Medicaid Tips on Immunizations and Pharmacy
MO HealthNet recently posted two tips for providers on immunizations and pharmacy dispensing fees. The department's Hot Tips can be found online here.
MO HealthNet providers billing vaccines for dual eligible participants shall bill Medicare for all vaccines. Vaccine coverage under Medicare Part B includes the pneumococcal, influenza, and Hepatitis B vaccines for individuals at high or intermediate risk, and vaccines directly related to the treatment of an injury or direct exposure to a disease or condition. Other vaccines not covered by Part B are covered by Medicare Part D (pharmacy benefit). When a provider cannot bill the Part D plan directly, the vaccine should be dispensed at a pharmacy. In some cases, a pharmacist may administer the vaccine following the MO Board of Pharmacy guidelines.
Pharmacy Dispensing Fees
Providers must charge and collect the shared pharmacy dispensing fee amount required to be paid by MO HealthNet participants. Providers may not deny or reduce services solely on the basis of the participant's inability to pay the fee when charged. A participant's inability to pay a required amount shall in no way extinguish the participant's liability to pay the amount. The amount is a legal debt and is due to the provider. The provider must keep a record of the cost sharing amounts collected and the amounts due but uncollected because the participant did not make payment when the service was rendered.