DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for ...

CMS-1503-FC 816
regulations which pertain to the description of Medicare FQHC services and not
payment. We made no proposal to change payment and accordingly make no changes to
Medicare FQHC payment regulations.
Finally, we note that we did not propose, nor are we making any changes to, how
influenza, pneumococcal and hepatitis B vaccinations are paid in Medicare FQHCs.
Accordingly, health centers will not lose their current reimbursement structure for these
services. We agree that health centers are reimbursed 100 percent of their costs for the
provision of influenza and pneumococcal vaccinations. We further agree that payment
for influenza and pneumococcal vaccinations in Medicare FQHCs is done separately and
outside the Medicare FQHC upper payment limit. However, we note for clarification
purposes that prior to the effective date of the ACA provisions adding new preventive
services to the Medicare FQHC benefit, the waiver of Part B coinsurance did not extend
to Hepatitis B vaccinations. Hepatitis B vaccinations were covered in Medicare FQHCs
in accordance with Section 1861(aa)(3)(A) of the Act which through reference to section
1861(aa)(1)(A) of the Act included all section 1861(s)(10) of the Act services including
section 1861(s)(10)(B) of the Act, Hepatitis B vaccinations. The waiver of the 20 percent
Medicare Part B coinsurance in Section 1833(a)(3)(A) of the Act extended only to
Section 1861(s)(10)(A) of the Act services and not to section 1861(s)(10)(B) of the Act
Hepatitis B vaccinations. To summarize this clarification, prior to the effective date of
the ACA provisions adding new preventive services to the Medicare FQHC benefit, the
waiver of Medicare Part B coinsurance did not extend to Section 1861(s)(10)(B) of the
Act Hepatitis B vaccinations, hence these services were subject to Medicare Part B
coinsurance and paid at 80 percent (not 100 percent) of reasonable costs in accordance