photo Courtesy of Heather Hazzan , SELF Magazine
recently worked together to procure funding to help . “ Specifically , ARAAP proposed to the Arkansas Department of Human Services that the state allocate funding from the Federal CARES Act to reimburse qualifying physicians for otherwise non-reimbursable expenses related to immunizing children ,” explained Strong . “ We had the support of the Arkansas Medical Society , Arkansas Academy of Family Physicians , and other important partners in delivering vaccines to kids across the state .
“ I have not heard of another state tapping into their CARES Act funding in this way . In the end , we developed a program that allowed primary care practices who were participants in the Medicaid Primary Care Case Management and the Vaccines For Children programs to apply for funding of up to $ 30 per Medicaid-attributed child in reimbursement for activities to increase and enhance compliance .”
In all , the group procured $ 8.7 million , providing an efficient and effective path for children to get missed vaccines from trusted primary care physicians . Though the incentive has ended , it significantly helped many Arkansas physicians . “ We estimated that for a pediatric practice of about seven physicians , it would be about $ 130,000 to pay for enhanced outreach and care coordination ,” said Strong . “ This effort was one more way for us to support and emphasize the importance of immunizations , particularly within the context of a wellchild visit in a medical home .”
Long-Awaited Medicaid Reimbursement Increase
“ Another positive that happened this year had to do with reduced losses for our immunization program ,” said ADH Senior Medical Advisor and ARAAP President Gary Wheeler , MD . Dr . Wheeler has long preached the inadequacy of Medicaid ’ s immunization reimbursement – and how far it was from covering costs for practices . “ Most practices have been losing money every time they give a vaccine covered by Medicaid . The actual cost for administering a vaccine is roughly $ 25 , but Medicaid has been paying only about a third of that . We had petitioned to take that number up to the limit of what Medicaid allows , which is about $ 20 per vaccine .”
Recently , Medicaid increased that reimbursement – that ’ s welcome news for Arkansas physicians taking Medicaid . “ We didn ’ t get it all the way up , but we got much closer ,” Dr . Wheeler explained . “ Previously , reimbursement was $ 9.56 for pediatric vaccines administered from the Vaccines For Children program . Starting July 1 , flu vaccine administration increased by 62 % to $ 15.45 and other Medicaid-payable vaccines increased by 37 % to $ 13.14 .”
More Reimbursement Help Needed on the Adult Side
Scheduled vaccines for young children aren ’ t the only concern raised by the pandemic . “ Comparing this year to last year , we did see a drop in adult rates , too ,” mentioned Dr . Wheeler . “ Adults may not feel that they need vaccinations as much as children , but there are few adults that don ’ t have contact with children . Children are very good at spreading infection , so adults need to get their vaccines to protect themselves .”
For Arkansas adults covered by Medicaid and for the physicians trying to serve them , this is easier said than done . Although slight improvements have been made in Medicaid reimbursements related to adult vaccines , much more needs to be done , according to John Vinson , Pharm . D ., and Chief Executive Officer for the Arkansas Pharmacists Association . “ The reality is that physicians and pharmacists serving Medicaid patients have largely had to stop providing most adult vaccines , including influenza
vaccine , due to lack of adequate compensation ,” said Vinson , who has been a spokesman for change on this issue .
With support from AMS and other groups , Vinson submitted a letter to Gov . Hutchinson in 2018 addressing shortfalls in Medicaid Immunization approved fees and reimbursements . His letter commended past reforms improving immunization coverage for Arkansas Works and
GARY WHEELER , MD
Employee Benefits Division plans and asked for similar reforms to Medicaid . Specifically , he asked for an increase in the Medicaid immunization administration fee for children and adults , an update to the Medicaid ingredient cost reimbursement for patients age 19 and over for vaccine product , and a required policy for Arkansas Medicaid coverage of all Centers for Disease Control Advisory Committee on Immunization Practices recommended vaccines and schedules for children and adults .
Some good changes came in response , explained Vinson . As Wheeler aforementioned , the immunization administration fee for adults , just like for children , increased . This was significant since previously , adult vaccine administration fees and administration-specific codes were not covered at all . “ Before July , providers of adult vaccine could only get reimbursed from Medicaid for the cost of the vaccine product ,” Vinson said , “ and that often did not cover actual cost . This new policy will help with influenza vaccination access for patients but not so much with other adult vaccines .
>> Continued on page 103 .
Drive-through testing . Photo courtesy of ADH .
Volume 117 • Number 5 NOVEMBER 2020 • 103