[Congressional Record Volume 168, Number 13 (Thursday, January 20, 2022)]
[Senate]
[Pages S375-S379]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           COVID-19 VACCINES

  Mr. CASEY. Mr. President, as our Nation battles another wave of 
COVID-19, I want to detail my efforts to lower barriers for Americans 
to access lifesaving vaccinations against this terrible disease.
  The Special Committee on Aging's investigation forced the largest 
commercial health insurer in the United States to reverse course and 
make whole providers who were paid far below the market rate for 
administering COVID-19 vaccines. These efforts will help ensure that 
every provider who can administer COVID-19 vaccines is doing so, 
helping get more shots in arms.
  Last year, news reports detailed how UnitedHealth had been 
shortchanging pediatricians who were vaccinating children against 
COVID-19. In short, Medicare set reimbursement rates for participating 
providers at $40 per dose in mid-March 2021. The Federal Government 
strongly recommended that private carriers do the same and most appear 
to have done so within weeks, but UnitedHealth did not.
  The committee's investigation found that UnitedHealth paid in-network 
providers roughly 40 percent below the Medicare rate until July 1, 
2021. Further, the company delayed action to make providers whole. 
During the investigation, pediatricians in Pennsylvania and beyond 
raised concerns that UnitedHealth's original reimbursement rate could 
dissuade providers from administering the vaccine.
  UnitedHealth covers 26 million people in employer and individual 
market health insurance plans, with 1.4 million

[[Page S376]]

in-network providers and an estimated 14 percent market share. 
UnitedHealth's decision to reimburse providers below the Medicare rate 
had the potential to harm families across our Nation at a critical 
juncture, just as the Food and Drug Administration prepared to expand 
the availability of vaccines to children ages 5-11.
  For parents with questions about vaccines, pediatricians are trusted 
advisers who can play a key role in overcoming lingering concerns or 
hesitancy, which remains a major issue in our Nation.
  In the long term, ensuring that all hands are on deck to deliver 
vaccines will help end this pandemic. Data has shown time and again 
that being vaccinated against COVID-19 reduces infections, severe 
disease, hospitalization, and death. Vaccinating children also will 
help protect adults by increasing the number of Americans shielded from 
the virus, reducing its spread. It also reduces the chance for the 
virus to mutate and spawn variants, like Omicron, that has led to 
another wave of illness and death. These concerns are particularly 
important for older adults who are more likely than the general 
population to experience both severe COVID-19 and breakthrough 
infections. Vaccinating children helps protect older generations, 
particularly older adults living in multigenerational households, 
including more than 7 million grandparents who live with grandchildren 
under the age of 18.
  Providing more parents with the information they need to ensure they 
are comfortable vaccinating their kids will help protect all of our 
children. While pediatric hospitalizations remain relatively rare, 
there has nonetheless been a significant increase of such 
hospitalizations as the Omicron variant has spread in recent weeks. The 
Wall Street Journal recently reported that pediatric hospitalizations 
due to COVID-19 reached pandemic highs in the United States.
  Vaccinating more children is essential to keep schools open for in-
person learning, a live issue for schools throughout our Nation that 
have been forced to return to online classes in the face of the Omicron 
variant. We must do all that we can to safely keep students in the 
classroom so that they can receive the high-quality education they 
deserve. School closures also cause a disruption in the lives of 
families, with parents often struggling to find childcare or forcing 
them to take time from work. Vaccinating children will help schools 
remain open, protect students and educators, and help parents stay in 
the workforce.
  After Aging Committee investigators reached out to UnitedHealth, the 
company quickly and voluntarily committed to change course, commitments 
I detailed in an October 20, 2021, letter. In response to my letter, 
UnitedHealth confirmed its plans to retroactively increase 
reimbursements for approximately 2 million COVID-19 vaccine 
administration claims to the Medicare rate across its entire commercial 
network, including individual plans on the Affordable Care Act 
marketplace. On January 14, 2022, the company reported that it had 
processed 1.64 million claims in connection with its commitment to the 
committee--more than 99.8 percent of the affected total--at an average 
cost of $14.55 per claim for a total of $23.9 million. The company 
expects the remaining claims, which number less than 2,900, to be 
processed by February 1, 2022.
  UnitedHealth also committed to more quickly update reimbursement 
rates for future emergent vaccines and therapeutics, whether for COVID-
19 or the next pandemic. The company added that it is ``redirecting 
additional internal resources and automating updates whenever 
possible,'' while noting that their new processes still might involve 
withholding claims ``for a short time,'' which it characterized as no 
longer than 30 days. On January 14, the company went further, stating 
that it will implement new billing codes in a national public health 
emergency ``faster than industry standard,'' while noting that it has 
``learned over the past few months the required technology and human 
resources that need to be brought forward to accelerate'' adoption of 
new billing codes in a public health emergency.
  While lacking some details, the steps UnitedHealth has described 
appear to be an appropriate response. However, UnitedHealth has not 
adequately addressed an issue that a senior company official raised 
when speaking with Aging Committee investigators in September, that the 
company's size and numerous claims systems presented a barrier to 
quickly updating COVID-19 vaccine reimbursement rates in the first 
place. In its responses to subsequent questions about the issue from 
committee staff, UnitedHealth has cited reasons such as contracting 
language for the delay, but has failed to provide additional 
information or explanation in their written responses. The fact that a 
senior UnitedHealth official told the committee that the company's size 
negatively affected the quality and efficiency of its interactions with 
the market is concerning and a matter that deserves continued oversight 
from Congress and regulators.
  In recent weeks, the world has been upended by the Omicron variant. 
Case rates have skyrocketed, and hospitals are once again filling up, 
primarily with people who have not gotten a COVID-19 vaccine or 
booster. In order to leave the tragedy, the disruptions and the 
closures of the pandemic behind, every person who can be vaccinated has 
a duty to the country to roll up their sleeves and get the shot.
  We will continue to learn more about the Omicron variant and variants 
to come. However, there is one thing about this variant, past variants, 
and future variants that will not change: The key to ending this 
pandemic is getting more people vaccinated.
  I remain committed to removing future roadblocks that may emerge to 
widespread vaccination against COVID-19.
  This body should do the same.
  In closing, I ask unanimous consent to have printed in the Record the 
following documents: a September 3, 2021 Modern Healthcare article 
detailing UnitedHealth's under reimbursement for COVID-19 vaccines 
compared to most other major carriers; my October 20, 2021 letter to 
UnitedHealth; UnitedHealth's November 5, 2021 response to my letter; a 
November 12, 2021 supplement to the company's original response; and a 
January 14, 2022 email from UnitedHealth providing further updates.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                [From Modern Healthcare, Sept. 3, 2021]

