Mo healthnet managed care policy statements table of contents



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Ancillary Services Meals and lodging are part of the transportation package for members when the member requires a particular medical service which is only available in another city, county, or state and the distance and travel time warrants staying in that place overnight. For children under the age of 21, ancillary services may include an attendant and/or one parent/guardian to accompany the child.
Attendant An individual who goes with a MO HealthNet Managed Care member under the age of 21 to the MO HealthNet covered service to assist the MO HealthNet Managed Care member because they cannot travel alone or a long distance without assistance. An attendant is an employee of, or hired by the MO HealthNet Managed Care health plan or a NEMT provider.
Free Transportation Any appropriate mode of transportation that can be secured by the MO HealthNet Managed Care member without cost or charge, either through volunteers, organizations/associations, relatives, friends, or neighbors.
Most Appropriate The mode of transportation that accommodates the MO HealthNet Managed Care member’s physical, mental, or medical condition.
Public Entity State, county, city, regional, non-profit agencies, and any other entity, who receive state general revenue or other local monies for transportation and enter into an interagency agreement with the MO HealthNet Division to provide transportation to a specific group of eligibles.
Transportation Leg From pick up point to destination.

MISCELLANEOUS


The Ambulance Manual and Section 22 of the manuals can be referenced online at the MO HealthNet Division website www.dss.mo.gov/mhd for additional information. Special bulletins may also be referred online for additional information.
VACCINES FOR CHILDREN
PROGRAM DESCRIPTION
Under the provision of the Omnibus Budget Reconciliation Act (OBRA) of 1993, vaccines are available free to providers who enroll with the Vaccines for Children (VFC) Program for children ages under age 19 who are MO HealthNet enrolled, uninsured, American Indian/Alaskan Native, or underinsured (RHC or FQHC only). MO HealthNet Managed Care health plan providers must enroll in the VFC Program administered by the Missouri Department of Health and Senior Services and must use the free vaccine when administering the vaccine to MO HealthNet Managed Care members under age 19 years of age.
A separate administration fee will not be paid to the MO HealthNet Managed Care health plans as the reimbursement is included in the capitation payment. MO HealthNet Managed Care health plans may have differing payment arrangements with their providers and the VFC administration fee is permissible to be included in the capitation payment from the MO HealthNet Managed Care health plan to the provider. However, the MO HealthNet Managed Care health plan’s reimbursement to local public health agencies is $5.00 per vaccine component.
Vaccines provided through the VFC Program include:
DT

Administration Procedure Code 90702SL



  • Provided for VFC-eligible children younger than 7 years of age, if pertussis vaccine is contraindicated.


DTaP

Administration Procedure Code 90700SL



  • Provided for VFC-eligible children 6 weeks through <7 years of age. The vaccine is approved for all doses of the DTP series.

DTaP/HB/IPV (Pediarix)

Administration Procedure Code 90723SL


  • Provided for VFC-eligible children 6 weeks through <7 years of age. The combined vaccine is approved for the primary series (Doses 1-3) only.


DTaP/Hib/IPV (Pentacel)

Administration Procedure Code 90698SL



  • Provided for VFC-eligible children 6 weeks through <7 years of age. The combined vaccine is approved for the primary series.


DTaP/IPV (Kinrix)

Administration Procedure Code 90696SL



  • Provided for VFC-eligible children ages 4 to 6 years of age as the booster dose only.


EIPV

Administration Procedure Code 90713SL



  • Provided for VFC-eligible children 6 weeks through 18 years of age.

Hep A


Administration Procedure Code 90633SL

  • Provided for VFC-eligible children who are 1 year through 18 years of age.

Hep B


Administration Procedure Code 90744SL

  • Provided for VFC-eligible children 0 through 18 years of age.

Hep B/Hib (Comvax)

Administration Procedure Code 90748SL


  • Provided for VFC-eligible children 6 weeks through 59 months of age. The vaccine is licensed for use at 2, 4 months, and 12-15 months of age.

Hib (ActHIB and Hiberix)

Administration Procedure Codes 90648SL


  • Provided for VFC-eligible children 6 weeks of age to 59 months of age. Hiberix is approved for booster dose only.


Hib (PedvaxHIB)

Administration Procedure Codes 90647SL



  • Provided for VFC-eligible children 6 weeks of age to 59 months of age.

