Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.21-012 - COVID-19 Vaccinations for Home-Bound Medicaid Clients

Current through Register Vol. 49, No. 6, June, 2024
DMS COVID-19 RESPONSE MANUAL
270.000
COVID-19 Vaccination
			 Administration for Home-Bound Medicaid Clients
Division of Medical Services (DMS) is covering
				administration of COVID-19 vaccination shots for home-bound Medicaid clients
				through the end of the Federal Public Health Emergency. This section will
				affect Home Health and Pharmacy provider types, and the policies herein are in
				addition to current policies.
Authorized
				Providers
The following Arkansas Medicaid providers will be authorized to
				administer COVID-19 vaccinations in a Medicaid client's home or similar
				location:
* Home Health Providers (Provider Type 14); and
* Pharmacy Providers (Provider Type 07/PV)
Eligibility and Place of
				Service
The following eligibility and place of service requirements
				apply to this service for Home Health providers:
* For Medicaid clients who currently receive Home Health
				services:
* If the Medicaid client is currently receiving Home Health
				services for prior medical services, the Home Health provider may bill the
				vaccination administration in addition to the Home Health visit.
* A Home Health provider may not charge for a Home Health visit
				if the vaccine administration is the sole medical service provided.
* Visits for Covid Vaccine administration will not count
				against the fifty-visit Home Health visit limit.
* For Medicaid clients who do not currently receive Home Health
				services:
* Admission to the Home Health Services program is not required
				for visits that are solely to administer the COVID-19 vaccination.
* Examples of Medicaid clients eligible for this service can
				include those who face barriers or challenges to obtaining a COVID-19
				vaccination and who might not get vaccinated without this service being
				provided in their home by Medicaid Home Health providers. The Centers for
				Medicare & Medicaid Services (CMS) created an infographicto help Medicare
				providers understand the scope of this service, which Medicaid providers may
				find helpful.
* The basis for eligibility must be documented by the Home
				Health provider.
Required
				Recordkeeping
All providers should maintain accurate records for auditing
				purposes.
For this program, Home Health or Pharmacy Providers are
				required to maintain at least the following documentation in their
				records.
* Eligibility: Home Health or Pharmacy providers must document
				the Medicaid client's eligibility for the Home Health service, including
				without limitation:
* The client's clinical status; and
* The barriers faced by the client to get the vaccine outside
				the home.
* Clinical Information: Home Health or Pharmacy providers
				must:
* Have and maintain a record of the physician order, vaccine
				administration, and how the vaccine was tolerated; and
* Communicate vaccinations to the appropriate entity that will
				record vaccinations in the vaccine registry.
Billing Guidelines and Payment of
				Claims
* Single Medicaid Client: The claim for a single Medicaid
				client's home (or similar location) vaccine administration is limited to one
				(1) time per home or location per date of service (DOS). The timeframes between
				vaccination shots must be adhered to.
* Multiple Medicaid Clients: If the vaccination is being
				administered in a group-living location where fewer than ten (10) Medicaid
				clients reside, up to five (5) vaccine administration claims are allowed in
				that home or communal space location per DOS.
* Home Health and Pharmacy providers may file eligible claims
				for the vaccination doses included in this Official Notice for three-hundred
				and sixty-five (365) days from the DOS.
Covered Vaccinations, Procedure Codes, and
				Rates
The section applies to the first, second, and third doses of
				the Pfizer and Moderna vaccines and the single-shot Johnson & Johnson
				vaccine and booster(s).
The reimbursement rate for vaccine administration fee is based
				on the DOS that the COVID-19 vaccine medicine is provided.
The effective date for
home administration
of
				COVID-19 vaccinations (all shots) and the procedure code that must be used
				is:
Procedure
						  Code
Description
Effective
						  Date
Rate
M0201
Covid-19 vaccine administration inside a patient's
						  home
November 11, 2021
$35.50
This procedure code must be reported
in addition
				to
the correct procedure code for the product and dose-specific Covid
				Vaccine medication administration procedure code.
Guidance for Home Health Vaccine
				Administration
The Centers for Disease Control and Prevention (CDC)and CMS
				issued guidelines to assist Home Health providers in administering in-home
				COVID-19 vaccinations:
* Vaccinating Homebound Persons with COVID-19 Vaccine |
				CDC
* COVID-19 Vaccine FAQs for Healthcare Professionals |
				CDC
* Medicare COVID-19 Vaccine Shot Payment | CMS
Official Notice for this allowed
				Service
Providers should see Official Notice ON-014-21 for
				information.