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Medi-Cal Coverage of Immunizations

Coverage

  1. What are Medi-Cal Managed Care Plans (MCPs) responsibilities for immunizing their recipients?
    For recipients under 21 years of age, the MCP:
    • Is responsible for ensuring that all children receive necessary immunizations at the time of any health care visit.
    • Shall cover and ensure the timely provision of vaccines in accordance with the Advisory Committee on Immunization Practices (ACIP). If immunizations cannot be given at the time of the visit, the recipient must be instructed as to how to obtain necessary immunizations or a scheduled and documented appointment must be made.

    For recipients 21 years of age and older there is no contractual requirement that the immunizations be provided onsite in the provider's office. However, the MCP:

    • Is responsible for ensuring that all adults are fully immunized.
    • Shall cover and ensure the timely provision of vaccines in accordance with the most current “California Adult Immunization Recommendations.” Note that California adult immunization recommendations typically follow ACIP.
    • Shall document attempts to provide immunizations to adults. If a recipient refuses the immunization, proof of voluntary refusal shall be documents in the recipient's medical record.
    See Addendum C.
  2. What vaccines are covered by Medi-Cal, whether fee-for-service or managed care?
        Medi-Cal Program
        Managed Care Fee-For-Service
    Vaccines FDA-Licensed Yes Yes
    ACIP-Recommended Yes Yes

    The Medi-Cal Program (both fee-for-service and managed care) covers all FDA-licensed products (including vaccines) as soon as they are licensed for full-scope Medi-Cal recipients. All vaccines recommended by ACIP are covered, including indications that may be considered off-label per FDA licensure. Routine Medi-Cal reimbursement for a new vaccine or new recommendation may not begin until after ACIP recommends the vaccine for an age group or other specific indication. Updates to the Medi-Cal provider manual may lag behind, so the manual may not yet reflect current ACIP recommendations. Activation of the fee-for-service reimbursement mechanism may also lag behind.

    MCPs may practice utilization reviews against predetermined criteria to ensure that the vaccines are appropriate, medically necessary and not likely to result in adverse recipient outcomes. In addition, if a generic, biologically identical vaccine is already available, MCPs are able to choose which one to make available on their formulary.

    Each ACIP recommendation for children under 18 years of age is reflected in a resolution for the Vaccines For Children (VFC) program. If there is a delay between the federal publication of the VFC resolution and updating the Medi-Cal provider manual, then Medi-Cal will reimburse retroactively.

    Specific details may be found in the Medi-Cal provider manual under various manuals such as General Medicine or Obstetrics under the sections “Immunizations (immun)” and “Immunizations Code List (immun cd).”
  3. Are ACIP Category B recommendations covered by Medi-Cal?
    Yes. ACIP Category B recommendations are made for individual clinical decision making. By contrast, Category A recommendations are made for all persons in an age-based or risk-factor-based group. See Evidence-Based Recommendations – GRADE.

    Examples of Category B recommendations include Human Papillomavirus (HPV) vaccine for males 22 through 26 years of age, and meningococcal serogroup B vaccine for persons 16 through 23 years of age. Vaccination of these groups is covered by Medi-Cal, given certain clinical conditions or risk factors as outlined by ACIP are present. Similarly, Medi-Cal covers hepatitis A and hepatitis B vaccines for all adults, including non-high-risk persons.
  4. What vaccines are covered by the Child Health and Disability Prevention (CHDP) Program?
    CHDP covers preventive health assessments and immunizations for  Medi-Cal beneficiaries up to 21 years of age who have full scope Medi-Cal. Vaccines, both those provided by the federal VFC program and vaccines not provided by the VFC program, are covered by CHDP. The covered vaccines are listed on the CHDP Gateway to Health Coverage website.

    Note: The federal VFC program supplies free vaccines to enrolled physicians. Every Medi-Cal-eligible child younger than 19 years of age may receive vaccines supplied by the VFC program. To participate, providers must enroll in VFC even if already enrolled with Medi-Cal or the CHDP program. Providers billing VFC procedure codes are reimbursed for vaccine administration costs only.

