The following message is from the Colorado Department of Public Health & Environment
We would like to make you aware of a recent Medicaid vaccine administration reimbursement rate change as well as remind you of the vaccine administration reimbursement rate of non-Medicaid patients. In December 2014, the Colorado Department of Health Care Policy and Financing (HCPF), the agency that administers the Colorado Medicaid program, released a Provider Bulletin (https://www.colorado.gov/pacific/sites/default/files/Bulletin_1214_B1400360.pdf) that contains information on page 5 about an increased rate for vaccine administration and expiration of the Primary Care Supplemental Payment (also known as the "Medicaid Bump").
Increase in Medicaid Reimbursement for Vaccine Administration
In December 2014, HCPF submitted a request to the Centers for Medicaid and Medicare Services that the vaccine administration rate be increased to $25.22 for ALL enrolled Medicaid providers providing vaccine administration services to any Medicaid-eligible persons. The new rate will be retroactive to January 1, 2015 and remain in place through June 2016. Until HCPF receives approval for the new rate, they will reimburse for vaccine administration services at the old rate of $6.33. While HCPF has not yet received notification of approval or rejection, they have indicated that ALL enrolled Medicaid providers should begin billing at the new requested rate of $25.22 to ensure they receive reimbursement at the new rate, if approved. Note that this is a new rate and not a supplemental payment; therefore, no attestation requirements apply.
Primary Care Supplemental Payment Ending
The Affordable Care Act program to pay attested primary care physicians a supplemental payment that increased reimbursement to Medicare rates ended December 31, 2014. Claims for services after December 31, 2014 will not be evaluated for supplemental payments. Supplemental payments will be made in 2015 but only for services by attested physicians that were rendered in 2014.
REMINDER: Maximum Regional Vaccine Administration Fee for Non-Medicaid, VFC-eligible Patients
As a reminder, effective January 1, 2013, the maximum regional vaccine administration fee for non-Medicaid, VFC-eligible patients increased from $14.74 to $21.68. This is the maximum allowable fee that can be charged to non-Medicaid patients receiving VFC or Section 317 funded vaccine. This includes patients that are uninsured, American Indian or Alaskan Native. It also includes underinsured patients 18 and under who are served at Federally Qualified Health Centers, Rural Health Centers, or deputized Local Public Health Agencies. This fee must be waived if the patient reports they cannot afford to pay.
Click Here: New Medicaid Rate Memo
Once we receive notice from HCPF that the new vaccine administration rate has been approved or rejected, we will send out a new memo.
In December 2014, HCPF submitted a request to the Centers for Medicaid and Medicare Services that the vaccine administration rate be increased to $25.22 for ALL enrolled Medicaid providers providing vaccine administration services to any Medicaid-eligible persons. The new rate will be retroactive to January 1, 2015 and remain in place through June 2016. Until HCPF receives approval for the new rate, they will reimburse for vaccine administration services at the old rate of $6.33. While HCPF has not yet received notification of approval or rejection, they have indicated that ALL enrolled Medicaid providers should begin billing at the new requested rate of $25.22 to ensure they receive reimbursement at the new rate, if approved. Note that this is a new rate and not a supplemental payment; therefore, no attestation requirements apply.
Primary Care Supplemental Payment Ending
The Affordable Care Act program to pay attested primary care physicians a supplemental payment that increased reimbursement to Medicare rates ended December 31, 2014. Claims for services after December 31, 2014 will not be evaluated for supplemental payments. Supplemental payments will be made in 2015 but only for services by attested physicians that were rendered in 2014.
REMINDER: Maximum Regional Vaccine Administration Fee for Non-Medicaid, VFC-eligible Patients
As a reminder, effective January 1, 2013, the maximum regional vaccine administration fee for non-Medicaid, VFC-eligible patients increased from $14.74 to $21.68. This is the maximum allowable fee that can be charged to non-Medicaid patients receiving VFC or Section 317 funded vaccine. This includes patients that are uninsured, American Indian or Alaskan Native. It also includes underinsured patients 18 and under who are served at Federally Qualified Health Centers, Rural Health Centers, or deputized Local Public Health Agencies. This fee must be waived if the patient reports they cannot afford to pay.
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Colorado
Medicaid Vaccine Administration Reimbursement Fee for Medicaid Patients
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Maximum Regional Vaccine
Administration Reimbursement Fee for non-Medicaid, VFC-eligible Patients
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$25.22
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$21.68
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Click Here: New Medicaid Rate Memo
Once we receive notice from HCPF that the new vaccine administration rate has been approved or rejected, we will send out a new memo.
