May 7, 2021: National Advocacy Update


New program covering the cost of administering COVID-19 vaccines

New program covering the cost of administering COVID-19 vaccines

On May 3, the U.S. Department of Health and Human Services (HHS) through the Health Resources and Services Administration (HRSA) announced a new program covering the cost of administering COVID-19 vaccines to patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing.

Since providers cannot bill patients for COVID-19 vaccination fees, this new program, the COVID-19 Coverage Assistance Fund (CAF), addresses an outstanding compensation need for providers on the front lines vaccinating underinsured patients. CAF is focusing on instances where individuals have insurance, but vaccines are either not covered or are, but typically with patient cost-sharing. To address these gaps, the CAF will be compensating providers for eligible claims at national Medicare rates to reflect newer information on the true costs associated with administering the vaccines. CAF also builds on the HRSA COVID-19 Uninsured Program, which has been reimbursing providers for vaccine administration fees associated with uninsured individuals.

Effective for COVID-19 vaccines administered on or after March 15, the national average payment rate for physicians, hospitals, pharmacies and many other immunizers is $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines, and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. The exact payment rate for administration of each dose of a COVID-19 vaccine depends on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.

AMA responds to RFI from AHRQ on racial and ethnic bias in clinical algorithms

AMA responds to RFI from AHRQ on racial and ethnic bias in clinical algorithms

The Agency for Healthcare Research and Quality’s (AHRQ) recently issued a Request for Information (RFI) on the “Use of Clinical Algorithms That Have the Potential to Introduce Racial/Ethnic Bias Into Healthcare Delivery,” seeking additional information and evidence on clinical algorithms that may introduce bias into clinical decision making and/or influence access to care, quality of care or health outcomes for racial and ethnic minorities. The AMA recently responded to this RFI, detailing AMA’s current understanding of the scope of these issues and the efforts to work with the medical community to address biased algorithms.

The AMA has long recognized that racial and ethnic health inequities are an unjust and major public health reality in the United States. Understanding that race is a social and political construct and not a biological risk factor for disease and death, the AMA has publicly acknowledged that racism impacts public health and is a barrier to effective medical diagnosis and treatment. In addition, AMA House of Delegates in November 2020 passed new policy directing our organization “to collaborate with appropriate stakeholders and content experts to develop recommendations on how to interpret or improve clinical algorithms that currently include race-based correction factors.” The AMA is currently undertaking an effort to convene a variety of organizations to gather more information about the use of clinical algorithms and create an action plan for how to address these problems. The AMA looks forward to supporting, encouraging, and coordinating its efforts with these organizations to both better understand the algorithms in use today and how they can be improved upon to ensure they help drive equitable care.

The AHRQ is ideally situated to conduct and fund additional research into the use of race and ethnicity data in clinical settings and algorithms,

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