Vaccine Reimbursement Program for Public Providers

History:

The unexpected H1N1 influenza pandemic placed an added financial burden on cities and towns in Massachusetts that were already facing major fiscal challenges. Local boards of health were responsible for conducting H1N1 and seasonal influenza vaccination clinics for large numbers of children and families without a mechanism for reimbursement. Historically, health plans did not cover the cost of administering the influenza vaccine outside of the primary care setting.

To relieve the financial strain on the boards of health, the Center for Health Care Financing partnered with the Massachusetts Department of Public Health to increase access to vaccines in public clinics while providing financial support to public providers.

Since the program's inception, it has generated over $3 million in revenue for cities and towns in Massachusetts.

How Does It Work? 

For a 10% fee of paid claims, the Center for Health Care Financing (CHCF) will bill the contracted health plans for the: 

  • Administration of the influenza vaccine to individuals ages 6 months and older 
  • Cost of privately purchased vaccine administered to individuals ages 19 and older 
  • Administration of the pneumococcal vaccine to Medicare Advantage members  
  • Cost and administration of ACIP recommended adult vaccines 
  • Cost and administration for influenza and pneumococcal vaccines to Medicare Part B

CHCF will then distribute payments from the private health plans to public providers.

  

How Can Providers Participate?

In order to participate public providers must attend a training (located throughout the state in late summer or attend a Webinar training), and submit a simple contract to CHCF. Please call 800-890-2986 to request a contract.

 

2014-2015 Contracted Health Plans

  • Blue Cross Blue Shield of Massachusetts 
  • BMC HealthNet  
  • Celticare
  • Cigna
  • Fallon 
  • Harvard Pilgrim 
  • Health New England  
  • MassHealth*
  • Neighborhood Health Plan 
  • Network Health
  • Tufts 
  • Unicare  

*If you are eligible and choose to complete MassHealth's application process.

 

Contact Us:

Holly Oldham

Brittany Tibbetts

Email: vaccine.reimbursement@umassmed.edu
Phone: (800) 890-2986