[Federal Register Volume 60, Number 68 (Monday, April 10, 1995)]
[Notices]
[Pages 18136-18137]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-8646]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[MB-84-N]
RIN 0938-AG77


Medicaid Program; Rescission of the Guidelines for Documenting 
Medicaid Recipient Access to Immunizations Under the Vaccines for 
Children (VFC) Program

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Notice.

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SUMMARY: This notice rescinds the guidelines that we published in the 
Federal Register on October 3, 1994, that required States to document 
equal access to immunizations for Medicaid children if States elected 
to use lower vaccine administration fees than the maximum charges that 
were published and applicable under the Vaccines for Children program. 
These guidelines are rescinded in response to public comments on the 
October 3, 1994 notice. States indicated that there were numerous 
problems regarding the collection of useable data.

FOR FURTHER INFORMATION CONTACT: Marge Sciulli, (410) 966-0691.

SUPPLEMENTARY INFORMATION:

I. Background

    On October 3, 1994, we published in the Federal Register a notice 
with comment period (59 FR 50235) that listed, by State, the interim 
regional maximum charges that providers may impose for the 
administration of pediatric vaccines to Federally vaccine-eligible 
children under the Vaccines for Children (VFC) Program. (The VFC 
Program, which became effective on October 1, 1994, required States to 
provide a program for the purchase and distribution of pediatric 
vaccines to registered providers.) State Medicaid agencies may 
establish lower Medicaid fees than the maximum charges. According to 
the guidelines, States were required to provide assurances of equal 
access to immunizations for Medicaid children to the same extent as for 
the general population, unless their Medicaid payment rates equaled the 
maximum charges.
    The October 3, 1994, notice allowed States the option of using one 
or more of the following guidelines to document equal access to 
immunizations for Medicaid children:
    (1) Comparison of Ratios. In order for a State to have used this 
guideline as an equal access assurance, the ratio of Medicaid children 
immunized to the number of Medicaid children would have to be equal to 
or greater than the ratio of children in the general population 
immunized to the number of children in the general population.
    (2) Comparison to Private Insurance. In order for the State to have 
used this guideline as an equal access assurance, the Medicaid rates 
for the administration of pediatric vaccines would have to be set at a 
rate equal to or greater than the private insurance company's rates up 
to the established State maximum fee.
    (3) Practitioner Participation. Under this guideline, the State 
would have compared the number of Medicaid pediatric practitioners who 
are Medicaid program-registered providers to the total number of 
pediatric practitioners providing immunizations to children. The 
program-registered providers must have at least one Medicaid pediatric 
immunization claim per month or an average of 12 such claims during the 
year. The State would have needed 50 percent participation to show 
equal access through use of this guideline.
    (4) Other. States had the flexibility to devise alternative 
measures of equal access to immunizations. These measures were to have 
been evaluated by HCFA before being found acceptable. [[Page 18137]] 
    The October 1994 notice required State Medicaid agencies to specify 
the reimbursement for the administration of the pediatric vaccines, 
and, if applicable, submit documentation of equal access, due by April 
1 of each year, beginning April 1, 1995 (and which is effective July 1, 
1995), as part of its obstetrical/pediatric payment rate State Medicaid 
plan amendment submittal. The notice also stated that if the State 
Medicaid agency elected to pay the maximum regional amount statewide, 
it need only specify this in its State plan amendment submittal (no 
additional documentation would have been needed). However, if the State 
Medicaid agency elected to vary the vaccine administration fee by 
geographic areas within the State, the State must list the 
administration fee, specify the methodology, and provide data for each 
geographic area where the maximum charges are not applied. 
Additionally, the notice stated that, because of the October 1, 1994 
implementation date, the State plan amendment must have been submitted 
by December 31, 1994, and have been effective October 1, 1994. For the 
interim period of October 1, 1994, through March 31, 1995, the notice 
provided that States may claim Federal matching funds for the costs of 
administration of vaccines to Medicaid-eligible children using the 
maximum charges or lower fees established on the basis of the guidance 
provided in the notice. For this interim State plan amendment, the 
State would have been required to submit the methodology to document 
access to immunizations but would not have been required to supply 
supporting data by which Medicaid beneficiary access to immunizations 
was assured. Beginning April 1, 1995, documentation of equal access to 
immunizations would have been required to be included as part of the 
yearly obstetrical/pediatric State plan amendment submittal in 
accordance with section 1926 of the Social Security Act.

II. Rescission of Access Guidelines

    As a result of our preliminary review of public comments on the 
October 1994 notice regarding the documentation of access requirements, 
we are rescinding the requirement that States use the access guidelines 
to provide assurances of equal access, pending further evaluation.
    Following are some of the problems the commenters identified with 
the access requirements:
    <bullet> Difficulties in obtaining current data on the number of 
children in the general population who have received immunizations, 
despite the fact that States have data on the number of Medicaid 
children who have been immunized.
    <bullet> Difficulties in obtaining private insurance information 
only on administration fee reimbursement. It is unlikely that private 
insurance companies will have a reimbursement rate that only covers the 
provider's costs for administration of the immunization.
    <bullet> Difficulties in obtaining useable data currently. These 
problems stem from the fact that some States have not yet implemented 
the VFC Program for private providers.
    <bullet> Difficulties in obtaining VFC Program reimbursement data. 
Due to the October 1, 1994, implementation date, most of the claims 
data that would be used to document access in April 1995 would reflect 
provider participation based on the current reimbursement system rather 
than reimbursement through the VFC program.
    <bullet> Difficulties in obtaining reliable and meaningful measures 
of access. Commenters urged HCFA to develop meaningful measures of 
access for vaccines and for all other obstetrical and pediatric 
services.
    As a result of the rescission of the access guidelines, States will 
not be required to provide a methodology or data to document that 
payment levels are sufficient to enlist enough providers so that 
immunizations under the State plan are available to Medicaid recipients 
at least to the extent that those services are available to the general 
population.
    HCFA is forming a workgroup that will examine alternative measures 
of access to vaccines. After this examination is completed, we will 
evaluate the various suggestions of the group and formulate specific 
guidelines for States. These guidelines, along with responses to all 
other timely public comments on the October 3, 1994, notice, will be 
published in a final Federal Register document.
    In accordance with the provisions of Executive Order 12866, this 
notice has been reviewed by the Office of Management and Budget.


(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)


    Dated: February 5, 1995.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
    Dated: March 2, 1995.
Donna E. Shalala,
Secretary.
[FR Doc. 95-8646 Filed 4-4-95; 4:13 am]
BILLING CODE 4120-01-P