   UnitedHealthcare Pays Providers Below Standard Rates for COVID-19 
                                Vaccines

                            (By Nona Tepper)

       Pediatricians across the country are claiming the nation's 
     largest insurer is shortchanging them for administering 
     COVID-19 vaccines, jeopardizing access to the main tool for 
     stopping the virus' spread.
       The American Academy of Pediatrics has fielded complaints 
     from providers nationwide who are frustrated that 
     UnitedHealth Group is paying about 50% of the federal rate 
     for vaccine administration, said Dr. Sue Kressly, who chairs 
     the AAP's payment advocacy advisory committee and runs 
     Pennsylvania-based Kressly Pediatrics. While UnitedHealthcare 
     is not legally required to pay the federal rate, Kressly said 
     the Minnetonka, Minnesota-based insurer is the only national 
     carrier that has not agreed to pay at least $40 for vaccine 
     administration.
       The insurer also continues to pay pediatricians and family 
     medicine providers below-market rates for COVID-19 tests, 
     Kressly said, an issue the New York Times revealed in 
     February.
       With new variants of COVID-19 continuing to emerge, Kressly 
     worried that low fees for testing and vaccine administration 
     would lead some doctors to stop offering these services, 
     worsening the public health crisis, increasing medical costs 
     and inspiring more independent practices to shutter, 
     particularly as providers struggle with overwork during the 
     pandemic.
       ``They had record-breaking profits in 2020, and we 
     struggled with getting them to pay adequately for COVID 
     testing. That still not been resolved,'' Kressly said. ``Now 
     pediatricians who are giving the vaccine to people covered by 
     UnitedHealthcare, they're effectively opening their wallet, 
     and subsidizing that patient to get the vaccine.''
       At the end of the company's most recent second quarter on 
     June 30, UnitedHealthcare generated $55.5 billion in revenue, 
     up 13% from the $49.1 billion reported during the same period 
     last year. The company counted more than 49.6 million 
     enrollees, an increase of 1.2 million year-over-year. 
     Meanwhile, the insurer's low vaccine reimbursement rates 
     threaten the future of family practices, Kressly said. Unlike 
     most medical services, federal legislation bars providers 
     from balance billing patients for the COV[0-19 vaccine.
       ``If we don't at least make enough money to cover our 
     costs, then we won't be here as practices to serve the 
     community beyond the

