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With the recent Food and Drug Administration approval of COVID-19 vaccines, the Department of Health Care Services (DHCS) is seeking federal approval to help support delivery of the vaccine to all Medi-Cal beneficiaries.
DHCS will follow California’s COVID-19 vaccination plan, which was approved by the California Department of Public Health. It calls for implementation in several phases: pre-vaccine; limited doses available; larger number of doses available; and sufficient supply of doses available for the entire population.
Delivery System/Coverage
Consistent with the approach being taken by Medicare through Medicare Advantage Plans, DHCS will carve out the COVID-19 vaccine from Medi-Cal managed care health plans and will reimburse providers under the fee-for-service delivery system for both medical and pharmacy claims.
DHCS will also seek federal approval to cover the cost of the vaccine administration for Medi-Cal beneficiaries who are in restricted scope coverage, the COVID-19 uninsured population, and enrollees of the Family Planning, Access, Care, and Treatment Program.
Provider Reimbursement
Medi-Cal proposes to reimburse the associated COVID-19 vaccine administration fee at Medicare rates for all claims, medical and pharmacy, based on the number of required doses. As the federal government will pay for the initial vaccines, there is no Medi-Cal provider reimbursement for the COVID-19 vaccine itself. Providers will bill for administration of the COVID-19 vaccine on a medical or pharmacy claim, based on current policy.
Additionally, DHCS will seek federal approval to pay federally qualified health centers, rural health centers, and tribal 638 clinics for the vaccine administration fee outside of their current prospective payment system or all inclusive rate.
DHCS expects to issue initial guidance on COVID-19 vaccine administration and reimbursement policy by Dec. 25.
