Financing Administration of 2009 H1N1 Influenza Vaccine Megan C. Lindley, MPH National Center for Immunization and Respiratory Diseases July 27, 2009

Purpose of Presentation Discussion and vote on draft recommendations developed by CDC’s H1N1 vaccine financing subcommittee Discussion and vote on draft recommendations developed by CDC’s H1N1 vaccine financing subcommittee

Context for Draft Recommendations Based on September 2008 NVAC recommendations for child and adolescent vaccination financing Based on September 2008 NVAC recommendations for child and adolescent vaccination financing H1N1 financing subcommittee seeks recommendations from NVAC that are specific to challenges associated with impending H1N1 vaccination campaign H1N1 financing subcommittee seeks recommendations from NVAC that are specific to challenges associated with impending H1N1 vaccination campaign

Challenges for Financing H1N1 Vaccine Administration General General –Variable insurance coverage/underinsurance –Variable reimbursement rates for administration, particularly in Medicaid H1N1 specific H1N1 specific –Broader use of non-traditional vaccination settings Billing private insurance requires contracts Billing private insurance requires contracts Billing Medicaid requires state waiver Billing Medicaid requires state waiver –Unplanned strain on state budgets Medicaid matching; program implementation Medicaid matching; program implementation

Principles of NVAC Financing Recommendations Affirmed in H1N1 Recommendations Voluntary first-dollar insurance coverage by public and private plans Voluntary first-dollar insurance coverage by public and private plans Increased federal match for Medicaid vaccine administration reimbursement Increased federal match for Medicaid vaccine administration reimbursement Vaccine administration reimbursed for all VFC- eligible children, including those on Medicaid Vaccine administration reimbursed for all VFC- eligible children, including those on Medicaid Insurance reimbursements cover all costs associated with vaccine administration Insurance reimbursements cover all costs associated with vaccine administration Federal funding to support state vaccination infrastructure and vaccine implementation Federal funding to support state vaccination infrastructure and vaccine implementation

Assumptions Federal government purchases all doses of 2009-H1N1 influenza vaccine manufactured for distribution in the United States Federal government purchases all doses of 2009-H1N1 influenza vaccine manufactured for distribution in the United States Vaccine is provided at no cost to state public health, which distributes vaccine to the public and private sectors Vaccine is provided at no cost to state public health, which distributes vaccine to the public and private sectors Federal government provides funding to states to help implement the vaccination program, including covering costs of vaccine administration in clinics organized by the public sector Federal government provides funding to states to help implement the vaccination program, including covering costs of vaccine administration in clinics organized by the public sector

Organization of Recommendations 1. First-dollar coverage for administration of 2009 H1N1 influenza vaccine 2. Reimbursement rates for administration of 2009 H1N1 influenza vaccine 3. Community vaccinators and administration of 2009 H1N1 influenza vaccine 4. Funding to states for administration of 2009 H1N1 influenza vaccine

First-Dollar Coverage for H1N1 Vaccine Administration #1. Public and private health insurance plans should voluntarily provide first-dollar coverage for the administration of 2009-H1N1 influenza vaccine administered in any setting. All government sponsored programs providing healthcare for uniquely defined populations should voluntarily provide first-dollar coverage for administration of 2009-H1N1 influenza vaccine to their beneficiaries in venues where those beneficiaries are traditionally served. #1. Public and private health insurance plans should voluntarily provide first-dollar coverage for the administration of 2009-H1N1 influenza vaccine administered in any setting. All government sponsored programs providing healthcare for uniquely defined populations should voluntarily provide first-dollar coverage for administration of 2009-H1N1 influenza vaccine to their beneficiaries in venues where those beneficiaries are traditionally served.

Reimbursement Rates for H1N1 Vaccine Administration #2. Public and private health insurance plans should reimburse providers for administration of 2009-H1N1 influenza vaccine to, at a minimum, the nationally established Medicare payment rate, including geographic adjustment. Reimbursements should factor in all costs associated with administration of H1N1 influenza vaccine. #2. Public and private health insurance plans should reimburse providers for administration of 2009-H1N1 influenza vaccine to, at a minimum, the nationally established Medicare payment rate, including geographic adjustment. Reimbursements should factor in all costs associated with administration of H1N1 influenza vaccine. #3. CMS should establish a national policy where the federal government provides 100% reimbursement, at the nationally established Medicare payment rate, for the administration of 2009-H1N1 influenza vaccine to Medicaid and SCHIP beneficiaries and other non- Medicaid Vaccines for Children program (VFC)-eligible children served by VFC providers. #3. CMS should establish a national policy where the federal government provides 100% reimbursement, at the nationally established Medicare payment rate, for the administration of 2009-H1N1 influenza vaccine to Medicaid and SCHIP beneficiaries and other non- Medicaid Vaccines for Children program (VFC)-eligible children served by VFC providers.

Community Vaccinators and H1N1 Vaccine Administration #4. Community vaccinators and national, regional and local insurance plans should work together to develop formalized relationships allowing community vaccinators to bill insurance plans for administration of 2009-H1N1 influenza vaccine to plan beneficiaries. #4. Community vaccinators and national, regional and local insurance plans should work together to develop formalized relationships allowing community vaccinators to bill insurance plans for administration of 2009-H1N1 influenza vaccine to plan beneficiaries. #5. CMS should establish a national policy whereby community vaccinators are permitted to bill Medicaid, including via roster billing, for administration of H1N1 influenza vaccine to Medicaid beneficiaries outside the provider office, without requiring each state to obtain a Section 1115 Medicaid State Waiver #5. CMS should establish a national policy whereby community vaccinators are permitted to bill Medicaid, including via roster billing, for administration of H1N1 influenza vaccine to Medicaid beneficiaries outside the provider office, without requiring each state to obtain a Section 1115 Medicaid State Waiver

Funding to States for H1N1 Vaccine Administration #6. Funding to support mass immunization campaigns for 2009-H1N1 influenza managed by state and local health departments should be allocated to states from the unobligated contingency funds authorized in the Supplemental Appropriations Act of ($335M in funding for state and local immunization planning was announced on July 17, 2009; assessment of funding needs for states should be ongoing.) #6. Funding to support mass immunization campaigns for 2009-H1N1 influenza managed by state and local health departments should be allocated to states from the unobligated contingency funds authorized in the Supplemental Appropriations Act of ($335M in funding for state and local immunization planning was announced on July 17, 2009; assessment of funding needs for states should be ongoing.)