Public Notice: Reimbursement for Administration of COVID-19 Vaccine

PUBLIC NOTICE

Department of Health Services

Reimbursement for Administration of COVID-19 Vaccine

The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and s. 49.471 of the Wisconsin Statutes. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is in effect.

Reimbursement for Administration of COVID-19 Vaccine

Medicaid is reimbursing for the administration of federally approved COVID-19 vaccines to members. Medicaid coverage of the Pfizer-BioNTech COVID‑19 vaccine began on December 11, 2020 and Medicaid coverage of the ModernaTX COVID‑19 vaccine began on December 18, 2020 when Emergency Use Authorization (EUA) was approved. Medicaid will be reimbursing for administration of COVID-19 vaccines at the following rates:

- single dose vaccine schedule: $28.39; and

- multiple dose vaccine schedule: $16.94 for the initial dose(s) and $28.39 for the final dose.

Vaccines administered by skilled nursing facilities may be separately reimbursed outside of the regular nursing home per diem rate.

The rates will be retroactively effective December 11, 2020, and will apply to claims with dates of service on or after that date. The change to Medicaid, BadgerCare, and BadgerCare Plus is projected to result in increased/reduced annual expenditures of $50.0 million all funds (AF), composed of $29.7 million federal match (FED) and $20.3 million state funds/general purpose revenue (GPR).

Copies of Changes

Copies of the COVID-19 vaccine reimbursement modification may be obtained free of charge by calling or writing:

Mail:

Laura Brauer

Bureau of Benefits Policy

Division of Medicaid Services

P.O. Box 309

Madison, WI 53701-0309

Phone:

[phone]

Fax:

[phone]

Attention: Laura Brauer

E-Mail:

[e-mail]

Copies of the state plan change will be made available for review at the main office of any county department of social services or human services.

Written Comments

Written comments are welcome. Written comments on the proposed changes may be sent by FAX, e-mail, or regular mail to the Division of Medicaid Services as described above. All written comments will be reviewed and considered.

Because the State Office Building at 1 West Wilson Street, Madison, Wisconsin is currently closed to the public, written comments will not be available for in person public review. Requests to review written comments received may be submitted to the Division of Medicaid Services as described above. Revisions may be made in the proposed change based on comments received.