PHE Extension
The Secretary of Health and Human Services extended the nationwide public health emergency due to COVID-19 through April 15, 2022. This extension applies to cost-sharing waivers for FDA-authorized testing and testing-related services, as well as telehealth expansion waivers.
Vaccine Billing Change
Medicare changed billing guidelines around the administration of FDA-authorized and FDA-approved COVID-19 vaccines. As of Jan. 1, 2022, the cost of COVID-19 vaccine administration, including approved booster shots, should be billed to the plan for patients enrolled in a Medicare Advantage plan; Original Medicare won’t pay these claims. More information about COVID-19 vaccine policies and guidance is available through CMS COVID-19 vaccine toolkits.
Sequestration Heads-up
Beginning with the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act and extending through subsequent acts aimed at providing relief during the COVID-19 pandemic, sequestration was suspended for Medicare reimbursements and continues to be through March 31, 2022.
Sequestration will be reinstituted in phases.
- No payment adjustment for dates of service through March 31, 2022
- 1% payment adjustment for dates of service April 1 through June 30, 2022
- 2% payment adjustment for dates of service July 1, 2022, through the end of the year
At-Home COVID-19 Testing
Patients can acquire four free at-home-COVID-19 test kits by ordering through www.covidtests.gov. In addition, CMS recently announced a new initiative to expand access to free COVID-19 testing for Original Medicare and Medicare Advantage beneficiaries starting in spring 2022. Under the program, all Medicare beneficiaries will have access to up to eight FDA-approved or FDA-authorized over-the-counter (OTC) COVID-19 tests per month through eligible pharmacies and other participating entities at no cost and without the need for reimbursement. Be sure to visit our COVID-19 Updates for Providers page, as we’ll share news around the program as it develops (such as effective date and participating locations). Until the program launches, patients in Peoples Health plans that offer a benefit for purchasing approved OTC items may also use the benefit to buy approved brands of COVID-19 at-home test kits. There are limits on the number of tests that can be purchased and approved brands vary by plan. Members should visit their over-the-counter benefit website for more information. They can also review their benefit’s ordering options on our website.