    Effective July1, 2017, CHDP claims processing for non-school based CHDP providers officially transitioned to HIPAA-compliant formats for billing all CHDP services, including vaccines. Claims for CHDP services with dates of service on and after that date are to be billed to Medi-Cal as Early and Periodic Diagnosis and Treatment (EPSDT) preventive health assessments and immunizations in accordance with Medi-Cal policy, rates, and provider enrollment requirements. Please refer to the June 2017 Bulletin 152 or the most recent update of the CHDP Program Code Conversion Table for details on the transition.
  5. Are vaccines covered by Medi-Cal even if the adult requests the vaccine for employment, school, immigration or sports?
    Yes. If a vaccine is recommended by ACIP for all adults, the vaccine is covered by all MCPs and the full-scope Medi-Cal fee-for-service program. For example, if an adult Medi-Cal recipient needs influenza vaccine, MMR, varicella vaccine or Tdap, these vaccines are covered for all Medi-Cal recipients, regardless of whether they are required to have the vaccine for employment, school, immigration or sports. Hepatitis A and hepatitis B vaccines are also included in the ACIP Recommended Adult Schedule for adults seeking protection against these infections. In addition, if the recipient meets an ACIP-recommended indication (e.g., age or risk factor), Medi-Cal covers the indicated vaccine.
  6. Are vaccines covered for non-pregnant adults on restricted-scope Medi-Cal (also known as emergency Medi-Cal)?
    No. Restricted-scope Medi-Cal for non-pregnant adults does not cover vaccines unless a vaccine is needed for an emergency, such as tetanus toxoid-containing vaccine for wound management. Recipients would meet the eligibility criteria for Section 317-funded immunizations. See the Vaccine Eligibility Guidelines.
  7. Pregnancy-Related Coverage

  8. What vaccines are covered for pregnant Medi-Cal recipients?
    Medi-Cal covers all medically necessary services for all pregnant recipients, including all vaccines recommended by ACIP (Addendum F). ACIP recommendations include:
    • influenza vaccine* (if the recipient is or expects to be pregnant during influenza season), and
    • Tdap vaccine at the earliest opportunity in the 27 through 36-week gestational window, regardless of a recipient's prior history of receiving Tdap

    If the recipient refuses the immunization, proof of voluntary refusal shall be documented in the recipient's Medical Record (Addendum C).

    The Medi-Cal provider manual states that “Providers of prenatal care must implement a Tdap immunization program for all pregnant recipients. Health care personnel should administer a dose of Tdap during each pregnancy, irrespective of the recipient's prior history of receiving Tdap.” Department of Health Care Services (DHCS) and California Department of Public Health (CDPH) have defined the components of the Prenatal Tdap Program in the joint letter found here.

    * Note that per Health and Safety Code section 124172, pregnant women shall not be vaccinated with a vaccine that contains more than 1 μg of mercury per 0.5 mL dose. Multi-dose vials of influenza vaccine contain levels of thimerosal over this limit; however, pregnant women may receive influenza vaccine formulated in single dose vials or single dose prefilled syringes given via the intramuscular or intradermal route.
  9. How do providers bill for Tdap administered to pregnant recipients in Medi-Cal FFA (including emergency-only, pregnancy-related coverage)?
    As published in the Medi-Cal Update in July 2014 and repeated January 2015, providers should bill using CPT code 90715.

    A recipient who meets all eligibility requirements but does not have satisfactory immigration status for full-scope Medi-Cal is entitled to emergency and pregnancy-related services. See the Medi-Cal Eligibility and Covered California FAQs.
  10. Are immunizations covered under Medi-Cal presumptive eligibility?
    Yes. Immunizations including Tdap and influenza vaccine are covered, per the Medi-Cal July 2016 Provider Bulletin and Medi-Cal provider manual.