[[Page S377]]

     public health emergency,'' Kressly said. ``That's a bigger 
     problem.''
       UnitedHealthcare is not the only payer offering clinicians 
     low fees for vaccine administration--some regional plans and 
     employers are also paying below the federal rate, Kressly 
     said. But she said these payers are likely just slow to react 
     to payment standards. In March, the Centers for Medicare and 
     Medicaid Services nearly doubled what it was paying providers 
     for giving the vaccine, after the American Medical 
     Association found the previous rate did not cover the costs 
     associated with administering the shot. Most of these payers 
     are just confused about the update and, when Kressly reaches 
     out to them, she said they generally immediately increase 
     their rate. But UnitedHealthcare has refused to increase what 
     it is paying pediatricians.
       ``They say, `Our fee schedule is our fee schedule, it's up 
     to the contract that the practice has with UnitedHealthcare, 
     let them try to have the conversation,' '' Kressly said.
       UnitedHealthcare, for its part, said it recently offered to 
     increase reimbursement for COVID-19 testing for some 
     pediatric and family medicine practices that met specific 
     criteria. When it comes to vaccines, UnitedHealthcare said it 
     is continually reviewing its reimbursement rates.
       Dr. George Rogu, president of the Independent Pediatric 
     Collaborative of Long Island and head of RBK Pediatrics, 
     hopes to be one of the providers paid more for giving 
     UnitedHealthcare enrollees COVID-19 vaccines.
       When Rogu reached out to the insurer last month. a 
     UnitedHealthcare customer service representative blamed his 
     low rates on his different customers' plans and the different 
     fee schedules associated with each. The customer service 
     representative said Rogu was the first provider to complain 
     about the matter and offered to refer his case to the 
     company's management team.
       ``We cannot in good conscience say, `Oh, we can't give you 
     the vaccine because you have UnitedHealthcare.' That's not 
     right,'' Rogu said. ``It's just not humanely right. But 
     people that have a large panel of UnitedHealthcare customers? 
     It's killing them.''
       Rogu said he is still waiting to hear back from the 
     insurer.
       He said he noticed that he was being paid below the federal 
     rates in May and asked New York-based Canid Vaccines, his 
     vaccine administration software system, about the problem. 
     The startup verified that UnitedHealthcare reimbursed him at 
     about half the rate that other insurers did. Canid Vaccines 
     said it has identified at least 25 independent practices 
     representing more than 350 providers nationwide that 
     UnitedHealthcare is paying at less than the federal rate.
       Among pediatric circles, UnitedHealthcare is often referred 
     to as the ``evil empire'' since they are the least 
     transparent and least cooperative among the major insurers, 
     said Dr. Peter Pogacar, vice president of the Rhode Island 
     chapter of the AAP and a pediatrician at East Greenwich 
     Pediatrics. He said UnitedHealthcare is underpaying 
     physicians for COVID-19 vaccine administration there too.
       ``Healthcare should be about healing with business as a 
     sideshow, not the main event,'' Pogacar wrote in an email.
       The insurer isn't just offering low rates for administering 
     the COVID-19 vaccine. UnitedHealthcare has also reimbursed 
     providers for less than what it cost them to purchase COVID-
     19 testing kits. After significant media attention, the 
     manufacturer and distributor of the tests dropped their 
     prices so that providers were no longer losing money when 
     they were paid UnitedHealthcare rates, said Dr. Reshma 
     Chugani, a pediatrician at the Atlanta Children's Clinical 
     Center. The insurer also announced it would increase the rate 
     paid for the tests, as well as allow pediatricians to 
     resubmit patient claims, she said. But they are still not 
     offering to reimburse providers for tests previously paid at 
     below-market rates.
       ``We lost money on every United patient,'' Chugani said.
       Additionally, the insurer has made it difficult for 
     providers to recoup the money it said it owes them, forcing 
     them to go through multiple administrative layers and still 
     failing to reimburse one type of test at the full rate, said 
     AAP's Kressly. She said she talked to UnitedHealthcare about 
     this issue two weeks ago and that it has still not been 
     resolved.
       ``They've put barriers for us to have to act when we have 
     no time, energy or resources to do so,'' she said.
                                  ____

