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PA Bulletin, Doc. No. 21-678

NOTICES

DEPARTMENT OF HUMAN SERVICES

Fee Increases for the Administration of SARS-CoV-2 Vaccines

[51 Pa.B. 2450]
[Saturday, May 1, 2021]

 The Department of Human Services (Department) announces that it will increase fees in the Medical Assistance (MA) Program Fee Schedule for the administration of vaccines for the novel coronavirus (SARS-CoV-2) in both the Fee-for-Service (FFS) and managed care delivery systems, effective March 15, 2021.

Discussion

 On March 15, 2021, the Centers for Medicare & Medicaid Services (CMS) announced an increase to the Medicare payment amount for the administration of the SARS-CoV-2 vaccines to $40 for the administration of each dose of a SARS-CoV-2 vaccine. CMS explained that this rate increase reflects updated information about the costs involved in administering the SARS-CoV-2 vaccine and the additional resources necessary to ensure the vaccine is administered safely and appropriately.

 After discussion with medical providers and other stakeholders about the additional costs and resources to administer the SARS-CoV-2 vaccine, the Department made the decision to increase the MA Program fee schedule rate to that of Medicare for the administration of the SARS-CoV-2 vaccines, effective March 15, 2021.

Vaccine Manufacturer Code Code Description Current MA FeeNew MA
Fee
Pfizer, Inc. 0001A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose $16.94 $40
0002A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose $28.39 $40
Moderna, Inc. 0011A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose $16.94 $40
0012A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose $28.39 $40
AstraZeneca 0021A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus diseases (COVID-19)) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×010 viral particles/0.5mL dosage; first dose $16.94 $40
0022A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus diseases (COVID-19)) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×010 viral particles/0.5mL dosage; second dose $28.39 $40
Janssen Biotech, Inc. 0031A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus diseases (COVID-19)) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×010 viral particles/0.5mL dosage; single dose $28.39 $40

 The Department also issued an MA Bulletin to providers enrolled in the MA Program advising of the fee increase for the administration of SARS-CoV-2 vaccines.

Fiscal Impact

 The estimated fiscal impact of increasing the fee for the administration of the SARS-CoV-2 vaccine for FFS for Fiscal Year (FY) 2020-2021 is $3.464 million. There is no impact to Capitation and Community HealthChoices in FY 2020-2021. The estimated fiscal impact for FY 2021-2022 is $100.203 million in Capitation, $2.132 million in Community HealthChoices and $10.495 million in FFS. These costs are 100% Federally funded.

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revision to the MA Program Fee Schedule.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

MEG SNEAD, 
Acting Secretary

 Fiscal Note: 14-NOT-1435. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 21-678. Filed for public inspection April 30, 2021, 9:00 a.m.]


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