KEYWORDS:
Medicare reimbursement, influenza vaccine, pneumococcal vaccine

BACKGROUND:
In 2002, the Massachusetts Department of Public Health (MDPH) provided 568,000 doses of flu vaccine and approximately 100,000 doses of pneumococcal polysaccharide vaccine free of charge to public and private providers. Since 1999, the cost of influenza vaccine has increased 150%. At the same time state budgets for vaccine have been adversely affected by the national economic downturn. State, county and local health departments are increasingly looking to new ways to offset the cost of adult vaccines. Medicare reimburses for the cost of influenza and pneumococcal vaccine and for its administration.

OBJECTIVE(S):
Ensure sustainability of the state adult vaccine program by offsetting the costs of the program to the state and local health departments.

METHOD(S):
MDPH has contracted with the University of Massachusetts Medical School Center for Health Care Financing to complete the application process to submit roster bills to Medicare for reimbursement of the cost of state-supplied influenza and pneumococcal vaccine. MDPH is working with MassPRO and its other partners to encourage local health departments to participate in roster billing for Medicare reimbursement for the cost of administration of state-supplied vaccine. MDPH will submit copies of their rosters to Medicare for reimbursement for the cost of the vaccine itself.

RESULT(S):
MDPH could potentially generate > $750,000 through Medicare reimbursement for state-supplied vaccine administered to Medicare beneficiaries, ensuring the sustainability of the adult immunization program.

CONCLUSIONS(S):
Without new ways to generate revenues to support state immunization programs it will be difficult to sustain adult immunization activities. Medicare reimbursement can offset some of the cost of state-supplied vaccine.

LEARNING OBJECTIVES:
The participants will be able to describe the steps necessary to obtain Medicare reimbursement for state-supplied vaccine.