Provider Information Session: MassHealth Flu and Adult Vaccine - - PowerPoint PPT Presentation

Provider Information Session:

MassHealth Flu and Adult Vaccine Program for Local Public Health Providers

August, 2015

Executive Office of Health & Human Services I Office of Medicaid in collaboration with Massachusetts Department of Public Health

Agenda ■ Mission and Program goals ■ MDPH’s Immunization Program Requirement ■ Flu Vaccine Component ■ Adult Vaccine Component ■ General Program Requirements ■ Contact Information

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MassHealth Mission and Program Goals

■ MassHealth

To improve the health outcomes of our diverse members, their families and their communities, by providing access to integrated health care services that sustainably promote health, well-being, independence, and quality of life.

■ MassHealth Flu and Adult Vaccine Program goals

To increase access and provide certain influenza (flu) and adult vaccines to eligible MassHealth members in public health settings particularly in geographic areas where members have difficulty accessing vaccines ■ Eligibility: Local Public Health Departments (LPHDs) and Public School Districts (PSDs) enrolled in the Massachusetts Department of Public Health (MDPH) Immunization Program ■ MassHealth pays for:

• Flu vaccine: cost of purchasing (when not state-supplied) and administering flu

vaccine to eligible MassHealth members

• Adult vaccine: cost of purchasing and administering of certain adult vaccines to

eligible MassHealth members

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MassHealth Flu and Adult Vaccine Program & MDPH Immunization Program for 2015

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• LPHDs and PSDs must be enrolled in the MDPH Immunization

Program for 2015 before applying for this MassHealth program

• In order to remain enrolled in this MassHealth program, LPHDs and

PSDs must enroll in the MDPH Immunization Program on a calendar year basis: i.e., be enrolled for 2016 before having a flu clinic in 2016

• To enroll or re-enroll in the MDPH Immunization Program, LPHDs and

PSDs should go to the MDPH Immunization Program’s website (https://www.contactmiis.info/ ) or call MDPH at 617-983-6828; this is separate from MassHealth program enrollment

• LPHDs and PSDs cannot be enrolled in this MassHealth program if

they are not enrolled in the MDPH Immunization Program

Flu Vaccine Component

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• LPHDs and PSDs already enrolled in the MDPH Immunization

Program for 2015 and this MassHealth program can submit claims for services rendered according to covered procedure codes

• LPHDs and PSDs not yet enrolled in this MassHealth program:
• MassHealth e-mailed, in August 2015, enrollment packets to LPHDs

and PSDs that are on the MDPH Immunization Program list but are unenrolled in the MassHealth Flu and Adult Vaccine Program

• LPHDs and PSDs will receive payment for:
• Administering flu vaccines to MassHealth members 18 and under*

*For MDPH-supplied vaccines, MassHealth covers only the cost of administration

• Cost of purchasing and administering flu vaccines to MassHealth

members 19 and older

• Flu vaccine procedure codes: http://www.mass.gov/eohhs/docs/masshealth/provlibrary/masshealth-

flu-vaccine-program-procedure-codes-for-public-providers.pdf

Adult Vaccine Component

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• Only LPHDs can apply for the adult vaccine component
• LPHDs must be enrolled in the MDPH Immunization Program for 2015 in
• rder to apply or maintain enrollment in this MassHealth program
• MassHealth e-mailed, in August 2015, enrollment packets to LPHDs that

are on the MDPH Immunization Program list for 2015 but are unenrolled with this MassHealth program

• LPHDs already enrolled in the MassHealth Flu and Adult Program can submit

claims for services rendered according to covered procedure codes

• LPHDs enrolled only in the MassHealth Flu Vaccine Component must

amend their contract if they wish to get reimbursed for adult vaccines

• Adult vaccine procedure codes: http://www.mass.gov/eohhs/docs/masshealth/provlibrary/masshealth-

adult-vaccine-procedure-codes.pdf

General Program Requirements

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• LPHDs and PSDs should regularly monitor COMMBUYS:

https://www.commbuys.com/bso/external/bidDetail.sdo?docId=BD-15-1039-EHS01-EHS02- 00000004399&external=true&parentUrl=bid

• This Program’s website:

http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/masshealth-flu-and-adult-vaccine-program.html

• In order to bill MassHealth, providers must have fully executed
• contracts. MassHealth will not pay for services provided before the

effective date of your approved contract

• LPHDs/PSDs can submit claims using Direct Data Entry (DDE):

https://newmmis- portal.ehs.state.ma.us/EHSProviderPortal/appmanager/provider/desktop

• Claims must be submitted within 90 days of the date of service
• List of HIPAA-Approved Vendors can be found at:

www.mass.gov/eohhs/docs/masshealth/privacy/hipaa-vendor-list-production.pdf

Contact Information

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Questions about the MDPH Vaccine Program? 617-983-6800 Need MassHealth vaccine enrollment materials? 617-847-3130 Need assistance with completing the MassHealth enrollment materials? Contact the MassHealth Flu and Adult Vaccine Program Specialist at the MassHealth Customer Service Center 1-800-841-2900 / TTY: 1-800-497-4648 for persons who are deaf, hard of hearing, or speech disabled Hours: Monday-Friday, 8:30 a.m.-5:00 p.m. Send completed MassHealth enrollment materials to: MassHealth Customer Service Center Attention: Provider Enrollment and Credentialing P.O. Box 9162 Canton, MA 02021