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The Centers for Medicare and Medicaid Services wants a free COVID-19 vaccine available to all

Since the government is going to pay for the cost of the vaccine, CMS wants to ensure that insurers will not make cost a barrier, Seema Verma says.

Mallory Hackett, Associate Editor

The Centers for Medicare and Medicaid Services will make sure that a COVID-19 vaccine will be made available to seniors at no cost once a vaccine is approved, CMS Administrator Seema Verma said during today's HLTH 2020 virtual conference.

And while it is important that seniors – who are in a high-risk category for COVID-19 – don't have any barriers to getting the vaccine, CMS is working to guarantee a free vaccine for Medicaid and private insurance members as well, Verma said.

"We also just want to make sure that all of our rules make it very clear to insurers that we want to make sure that every American can have access to these vaccines," Verma said. "The government's going to pay for the costs of the vaccines, so we want to make sure insurance companies and all the programs across the country ensure that people have timely access and that cost is not a barrier."

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CMS has been working on getting Medicare and Medicaid members access to COVID-19 treatments – which is a time-consuming process that can take upwards of three years, she said.

"We want to make sure that our payment policies aren't standing in the way of beneficiaries having access to the latest treatments," Verma said.

As is customary with government-purchased vaccines, healthcare professionals could charge insurers for the cost of administering the vaccine, the Department of Health and Human Services said in July.

TELEHEALTH

Of all the regulatory measures CMS took during the pandemic, the one that stands out the most is the agency's policy updates on telehealth.

"We very quickly tried to remove all the regulatory burdens around telehealth, making sure all providers could offer the services in different settings, getting rid of the regulations that require in-person visits," Verma said. "And we did that very quickly. And I think that's one of the efforts that we made that certainly saved many lives across the country."

Making sure that telehealth is an option for everyone is a priority for CMS, Verma said. While the agency has done the work to make it available for Medicare and Medicare Advantage beneficiaries, Congress needs to do its part in expanding access for all patients, she said.

"We're looking at our regulatory flexibilities," Verma said. "We do need Congress to help us to make sure that telehealth can be provided outside of rural areas, that people can get these services from [their] home."

VALUE-BASED CARE

Moving forward, CMS is making even more of a push towards better value-based care models, which proved to be effective during the pandemic, according to Verma.

"We're strong believers in value-based care and during the pandemic, those providers that were participating in value-based care fared better," she said. "They had predictable, stable revenue."

Despite that, there is still a need to create better models that produce more savings and better quality of care, Verma said.

"We're right now going through the process of looking at all of these models," she said. "A lot of it had to do with the way that they were set up. They were set up to encourage participation, they weren't set up to garner savings or to produce necessarily better outcomes for patients. And so we're looking at all of that. We're still firm believers in value-based care."

LOWERING DRUG PRICES

Additionally, CMS is working toward lowering drug prices, particularly for Medicare Part B, which currently doesn't allow for negotiations around pricing.

"We are actively engaged around working with our CMMI (Centers for Medicare and Medicaid Innovation) team around a model that would give us lower prices in Part B and ensure that Americans and our seniors are getting the best deal," Verma said.

Twitter: @HackettMallory
Email the writer: mhackett@himss.org