    The Presumptive Eligibility for Pregnant Women (PE4PW) program allows Qualified Providers to grant immediate, temporary Medi-Cal coverage for ambulatory prenatal care and prescription drugs for conditions related to pregnancy to low-income, pregnant recipients, pending their formal Medi-Cal application. PE4PW is designed for California residents who believe they are pregnant and who do not have Medi-Cal coverage for prenatal care. For more information on the PE program, see the Presumptive Eligibility for Pregnant Women web page.
  11. Eligibility
    (Also see Question #8 regarding adults without satisfactory immigration status, and Question #9 regarding presumptive eligibility based on pregnancy.)

  12. When Medi-Cal recipients move to a new county, when are they eligible for immunization services? Must they wait until their Medi-Cal is approved in the new county?
    When Medi-Cal recipients move to a new county, they should request an inter-county transfer from their Medi-Cal case worker. The transfer can take about one to two weeks before the recipient information is in the new county's system. During the transfer, recipients still have Medi-Cal coverage and can receive services using their existing Medi-Cal card (their client identification number will not change). They can call the state Medi-Cal office or go online for a list of eligible providers and MCPs in the new county.
  13. Does immigration status impact Medi-Cal eligibility for children under 19-years of age?
    Under a new law, children under 19 years of age are eligible for full-scope Medi-Cal benefits regardless of immigration status as long as they meet the income standards. DHCS uses the current Medi-Cal Managed Care enrollment process for new enrollees. Counties continue to transition the remaining children without satisfactory immigration status from restricted scope to full-scope Medi-Cal. For more information, see the SB 75 Medi-Cal for All Children web page of the DCHS website.
  14. Appointment Logistics and Access to Services
    (Also see Question #18 for access to local heal department clinics.)

  15. A Medi-Cal Managed Care recipient needs to receive immunization before starting school; however, the recipient cannot get an appointment for 11 business days (which is after the first day of school) with her primary care provider. What should be done?

    The recipient or parent/guardian should call the MCP as this exceeds the maximum allowed time (per contract) for non-urgent primary care appointments (within 10 business days of request). If there is a provider shortage, the MCP is required to refer recipients to, or assist recipients in locating, available and accessible contracted providers in neighboring service areas for obtaining health care services in a timely manner appropriate for the recipient's needs. See Addendum A.

    Similarly, for recipients less than 21 years of age,* when a parent or guardian requests a preventive care visit or has a referral from the local CHDP program, the MCP shall make an appointment for the recipient within two weeks of the request. See Addendum C.

    If the local health department holds immunization clinics offering the needed vaccine(s) for which the recipient is eligible (e.g., Medi-Cal, pediatric), MCP recipients may receive immunizations at these local health department clinics depending on the health plan – local health department Memorandum of Understanding (MOU) or contract.

    * Note that vaccines obtained through the VFC program may only be used for eligible recipients through 18 years of age
  16. What are the time and distance standards for access to a primary care physician in Medi-Cal Managed Care? What is the maximum distance a recipient should need to travel to see a network primary care physician?

    DHCS contracts specify that the MCP shall maintain a network of primary care physicians within 30 minutes or 10 miles from a recipient's residence unless DHCS has approved an alternative time and distance standard. See Addendum B.
  17. Must MCPs or CHDP ensure their providers offer immunization-only visits?
    There is no specific requirement to provide immunization-only visits. However, MCPs are required to ensure that all children receive necessary immunizations at the time of any health care visit and that vaccines are provided in a timely fashion in accordance with the recommendations published by ACIP (Addendum C); or they must provide instruction on how to obtain necessary immunizations; or a scheduled and documented appointment must be made. MCPs are required to cover preventive health visits according to the American Academy of Pediatrics (AAP) Periodicity schedule.

