Provider Alert! CHIP Vaccine Updates

Date: August 12, 2022

Attention: All Providers

Effective date: September 1, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that the Health and Human Services Commission (HHSC) has completed a comprehensive review of vaccine-related services. To align with Advisory Committee on Immunization Practices (ACIP) recommendations, HHSC is updating its policy for vaccines and vaccine administration covered by CHIP under Physician/ Physician Extender Professional Services.

How this impacts providers: Effective for dates of service on or after September 1, 2022, vaccine and vaccine administration benefits will change for Texas CHIP.

The following vaccines and administration of these vaccines will become benefits for nephrology providers in the office setting and nephrology providers and renal dialysis facilities in the outpatient hospital setting. However, FQHC providers will no longer be reimbursed for these services rendered in the home setting.

• Hepatitis B immune globulin
• Hepatitis B vaccine for immunocompromised/dialysis patients
• Influenza vaccine
• Pneumococcal vaccine

Updates by vaccine:

Influenza

The following places of service and provider types will no longer be reimbursed for influenza vaccine administration:

Place of Service	Provider Type
Office	Comprehensive Health Center (CHC), Family Planning Clinic
Home	Certified Nurse Midwife, Registered Nurse, Licensed Midwife
Outpatient Hospital	Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Group, Certified Nurse Midwife, Registered Nurse, Licensed Midwife, Birthing Center, CHC
Other Locations	Certified Nurse Midwife, Registered Nurse, Licensed Midwife, CHC, Family Planning Clinic

 

Rabies Post-Exposure Prophylaxis

The following places of services and provider types will no longer be reimbursed for rabies post-exposure prophylaxis and rabies vaccines:

Place of Service	Provider Type
Office	Rural Health Clinic – Freestanding/Independent and Rural Health Clinic – Hospital Based
Home	Rural Health Clinic – Freestanding/Independent
Outpatient Hospital	Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Clinic/Group Practice, Rural Health Clinic – Freestanding/Independent and Rural Health Clinic – Hospital Based
Other Locations	Rural Health Clinic – Freestanding/Independent and Rural Health Clinic – Hospital Based

 

Meningococcal Vaccine

Meningococcal vaccine may now be reimbursed to Comprehensive Care Program (CCP) providers for services rendered in the office, home, and other settings.

Bacille Calmette-Guerin (BCG) Vaccine.

The following places of service and provider types may now be reimbursed for BCG vaccine:

Place of Service	Provider Type
Office	Certified Nurse Midwife, Registered Nurse, Licensed Midwife, Comprehensive Care Program (CCP)
Home	Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Group, CCP
Other Locations	Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Group, CCP

 

Next steps for providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers