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Clinics and Providers Due CMS Reimbursement for COVID-19 Innoculations

Many community clinics haven't been paid for COVID-19 vaccine administration

Alia Paavola - Tuesday, October 12th, 2021, Becker's Hospital CFO Report

Many community clinics haven't been reimbursed for administering COVID-19 shots since the vaccines obtained emergency use authorization, Kaiser Health News reported Oct. 11. In particular, community clinics in California said they haven't been paid for 1 million COVID-19 vaccine doses since January. The payment lapse has created a "massive cash flow problem" for some clinics and is worsening the ability to retain staff, the publication reported.

Clinics in Michigan and Mississippi also told KHN that they are awaiting payment. Under federal law, the government pays community health centers a set rate for patient visits. During the pandemic, many state Medicaid agencies said that if a patient receives a COVID-19 shot while getting a different service, the vaccine will be covered as part of that typical payment rate.

However, many clinics set up vaccination clinics, where getting the vaccine was the only service provided. This complicates the billing process, KHN reported. Some states have told these health clinics they can bill Medicaid separately for each dose administered in the event that no other service was provided. However, clinics in 13 states are waiting for CMS to approve proposals to pay clinics for these vaccinations. "We are continuing to work with states on their proposals," a CMS spokesperson told KHN, adding that if the payment formulas are approved, the clinics would be paid retroactively.

Barbara Ferrer, director of Los Angeles County Department of Public Health, wrote in a Sept. 22 letter to CMS that the payment delay is "untenable given these providers' financial restraints and tremendous outlay of resources during this historic pandemic response."

While the reimbursement for COVID-19 vaccine administration is delayed, many community health center leaders think that money will come in eventually. "I'm fairly confident that we will eventually get paid, but this is one of the downsides to being a community health center," Scott McFarland, CEO of Ukiah, Calif.-based MCHC Health Centers, told KHN. "It's just a timing issue, I guess."

The preceding article is not representative of AIA's position on any topic or discussion and is provided for the educational and/or informational benefit of AIA's readers.

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