Feb 03, 2021
COVID-19 Conversations: Vaccination reimbursement and administrative policies update
Empire is committed to supporting care providers and protecting our members and communities against COVID-19. We’re encouraging all members to get vaccinated and we’ve created a consistent and simple approach to reimburse providers for administering the vaccine
Vaccine reimbursement
The federal government will initially pay for FDA-approved COVID-19 vaccines. Empire will reimburse for the administration of FDA-approved COVID-19 vaccines at the established national Centers for Medicare & Medicaid Services (CMS) rates, unless otherwise required by state directives, for members of fully-insured employer and Individual plans, as well as self-funded plans. We will cover the vaccinations with no cost share for providers both in and out of a member’s network during the national public health emergency. The federal mandate does not allow providers to balance-bill members for vaccines or the administration of vaccines.
Temporary adjustments to administrative policies
Based on the impact to the healthcare system due to COVID-19 surges across the United States, Empire will continue to make temporary adjustments to certain administrative and clinical policies. These temporary policy adjustments allow us to ensure our members receive care when they need it.
For example, prior authorization requirements have been suspended for patient transfers from hospitals to skilled nursing facilities or any other lower level of care. Some states have also put in place additional clinical and administrative mandates. Based on local needs, Empire may also agree to state-specific clinical and administrative mandates that support member access to care. These temporary policy adjustments will apply to self-insured groups unless different intent is shared with us. They can make changes to these options during their renewal period.
As a reminder, under the CARES Act, COVID-19 testing and vaccine administration is covered in full during the public health emergency. This applies to all members, regardless of the type of health plan they have or which doctor they choose to visit. The current public health emergency extension is effective January 21, 2021 and extends into April, and will likely remain in place for the entirety of 2021.
If you have any questions, contact your account representative for more information.