                                                 October 20, 2021.
     Sir Andrew Witty,
     Chief Executive Officer,
     UnitedHealth Group.
       Dear Sir Andrew: I write in regard to commitments 
     UnitedHealth Group (UnitedHealth) made to the U.S. Senate 
     Special Committee on Aging related to reimbursement policies 
     for the administration of COVID-19 vaccines. UnitedHealth's 
     past policies appeared to have created access barriers for 
     children seeking COVID-19 vaccination from their primary care 
     pediatrician--barriers that affected younger and older 
     Americans alike. I appreciate the company's decision to 
     reprocess certain COVID-19 vaccine claims, which I expect 
     will facilitate the broadest possible access to COVID-19 
     vaccines among UnitedHealth's members. I expect that the 
     steps UnitedHealth has committed to take will help children 
     seeking COVID-19 vaccines as well as older Americans under 
     the purview of the Aging Committee, including the millions 
     who live with and care for their grandchildren or other 
     younger relatives. I appreciate your company's assurance that 
     UnitedHealth will keep the Aging Committee updated on its 
     progress toward expeditiously resolving the concerns raised 
     with the company.
       The Aging Committee's attention was drawn to this issue by 
     press reports highlighting that during a four-month period 
     earlier this year, UnitedHealth reimbursed pediatricians at 
     rates that failed to meet the costs of administering COVID-19 
     vaccines. During that time, other large insurers reportedly 
     reimbursed pediatricians and other health care providers at a 
     higher rate, in line with what the Centers for Medicare & 
     Medicaid Services (CMS) set in March 2021. Pediatricians 
     raised concerns that UnitedHealth's low reimbursement rates 
     would deter in-network providers from administering COVID-19 
     vaccines, creating barriers for patients. The additional 
     costs of administering COVID-19 vaccines have been 
     significant for providers, a point that CMS noted at the time 
     it increased reimbursement rates, citing ``updated 
     information about the costs involved in administering the 
     COVID-19 vaccine for different types of providers and 
     suppliers and the additional resources you need to safely and 
     appropriately administer the vaccine.'' The agency 
     furthermore encouraged private payers to follow suit, noting 
     that ``in light of CMS's increased Medicare payment rates, 
     CMS will expect commercial carriers to continue to ensure 
     that their rates are reasonable in comparison to prevailing 
     market rates.'' Given UnitedHealth's status as the Nation's 
     largest commercial payer--with 26 million people enrolled in 
     employer and individual plans, 1.4 million in-network 
     providers and an estimated 14 percent market share--it is 
     critical that the company do all it can to ensure that 
     vaccines are available to every person that is eligible to 
     receive one. To that end, the Aging Committee requested that 
     UnitedHealth provide information about the company's 
     reimbursement rates, the timeliness of future fee schedule 
     updates and the company's progress toward making providers 
     whole for vaccines they administered while UnitedHealth was 
     reimbursing below reimbursement rates set by CMS.
       The ongoing effort to increase COVID-19 vaccination rates 
     across our Nation demands an all-hands-on-deck approach. 
     Ensuring that all eligible children are vaccinated against 
     COVID-19 is key to improving the overall vaccination rate, 
     which will better protect older Americans by helping stem the 
     spread of the virus. Such efforts are of particular 
     importance ahead of the Food and Drug Administration's (FDA) 
     expected consideration of COVID-19 vaccines for young 
     children later this month. Older Americans have been among 
     those hit hardest by COVID-19 and face the greatest health 
     risks if they contract the disease, even after being 
     vaccinated. Recognizing the elevated risk of breakthrough 
     infections in older adults, the Biden administration recently 
     authorized third doses of the Pfizer-BioNTech vaccine for 
     people ages 65 and over. The serious health risks COVID-19 
     poses for older adults are especially acute for those living 
     in multi-generation households, including more than 7 million 
     grandparents who live with grandchildren under the age of 18. 
     Those older Americans are at even greater risk of exposure 
     when they live with unvaccinated individuals, an important 
     consideration given the greater impact of the delta variant 
     on children. The current wave of COVID-19 has led to higher 
     pediatric case rates, record pediatric hospitalizations and 
     school closures that have affected more than 900,000 students 
     at 1,800 schools across 44 states in August and September 
     alone.
       During calls in September with Aging Committee staff, 
     UnitedHealth officials confirmed press accounts that reported 
     a months-long period when the company was reimbursing 
     providers up to 40 percent less for COVID-19 vaccine 
     administration than the rate set by the CMS. While other 
     major payers reportedly adopted the reimbursement rate set by 
     CMS swiftly, UnitedHealth continued reimbursing at a lower 
     rate until the end of June. During conversations with staff, 
     UnitedHealth reported that it had problems uploading the CMS 
     rate to the company's various fee schedules. Aging Committee 
     staff have heard concerns from providers that the 
     reimbursement issues pediatricians experienced with 
     UnitedHealth earlier this year could resurface when the FDA 
     authorizes a COVID-19 vaccine for 5-11 year-olds, which will 
     carry a different billing code.
       Following the concerns raised by the Aging Committee last 
     month, UnitedHealth informed Aging Committee staff during a 
     call on October 6 that the company planned to address the 
     concerns outlined above. Specifically, UnitedHealth committed 
     to reprocessing all of its commercial claims--not just 
     pediatric claims--from the time CMS issued new rates for 
     COVID-19 vaccines in mid-March to the time United updated its 
     fee schedule on July 1. Company officials further stated that 
     United Health would reprocess the claims automatically and 
     that providers would not be required to resubmit claims for 
     reprocessing. Noting that the company expected to reprocess 
     ``millions'' of claims that

