The Ohio Chapter, American Academy of Pediatrics, won a reversal of a policy decision by Ohio Medicaid. Ohio Medicaid issued a policy change in December regarding payment for VFC vaccines. Our members were concerned that they were only being paid for one vaccine administration code – even though multiple vaccines were given.
Ohio AAP worked with our members and put pressure on Ohio Medicaid using information gathered from both our members and our national organization. Ohio Medicaid sent a memo to all plans on April 24 letting them know they could not cap payment for the administration of VFC vaccines per encounter and had to pay the enhanced fee per vaccine administered. In addition, Ohio Medicaid said both plans and ODM must make adjustments to make sure qualifiying physicians get the additional reimbursement they are owed. Ohio Medicaid also thanked Ohio AAP and its members for bringing this to their attention.
You can read the memo Ohio Medicaid sent to all Medicaid Coordinators and Contracted Managed Care plans by clicking here: Payment for Vaccines for Children under the Primary Care Rate Increase