HPV (Cervarix)

Administration Procedure Codes 90650SL


  • Provided for VFC-eligible females 9 through 18 years of age only.

HPV (Gardasil)

Administration Procedure Codes 90649SL


  • Provided for VFC-eligible males and females 9 through 18 years of age.

Influenza

Administration Procedure Codes (0.25mL preservative-free) 90688SL, (0.5mL preservative –free) 90656SL, (5mL multi-dose preservative-containing) 90658SL


  • Provided for all healthy VFC-eligible children 6 months through 18 years.

Influenza Live Attenuated (FluMist)

Administration Procedure Code 90660SL


  • Provided for all VFC-eligible children (those who do not have an underlying medical condition that predispose them to influenza complications) age 2 through 18 years.


Influenza Virus, Quadrivalent, Live

Administration Procedure Code 90672SL



  • Intranasal use, provided for VFC-eligible children aged 0-18 years of age.


Influena Virus, Quadrivalent, Split Virus

Administrative Procedure Code 90685SL




Influenza Virus, Quadrivalent, Split Virus

Administrative Procedure Code 90686SL



  • Preservative free for intramuscular use, provided for VFC-eligible children ages 3-18 years of age.


Meningococcal (MCV4)

Administration Procedure Code 90734SL



  • Provided for VFC-eligible children 11 through 18 years of age.


Meningococcal Conjugate, Serogroups C & Y and Hemophilis Influenza B

Administration Procedure Code 90644SL



  • Four (4) dose schedule, provided for VFC – eligible children 2 – 15 months;

Intramuscular use with complement component deficiency, functional or anatomic asplenia, or part of a community or organizational outbreak.

  • The MO HealthNet Reimbursement for the administration of this vaccine is $10.00.

MMR


Administration Procedure Code 90707SL

  • Provided for VFC-eligible children 12 through 18 years of age.


MMRV

Administration Procedure Code 90710SL



  • Provided for VFC-eligible children 1 through 12 years of age.



Pneumococcal 13-valent Conjugate (Prevnar 13)

Administration Procedure Code 90670SL



  • Provided for VFC-eligible children 6 weeks through 59 months of age. A single supplemental dose of PCV13 is recommended for all children ages 14 through 59 months who have completed the 4-dose series of PCV7. Additionally, a single additional dose is recommended for high risk children 5 years to 71 months of age who have completed the PCV7 series.


Pneumococcal 23-valent (Polysaccharide)

Administration Procedure Code 90732SL



  • Provided only to VFC-eligible children 2 years through 18 years of age who have functional or anatomical asplenia, immunocompromising illness or medications, chronic illness (as specified above), who are Alaskan Native or American Indian, or who have received a bone marrow transplant.


Rotavirus (Rotateq)

Administration Procedure Code 90680SL



  • Provided only for VFC-eligible infants 6 weeks through 32 weeks of age.


Rotavirus (Rotarix)

Administration Procedure Code 90681SL



  • Provided only for VFC-eligible infants 6 weeks through 32 weeks of age.

Td

Administration Procedure Code 90714SL



  • Provided for VFC-eligible children 7 years of age or older. Td may be used to complete the primary DTaP/DT/Td series for persons 7 years of age or older or for catch-up schedule. Td used for routine 10 year booster dose or wound management following administration of a single dose of Tdap that is recommended beginning at age 11 years or older.

Tdap


  • Administration Procedure Code 90715SLProvided for VFC-eligible adolescents 11 through 18 years of age as the recommended one-time booster dose rather than Td.

Varicella

Administration Procedure Code 90716SL


  • Provided for VFC-eligible children who are at least 12 months of age through 18 years.

MISCELLANEOUS


To enroll in the Vaccines for Children (VFC) Program contact:
Missouri Department of Health and Senior Services

Bureau of Immunization Assessment and Assurance

P.O. Box 570

920 Wildwood

Jefferson City, MO 65102-0570

1-800-219-3224 or 573-751-6124


Refer to the Physician’s Manual available online at the MO HealthNet Division Web site dss.mo.gov/mhd and the MO HealthNet Managed Care Physician/Advanced Practice Nurse Services Policy Statement for additional information. Special bulletins may also be referred online for additional information.




MO HealthNet Managed Care Policy Statements

Revised 03/2016

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