Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Standard XV: Immunizations, Pregnancy, Drugs & Transportation
CONTRACT
SECTION
CC-V.H.14.d–g
3. CAPITATED
PLANS:
Vaccine
Administration
Fee
CC-V.H.14.h
4. CAPITATED
PLANS: Paying
the Vaccine
Administration
Fee
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT REQUIREMENT COMPLIANT SCORING
1 of each Contract year to BMHC that the
health plan, or its participating providers, are
enrolled in the VFC program.
• Provides coverage and reimbursement to the
participating provider for immunizations
covered by Medicaid, but not provided
through VFC.
• Ensures that providers have a sufficient
supply of vaccines if the health plan is
enrolled in the VFC program. The health plan
directs those providers that are directly
enrolled in the VFC program to maintain
adequate vaccine supplies.
The health plan will pay no more than the Medicaid
program vaccine administration fee of $10 per
administration, unless another rate is negotiated with
the participating provider.
The health plan will pay the immunization
administration fee at no less than the Medicaid rate
when an enrollee receives immunizations from a nonparticipating
provider so long as:
• The non-participating provider contacts the
health plan at the time of service delivery.
• The health plan is unable to document to the
non-participating provider that the enrollee
has already received the immunization.
• The non-participating provider submits a
claim for the administration of immunization
DOCUMENTS
REVIEWED
FINDINGS
State of Florida Compliance Monitoring_Standard_XV_F2_07_11
Yes
No
N/A
Yes
No
N/A
Met
Partially Met
Not Met
Met
Partially Met
Not Met
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