DHCS Guidance – COVID-19 Vaccines & Vaccination Administration

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Date: January 7, 2021
To: Health Plan of San Joaquin (HPSJ) Providers and Pharmacists
From: Health Plan of San Joaquin
Subject: DHCS Guidance – COVID-19 Vaccines & Vaccination Administration
Business: Medi-Cal

The California Department of Health Care Services (DHCS) has now issued guidance for all Medi-Cal managed care health care plans regarding both COVID-19 vaccine coverage and vaccination administration. As a valued member of the Health Plan of San Joaquin (HPSJ) Provider Network, we want you to be aware of this important information. Essentials to know from the attached All Plan Letter (APL 20-022) include the following –

  • Medi-Cal members will incur no costs for COVID-19 vaccines or the administration of these vaccines.
  • This is a carve-out Medi-Cal benefit – DHCS will carve out the COVID-19 vaccines and associated administrative fees from the Medi-Cal managed care delivery system; DHCS will reimburse providers under Medi-Cal fee-for-service (FFS) for medical, pharmacy and outpatient claims. Claims will NOT come through HPSJ.
  • For the initial phases of vaccination distribution, the federal government is paying for the vaccines and there will be no provider reimbursement – however, providers will be able to bill Medi-Cal FFS for COVID-19 vaccine administration fees.
  • As supplies of vaccines become increasingly available in California:
  • DHCS currently is seeking federal approval for reimbursement rates, as
    described in the attached (APL 20-022), including for Federally Qualified Health
    Centers, Rural Health Centers and Tribal 638 clinics.
  • Pharmacies, retail clinics, providers and any other sites of care must sign an agreement with the U.S. government to receive free supplies of the COVID-19 vaccines. Details for how to enroll in the CALIFORNIA COVID-19 VACCINATION PROGRAM are included in the attached APL 20-022.

Medi-Cal Rx: Transition Postponed

The April 1, 2021 transition to Medi-Cal Rx has been delayed by the California Department of Health Care Services (DHCS). Additional information will come from DHCS. Until further notice, HPSJ will continue to offer the pharmacy benefit.

ATTACHED: All Plan Letter (APL 20-022) – 5 pages

Posted on January 7th, 2021 and last modified on March 12th, 2021.