Provider Notice issued 09/19/2016

Vaccines For Children (VFC) Program Changes Effective October 1, 2016

​To: ​Physicians, Advanced Practice Nurses, Local Health Departments, School-Based Linked Health Centers, and Local Education Agencies
​Date: ​September 19, 2016
​Re: ​Vaccines For Children (VFC) Program Changes Effective October 1, 2016
 

This notice is to provide information regarding changes to the Vaccines for Children (VFC) program effective with dates of service on or after October 1, 2016. Changes to the program were previously announced via written notification dated August 24, 2016 (pdf) from the Illinois Department of Public Health (DPH) and the Illinois Department of Healthcare and Family Services (HFS).

Previously, All Kids participants ages 0 through 18 eligible under Illinois’ State-funded only program or Title XXI [21] of the Social Security Act, were eligible to receive free VFC vaccines through an Intergovernmental Agreement between HFS and DPH. Effective October 1, 2016, children who have the state’s Title XXI [21] and State-Funded All Kids eligibility are no longer eligible to receive vaccines through the federal VFC program. Participants through age 18 with Title XIX [19] coverage continue to be eligible for vaccination through the VFC program.

To ensure correct reimbursement, providers must verify a child’s eligibility status through use of an eligibility system that will provide the Title XXI [21] and State-Funded information. The HFS MEDI system returns this information with verification of eligibility. The 270/271, Health Care Eligibility Benefit Inquiry and Response, transaction also provides eligibility/Title information in Loop 2110C, MSG01. The Chapter 300, Companion Guide provides HFS specific eligibility information. Providers using an outside billing vendor should contact their vendor in order to determine where and how the Title and State Funded information will be presented.

Providers must privately purchase vaccines for administration to the Title XXI [21] and State-Funded All Kids eligible children and seek reimbursement from HFS or the HFS Managed Care Organization (MCO) reflected in MEDI. HFS will reimburse the cost of the vaccine fee-for-service (FFS). Providers must bill the MCO directly for children enrolled in managed care. The FFS reimbursement rates will be published in the State Max column of the Practitioner Fee Schedule. Providers billing MCOs should reference the individual plan’s policies and procedures. Detailed billing examples can also be found on the HFS website (pdf).

Additional information specific to the VFC program changes are located on the Non-Institutional Providers webpage.

For information about recommended vaccines for children, go to the Centers for Disease Control Website or the Illinois Chapter, American Academy of Pediatrics Website.

Questions regarding this notice should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.

 

Felicia F. Norwood

Director

 
Illinois Bicentennial