[[Page S378]]

     were submitted by providers during the three-and-a-half month 
     period prior to July 1, UnitedHealth officials told Aging 
     Committee staff that they hoped to make ``significant 
     progress'' within 30-45 days. Company officials further 
     committed to:
       1. Review UnitedHealth's claims process to minimize delays 
     in making payments to providers for COVID-19 vaccines;
       2. Verify that there are no similar underpayment issues in 
     its Affordable Care Act Exchange and Medicaid Managed Care 
     books of business: and
       3. Provide updates to Aging Committee staff on the 
     company's progress toward meeting these goals.
       As part of these updates, please also provide me with the 
     following information no later than November 5, 2021:
       1. How many claims does UnitedHealth expect to reprocess 
     for COVID-19 vaccinations that were administered prior to 
     July 1, 2021? What was the average difference between the 
     initial reimbursement and the reprocessed claim? What was the 
     total amount that UnitedHealth paid to providers to settle 
     these claims at the CMS rates?
       2. UnitedHealth told Aging Committee staff that it is 
     difficult to quickly update its reimbursement rates when new 
     vaccine billing codes and rates are issued by CMS. 
     UnitedHealth further stated that its expected solution for 
     this issue may involve delaying payments to providers to give 
     the company's payment systems time to reflect new codes and 
     rates. In order to minimize access delays in the future, what 
     steps is UnitedHealth taking to ensure that pediatricians and 
     other providers will be reimbursed in a timely manner when 
     CMS issues new rates for COVID-19 vaccines or other emergent 
     vaccines and therapeutics in the future?
       Thank you for your attention to this important issue. If 
     you or your staff has questions, please contact Peter 
     Gartrell, Chief Investigator for Chairman Casey.
           Sincerely,

                                         Robert P. Casey, Jr.,

                                                         Chairman,
     U.S. Senate Special Committee on Aging.
                                  ____