    In 2016, CHDP implemented the AAP Periodicity Schedule. With the CHDP code conversion to national HIPAA-compliant CPT-4 codes, CHDP providers are to bill the appropriate CPT-4 procedure codes for CHDP services as listed in the CHDP Code Conversion Table to ensure that CHDP recipients receive all ACIP-recommended vaccines. CHDP providers with questions are advised to contact their county CHDP program.
  18. Must MCPs provide transportation for recipients to access medical services?
    Yes. As of July 1, 2017, MCPs must provide transportation for MCP recipients to obtain medically necessary MCP-covered services. This could include transporting a recipient to a pharmacy in their MCP network for immunization. Effective October 1, 2017, MCPs must provide transportation for all Medi-Cal services, including those not covered by the MCP contract.

    See All Plan Letter 17-010 (Revised).
  19. Documentation of Immunization

  20. Are child and adult Medi-Cal Managed Care recipients' immunizations required to be reported to the California Immunization Registry (CAIR)?
    Yes. MCPs are required to ensure that recipient-specific immunization information is periodically reported to CAIR for both children and adults. Reports shall be made following the recipient's initial health assessment and all other health care visits which result in an immunization being provided (Addendum E).
  21. If an adult Medi-Cal Managed Care recipient declines a recommended vaccine, what should be documented?
    DHCS contracts require that MCPs document attempts to provide immunizations. If the recipient refuses the immunization, proof of voluntary refusal of the immunization in the form of a signed statement by the recipient or guardian of the recipient shall be documented in the recipient's medical record. If the responsible party refuses to sign this statement, the refusal shall be noted in the recipient's medical record. See Addendum C.
  22. Reimbursement

  23. Can Medi-Cal Managed Care recipients access local health department immunization clinics?
    Yes. Medi-Cal Managed Care recipients may access local health department clinics for immunizations if offered based on age and eligibility. DHCS contracts specify that MCPs shall reimburse local health departments for the administration fee for immunizations given to recipients (Addendum D). Local health departments must provide immunization records when immunization services are billed to the health plan.

    There is no specific requirement for the MCP to reimburse the local health department for the cost of the vaccine unless specified in the health plan – local health department MOU or contract. For Medi-Cal recipients 18 years of age and younger, the VFC program provides no-cost vaccine to both local health departments and Medi-Cal Managed Care providers enrolled in the VFC program.

    DHCS requires that each MCP enter into an MOU or subcontract with local health departments for immunizations (Addendum G). The subcontract shall specify responsibilities of both parties, billing and reimbursement, reporting and how services are coordinated including exchange of medical information. See the Billables Project.
  24. For health care providers who are part of the VFC program, what is the Medi-Cal fee-for-service reimbursement rate for administration of the vaccine?
    Fee-for-service Medi-Cal reimbursement for administration of VFC vaccine cannot exceed $9.00. This maximum rate is set in California Code of Regulations (CCR), Title 22, section 51503(e).

    MCPs may reimburse their network providers a different amount or by a different method (e.g., a capitated rate). Providers should confirm vaccine and administration reimbursement rates with each MCP.

  25. For medical providers who administer recommended vaccines to adults 19 years of age and older who are Medi-Cal recipients, how much are they reimbursed under fee-for-service Medi-Cal?
    They are reimbursed for the vaccine plus an administration fee. The administration fee is set at $4.46 (injection fee) and is included in the vaccine reimbursement rate. Vaccine reimbursement is set at the Medicare rate of reimbursement if a Medicare rate for that vaccine is available. Reimbursement for vaccines without a Medicare rate is at the pharmacy rate of reimbursement which is defined as the lower of:
    1. The average wholesale price (AWP)-17 percent,
    2. The federal upper limit (FUL), or
    3. The maximum allowable ingredient cost (MAIC).

