the Centers for Medicare & Medicaid Services (PDF - 1 MB) on how providers should report claims reimbursed through the HRSA COVID-19 Coverage Assistance Fund on the S-10 worksheet.

No. These are claims reimbursements, not loans, to health care providers, and will not need to be repaid, provided applicable terms and conditions are met or if it is later determined that the payments were made to ineligible providers or for ineligible beneficiaries or costs.

Yes. The program reimburses providers for COVID-19 vaccine administration fees for underinsured individuals; therefore, any money collected from the individual must be returned to the individual if the provider received funding for that patient through this program.
This requirement is included in the Terms and Conditions that the provider signs in order to enroll in the program.

No. All claims submissions and claims reimbursements must be submitted and remitted electronically.

Providers who self-identify an overpayment can send a check to return the funds. Providers must complete this form (PDF - 94 KB) and include it with their check to ensure funds are applied appropriately. Checks should be made payable to HRSA COVID-19 CAF and submitted with any supporting documentation.

Send Checks/Forms for Returned Funds to:
Provider Relief Bureau
Coverage Assistance Fund
Health Resources and Services Administration
5600 Fishers Lane
Mail Hub 9N34
Rockville, MD 20857