                                                 November 5, 2021.
     Chairman Bob Casey,
     U.S. Senate Special Committee on Aging,
     Washington, DC.
       Dear Chairman Casey: On behalf of UnitedHealth Group, 
     including our over 120,000 frontline doctors, nurses, and 
     other health care practitioners, thank you for your recent 
     letter regarding retroactive payment for COVID-19 vaccine 
     administration. Like many individuals and families, 
     clinicians and essential health workers have sacrificed 
     deeply these past two years as our country worked together to 
     fight COVID-19.
       We share your commitment to ensuring and expanding access 
     to critically important health care services and understand 
     these are extraordinarily challenging times for the millions 
     of people we are privileged to serve, as well as employers, 
     health care providers, governments, and the health care 
     system. We welcome this opportunity to provide you with an 
     overview of the significant actions we have voluntarily taken 
     regarding vaccine reimbursement and the steps we are taking 
     to quickly address the concerns expressed.
       UnitedHealth Group is committed to helping people live 
     healthier lives and making the health care system work better 
     for everyone. We do this by working with stakeholders and 
     partners to address the biggest challenges facing our system. 
     As we shared during our conversation, we have been in close 
     contact with the American Academy of Pediatrics regarding 
     concerns they raised about vaccine reimbursement.
       Consistent with the discussion with your staff on October 
     6th and your October 21st letter, we are writing to confirm 
     the following details related to our reimbursement for COVID-
     19 vaccine administration:
       UnitedHealthcare (UHC) has been reimbursing providers using 
     the new CMS rates since July 1, 2021, consistent with timing 
     specified in UHC's contracts with providers.
       UHC will adjust claims paid less than $40 between March 15 
     and June 30, 2021 to reimburse at $40 per administration, so 
     providers can benefit from the increase CMS announced on 
     March 15, 2021.
       The voluntary retroactive reimbursement changes are in 
     process and claims will be adjusted accordingly. Providers 
     will not need to take action to receive the change in 
     reimbursement.
       UnitedHealth Group recognizes the important role that 
     reimbursement plays in addressing the COVID-19 pandemic, 
     which is why we are taking action to adjust previous claims 
     and accelerating our processes to update reimbursement rates 
     when changes are announced by CMS. In your letter dated 
     October 21, 2021, you asked for the following information:
       The number of COVID-19 vaccine administration claims UHC 
     expects to reprocess.
       The average difference between the initial reimbursement 
     and the reprocessed claim.
       The total amount that will be reimbursed.
       Information on how we will ensure providers will be 
     reimbursed in a timely manner when CMS issues new rates for 
     COVID-19 vaccine claims going forward.
       Approximately two million COVID-19 vaccine administration 
     claims paid between March 15 and June 30, 2021 will be 
     impacted by this retroactive adjustment. We anticipate the 
     average adjustment will be approximately $12.50 per claim, 
     for total additional reimbursement of approximately $25 
     million. UHC has already begun processing these 
     reimbursements.
       With regard to new rates for COVID-19 vaccinations or other 
     emergent therapeutics for COVID-19, we will be accelerating 
     our process for updating our reimbursement to support the 
     COVID-19 vaccine codes and rates implemented by CMS as they 
     become available. Specifically, UHC will implement new COVID-
     19 codes and rates upon the publication of this information 
     by CMS rather than including these changes in our scheduled 
     quarterly reimbursement update processes. This will ensure 
     provider payments are updated as quickly as possible.
       We appreciate the services provided by health care 
     professionals during the pandemic. The actions we are taking 
     to adjust COVID-19 vaccine claims build on the many steps we 
     have taken to support providers over the last eighteen 
     months, including accelerating claims payments, assisting in 
     processing and administering CARES Act Federal funding to 
     providers, working with HHS to ensure clinicians who provided 
     COVID-19 testing or treatment for individuals without 
     insurance were reimbursed for their services, and removing 
     administrative requirements in highly impacted areas.
       We appreciate the opportunity to address the Committee's 
     questions.
           Sincerely,
                                                   Brian Thompson,
     CEO, UnitedHealthcare.
                                  ____

                                                November 12. 2021.
     Addendum to UHG--Senate Aging Committee Response on 11/5/21