    Medi-Cal reimbursement rates

    Medi-Cal immunization billing guidelines
  26. Troubleshooting

  27. If Medi-Cal recipients or a Medi-Cal provider has a specific question or would like help resolving a problem regarding a recipient accessing immunizations or answering a Medi-Cal coverage question, whom should they call?
    For questions on fee-for-service Medi-Cal, Medi-Cal recipients or providers, call the Medi-Cal Telephone Service Center at 1-800-541-5555. (If calling from a cellphone with an area code outside of California, call 916-636-1980.)

    If recipients of an MCP have questions about coverage of a vaccine (or would like to resolve a problem getting an appointment or being able to get a vaccine) they should call the recipient services number shown on the back of their benefits card. See the Medi-Cal Managed Care Health Plan Directory.

    The following recipient information should be available before calling:

    • The Medi-Cal beneficiary ID number or
    • The last four digits of the Social Security Number and
    • The date of birth in two-digit month and four-digit year format (i.e., 09/1961)

    For issues that cannot be resolved by calling the MCP or for other questions specific to Medi-Cal Managed Care, please contact the DHCS Office of the Ombudsman:

  28. What can a provider do if faced with difficulties being reimbursed for an immunization?
    If a Medi-Cal provider faces difficulties being reimbursed for a fee-for-service recipient, the provider should contact the Telephone Service Center (TSC) at 1-800-541-5555.

    Providers should bring immunization payment issues for Medi-Cal Managed Care recipients to the specific MCP's provider line. See the December 2015 Provider Bulletin for the MCP's provider services phone numbers.

    If an immunization reimbursement problem is not resolved after taking the steps above, the provider may contact the local or state immunization program as appropriate.
  29. Stocking Vaccines Onsite

  30. Some health care providers who do not vaccinate or only use a limited number of vaccines are concerned about some of the up-front costs for (additional) vaccine storage, including refrigerators, freezers and temperature monitoring devices. Are there any resources to defray the costs?
    Some of the MCPs have programs to defray these costs. For example, in recent years the Central California Alliance for Health (serving Santa Cruz, Monterey and Merced counties) had a grant program that offered grant opportunities to increase provider capacity, including for equipment purchases.

    ADDENDA – Excerpts of DHCS Contracts

    ADDENDUM A: Two-Plan Boilerplate – Exhibit A, Attachment 9, Section 4, Access Standards, and Section 16, Out-of-Network Providers

    A. Appropriate Clinical Timeframes
    Contractor shall ensure that Members are offered appointments for covered health care services within a time period appropriate for their condition.

    B. Standards for Timely Appointments
    Members must be offered appointments within the following timeframes:

    • Urgent care appointment for services that do not require prior authorization – within 48 hours of a request
    • Urgent appointment for services that do require prior authorization – within 96 hours of a request
    • Non-urgent primary care appointments – within ten business days of request
    • Appointment with a specialist – within 15 business days of request

    C. Provider Shortage
    Contractor shall arrange for a Member to receive timely care as necessary for their health condition if timely appointments within the time and distance standards required in Attachment 6, Provision 8 of this contract are not available. Contractor shall refer Members to, or assist Members in locating, available and accessible contracted providers in neighboring service areas for obtaining health care services in a timely manner appropriate for the Member's needs.

    Section 16, Out of Network Providers

    A. If Contractor's network is unable to provide necessary services covered under the Contract to a particular Member, Contractor must adequately and timely cover these services out of network for the Member, for as long as the entity is unable to provide them. Out-of-network providers must coordinate with the entity with respect to payment. Contractor must ensure that cost to the Member is not greater than it would be if the services were furnished within the network.

    ADDENDUM B: Two Plan Boilerplate Exhibit A, Attachment 6, Provider Network, Section 8, Time and Distance Standard

    Contractor shall maintain a network of Primary Care Physicians which are located within 30 minutes or 10 miles of a Member's residence unless the Contractor has a DHCS-approved alternative time and distance standard.

