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COVID-19 regulatory updates — March 16

By AOA Staff


COVID-19 regulatory updates from the last week include Medicare increasing payment rates for COVID-19 vaccines and an update from CMS on COVID-related MIPS policy changes.

Medicare increases payment rates for COVID-19 vaccines

Starting March 15, 2021, Medicare will pay physicians, hospitals, pharmacies, and other immunizers the same amount for administration of the first and second dose of the COVID-19 vaccine.  The AOA successfully advocated for equal payment amounts for both doses and applauds the Centers for Medicare & Medicaid Services (CMS) for the higher rates to ensure the resources necessary for physicians to provide the vaccine safely and appropriately are available.

The new rates increase the payment amount from approximately $28 to $40 for the administration of single-dose vaccines and approximately $45 to $80 for the administration of vaccines requiring two doses.  Prior to the increase, vaccines requiring two doses were paid about $17 for the first shot and $28 for the second shot.  The exact payment rate for administration of each dose of a COVID-19 vaccine will depend on the type of entity that furnishes the service and will be geographically adjusted based on where the service is furnished.

CMS also updated the set of toolkits for providers, states, and insurers to help the health care system swiftly administer the vaccine with the new Medicare payment rates. The toolkits are designed to increase number of providers that can furnish the vaccine and ensure adequate payment for administration.

CMS will not penalize physicians for MIPS performance in 2020 due to COVID-19 pandemic

In response to the ongoing COVID-19 public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) will hold MIPS eligible clinicians harmless from financial penalties (up to 9%) for performance year 2020. Instead, CMS will automatically apply the MIPS extreme and uncontrollable circumstances (EUC) policy to all eligible clinicians who do not submit any MIPS data for the 2020 performance period, resulting in a neutral payment for the 2022 payment year.

For individuals, group practices, virtual groups, and alternative payment model entities who would like to submit data for the 2020 MIPS performance year and potentially earn a bonus but missed the submission deadline, CMS is reopening the MIPS EUC hardship exception application through March 31, 2021 to request reweighting of the MIPS performance categories. Note, groups and eligible clinicians who submit data in at least two MIPS categories will override the hardship exception and be eligible to earn a bonus from the exceptional performance bonus pool or potentially be subject to a penalty.