       Thank you for the email of November 8, 2021 with follow-up 
     questions to UHG's letter dated 11/5/2021, and for your 
     continued engagement regarding how we reimburse providers for 
     COVID-19 vaccine administration. Please see our additional 
     responses below:
       Staff asked that we clarify whether ``similar underpayment 
     issues occurred in United's Affordable Care Act and Medicaid 
     Managed Care plans.''
       Answer: As discussed with staff, we have been paying 
     providers according to their contracts since the vaccines 
     first became available. These provider contracts explicitly 
     provide how new procedure codes are implemented and on what 
     timeline; those provisions are agreed to by all parties. 
     Because United paid its network providers according to these 
     contracts, there have been no ``underpayments.'' 
     Nevertheless, after reviewing concerns about the contracted 
     reimbursement amounts paid earlier this year, we elected to 
     voluntarily increase reimbursement--above and beyond 
     contractual rates--for all commercial plans (including 
     individual plans purchased via ACA exchanges), for dates of 
     service between March 15, 2021 and June 30, 2021.
       Within ACA Exchanges, we similarly have paid according to 
     contracts agreed to with providers. ACA Exchange plans will 
     be included in the voluntary increase in reimbursement 
     described above. The completion of that increase will be on 
     the same time frame as commercial plans. With respect to 
     managed Medicaid, as we noted in our first discussion with 
     staff on September 22, 2021, those plans pay according to 
     rates set by state law and state payment policies. United has 
     paid for vaccine administration consistent with those 
     parameters and will continue to do so.
       Staff asked that we provide detail about how we will timely 
     reimburse providers for emergent vaccines and therapeutics 
     unrelated to COVID-19 and the current Public Health Emergency 
     (PHE).
       Answer: In the event of a future pandemic or new PHE we 
     will take immediate actions (noted below) to accelerate 
     reimbursement updates. Outside of a pandemic or PHE how we 
     update codes and payment rates will continue to be guided by 
     our existing contracts with providers. Consistent with 
     industry practice, those contracts provide for timely and 
     substantial payment to providers while we complete the update 
     to our systems. At all times we will follow all applicable 
     state and federal requirements.
       Staff noted the complexity of adjusting reimbursement rates 
     for new procedure codes and asked for details on how United 
     might make those adjustments more quickly in the future.
       Answer: We hope that under less exigent circumstances CMS 
     will provide additional lead time for its pronouncements, but 
     United is not relying on that to speed its processes during 
     this PHE. Instead, we are devoting significant time and 
     effort to ensuring that the process of updating new COVID-19-
     related codes within our systems begins at the time of 
     publication of those codes and without regard to contractual 
     timelines. This includes, for example, redirecting additional 
     internal resources and automating updates whenever possible. 
     While some claims filed immediately after new payment codes 
     are announced might be held for a short time while those 
     updates are being made (generally no longer than 30 days 
     after receipt), we believe this will result in overall faster 
     reimbursement at updated rates. Indeed, it is common in the 
     industry to hold claims during a period of change or 
     uncertainty to help ensure that those claims are paid 
     accurately. We are confident we will be able to update new 
     codes for all claims platforms on a timely basis.
       Finally, staff asked for updates as to our progress on 
     increasing the reimbursement amount for the approximately two 
     million claims impacted by our decision to voluntarily 
     increase reimbursement for COVID-19 vaccine administration.
       Answer: To date, we have resolved approximately 60% of 
     these claims. We expect the

[[Page S379]]

     remaining claims to be completed in the coming 6-8 weeks. We 
     will update you when all claims are complete.
                                  ____

     From: Prible, John M.
     To: Gartrell, Peter (Aging)
     Cc: Hartman, Doug (Aging); Shakow, Peter
     Subject: RE: Follow Up on UnitedHealthcare's Response
     Date: Friday, January 14, 2022 5:12:29 PM

       Peter, thank you for your recent email, in which you asked 
     for an update on our voluntary efforts to retroactively 
     increase reimbursement to $40 for COVID-19 vaccine 
     administration. Answers to your questions are provided below; 
     however, we expect that this confidential information will 
     not be shared with third parties.
       To date, we have retroactively reimbursed providers for 
     1,640,996 claims, or more than 99.8% of all affected claims. 
     The average additional payment for those claims was $14.55, 
     for a total of approximately $23.9 million in additional 
     payments. At this time, fewer than 2,900 claims (less than 
     0.2% percent of all affected claims) remain to be 
     reprocessed. Because the original paid amount on those 
     remaining claims averaged about $36, the average additional 
     reimbursement to be paid will be about $4. Those remaining 
     reimbursements continue to be prioritized and sent out the 
     door. We anticipate those few remaining claims will be 
     completed by February 1, 2022.
       We note that you asked for claims and payment data by 
     state. There are a few reasons we are not able to cut this 
     data cleanly by state, including that providers submit claims 
     via tax identification numbers (TIN), many of which cover 
     physicians (and therefore claims) from multiple states.
       You also asked for additional information about how we will 
     shorten the adoption time of new rates in this or a future 
     national public health emergency (NPHE). As we stated 
     previously, contracts between United and its network provider 
     groups specifically provide for time to implement new rates 
     in an orderly way. We understand this to be routine across 
     the industry, understood and long accepted by the provider 
     community, and entirely proper. If there is another NPHE or 
     there are exceptional circumstances which dictate more timely 
     adoption of new rates, we have learned over the past few 
     months the required technology and human resources that need 
     to be brought forward to accelerate. As a point of reference, 
     should circumstances justify it, we commit to implement new 
     codes in an NPHE faster than industry standard.
                                                      John Prible,
                                 Vice President, External Affairs,
     UnitedHealth Group.

                          ____________________