    ADDENDUM C: Two Plan Boilerplate Exhibit A, Attachment 10, Scope of Services, Section 5, Services for Members Under 21 Years of Age

    Contractor shall cover and ensure the provision of screening, preventive and Medically Necessary diagnostic and treatment services for Members under 21 years of age including Early and Periodic Screening, Diagnosis and Treatment (EPSDT) supplemental services.

    Contractor shall ensure that appropriate diagnostic and treatment services are initiated as soon as possible but no later than 60 calendar days following either a preventive screening or other visit that identifies a need for follow-up.

    A. Provision of IHAs for Members under Age 21

    • For Members under the age of 18 months, Contractor shall ensure the provision of an IHA within 120 calendar days following the date of enrollment or within periodicity timelines established by the American Academy of Pediatrics (AAP) for ages two and younger whichever is less.
    • For Members 18 months of age and older upon enrollment, Contractor is responsible to ensure an IHA is performed within 120 calendar days of enrollment.
    • Contractor shall ensure that performance of the California Child Health and Disability Prevention (CHDP) program's age appropriate assessment due for each child at the time of enrollment is accomplished at the IHA. The initial assessment must include, or arrange for provision of, all immunizations necessary to ensure that the child is up-to-date for age, and an age appropriate IHEBA. See MMCD Policy Letter PL 13-001 for specific IHEBA requirements.

    B. Children's Preventive Services

    • Contractor shall provide preventive health visits for all Members under 21 years of age at times specified by the most recent AAP periodicity schedule. This schedule requires more frequent visits than does the periodicity schedule of the CHDP program. Contractor shall provide, as part of the periodic preventive visit, all age specific assessments and services required by the CHDP program and the age specific health education behavioral assessment as necessary.
    • Where the AAP periodicity exam schedule is more frequent than the CHDP periodicity examination schedule, Contractor shall ensure that the AAP scheduled assessment includes all assessment components required by the CHDP for the lower age nearest to the current age of the child.
    • Where a request is made for children's preventive services by the Member, the Member's parent(s) or guardian or through a referral from the local CHDP program, an appointment shall be made for the Member to be examined within two weeks of the request.
    • At each non-emergency primary care encounter with Members under the age of 21 years, the Member (if an emancipated minor) or the parent(s) or guardian of the Member shall be advised of the children's preventive services due and available from Contractor, if the Member has not received children's preventive services in accordance with CHDP preventive standards for children of the Members' age. Documentation shall be entered in the Member's Medical Record which shall indicate the receipt of children's preventive services in accordance with the CHDP standards or proof of voluntary refusal of these services in the form of a signed statement by the Member (if an emancipated minor) or the parent(s) or guardian of the Member. If the responsible party refuses to sign this statement, the refusal shall be noted in the Member's Medical Record.

    C. Immunizations
    Contractor shall ensure that all children receive necessary immunizations at the time of any health care visit. Contractor shall cover and ensure the timely provision of vaccines in accordance with the most recent childhood immunization schedule and recommendations published by the Advisory Committee on Immunization Practices (ACIP). Documented attempts that demonstrate Contractor's unsuccessful efforts to provide the immunization shall be considered sufficient in meeting this requirement.

    If immunizations cannot be given at the time of the visit, the Member must be instructed as to how to obtain necessary immunizations or a scheduled and documented appointment must be made. Appropriate documentation shall be entered in the Member's Medical Record that, indicates all attempts to provide immunization(s); instructions as to how to obtain necessary immunizations; the receipt of vaccines or proof of prior immunizations; or proof of voluntary refusal of vaccines in the form of a signed statement by the Member (if an emancipated minor) or the Parent(s) or guardian of the Member. If the responsible party refuses to sign this statement, the refusal shall be noted in the Member's Medical Record.

    Upon Federal Food and Drug Administration (FDA) approval of any vaccine for childhood immunization purposes, Contractor shall develop policies and procedures for the provision and administration of the vaccine. Such policies and procedures shall be developed within thirty (30) calendar days of the vaccine's approval date. Contractor shall cover and ensure the provision of the vaccine from the date of its approval regardless of whether or not the vaccine has been incorporated into the Vaccines for Children (VFC) Program. Policies and procedures must be in accordance with any Medi-Cal fee-for-service guidelines issued prior to final ACIP recommendations.

