Vaccine Reimbursement Program for Public Providers
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 and the Massachusetts Association of Health Plans to create a streamlined process for locally sponsored public flu clinics across the Commonwealth to obtain reimbursement from major health plans.
This program helps public providers to serve individuals of all ages in their community and removes potential barriers to vaccinations.
CHCF is pleased to announce that the health plans will cover all adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). This initiative will allow public providers to increase vaccine coverage rates and decrease vaccine-preventable diseases among members of their community.
How Does It Work?
For a 10% fee, 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
CHCF will then distribute payments from the private health plans to public providers.
|PROGRAM SEASON||# OF PUBLIC HEALTH PROVIDERS||# OF CLAIMS SUBMITTED||AMOUNT OF PAID CLAIMS|
|2009 H1N1 Pandemic||43||44,428||$320,000|
|2010-2011 Flu Season||110||45,676||$440,000|
|2011-2012 Flu Season||166||53,572||$800,000|
How Can Providers Participate?
In order to participate public providers must submit two signed originals of the contract to CHCF, located to the left under Documents and Forms. For cities and towns to receive payment, they must also submit a University of Massachusetts Substitute W-9 Form (Form UMW-9) to Commonwealth Medicine. Please feel free to contact us with any questions regarding the contracting process.
2012-2013 Contracted Health Plans
- Blue Cross Blue Shield of Massachusetts
- BMC HealthNet
- Harvard Pilgrim
- Health New England
- Neighborhood Health Plan
*If you are eligible and choose to complete MassHealth's application process.
Phone: (800) 890-2986