    Contractor shall provide information to all network providers regarding the VFC Program.

    Exhibit A, Attachment 10 Scope of Services, 6 Services for Adults
    C. Immunizations. Contractor is responsible for assuring that all adults are fully immunized. Contractor shall cover and ensure the timely provision of vaccines in accordance with the most current California Adult Immunization recommendations.

    In addition, Contractor shall cover and ensure the provision of age and risk appropriate immunizations in accordance with the findings of the IHA, other preventive screenings and/or the presence of risk factors identified in the health education behavioral assessment.

    Contractor shall document attempts to provide immunizations. If the Member refuses the immunization, proof of voluntary refusal of the immunization in the form of a signed statement by the Member or guardian of the Member shall be documented in the Member's Medical Record. If the responsible party refuses to sign this statement, the refusal shall be noted in the Member's Medical Record. Documented attempts that demonstrate Contractor's unsuccessful efforts to provide the immunization shall be considered evidence in meeting this requirement

    ADDENDUM D: Two Plan Boilerplate Exhibit A, Attachment 8, Provider Compensation Arrangements, Section 12, Immunizations; and Attachment 9, Section 9, Access to Services with Special Arrangements, E. Immunizations

    Attachment 8
    Health plans shall reimburse local health departments for the administration fee for immunizations given to Members. However, the health plan is not required to reimburse the local health department for an immunization provided to a Member who was already up to date. The local health department shall provide immunization records when immunization services are billed to the health plan. The health plan shall not be obligated to reimburse providers other than local health departments unless they enter into an agreement with the Contractor.

    Attachment 9
    Members may access local health department clinics for immunizations. Contractor shall, upon request, provide updated information on the status of Members' immunizations to the local health department clinic. The local health department clinic shall provide immunization records when immunization services are billed to the Contractor.

    For requirements of Medi-Cal Managed Care health plans to contract with the local health department, see Addendum G.

    ADDENDUM E: Two Plan Boilerplate Exhibit A, Attachment 11, Case Management and Coordination of Care, Section 19, Immunization Registry Reporting

    Contractor shall ensure that recipient-specific immunization information is periodically reported to an immunization registry(ies) established in the Contractor's Service Area(s) as part of the Statewide Immunization Information System. Reports shall be made following the Member initial health assessment and all other health care visits which result in an immunization being provided. Reporting shall be in accordance with all applicable State and Federal laws.

    ADDENDUM F: Exhibit A, Attachment 10, Scope of Services, Section 7, Pregnant Women

    A. Prenatal Care. Contractor shall cover and ensure the provision of all Medically Necessary services for pregnant women. Contractor shall ensure that the most current standards or guidelines of the American College of Obstetricians and Gynecologists (ACOG) are utilized to provide, at a minimum, quality perinatal services.

    ADDENDUM G: Two Plan Boilerplate Exhibit A, Attachment 12, Local Health Department Coordination

    1. Subcontracts. Contractor shall negotiate in good faith and execute a Subcontract for public health services listed in A through D below with the local health department. The Subcontract shall specify: the scope and responsibilities of both parties in the provision of services to Members; billing and reimbursements; reporting responsibilities; and how services are to be coordinated between the local health department and the Contractor, including exchange of medical information as necessary. The Subcontract shall meet the requirements contained in Exhibit A, Attachment 6, provision 12, regarding Subcontracts.

    • Family Planning Services: as specified in Exhibit A, Attachment 8, provision 9.
    • Sexually Transmitted Disease (STD) services …
    • HIV Testing and Counseling as specified in Exhibit A, Attachment 8, provision 11.
    • Immunizations: as specified in Exhibit A, Attachment 8, provision 12.


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