HHSC Does Not Cover Vaccines or Drugs That Do Not Have FDA Approval or Emergency Use Authorization

Date: September 25, 2023

Attention: All Providers

Effective date: August 31, 2023

Call to action: The purpose of this communication is to inform providers that Texas Medicaid and CHIP do not cover vaccines or drugs that are not authorized or approved by the U.S. Food and Drug Administration (FDA).

Health and Human Services Commission (HHSC) will not cover procedure codes related to COVID-19 vaccine or drugs administration as non-risk payments (NRP) if the COVID-19 vaccines or drugs no longer have FDA approval or authorization. As referenced in the notice titled “Update on Reimbursement for Non-Risk Criteria for COVID-19 and CHIP Copay Waiver” published on June 8, 2023, the non-risk payments COVID-19 reimbursement criteria had an end date of service of August 31, 2023.

Resources:

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html#recommendations

https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html

How this impacts providers: Texas Children’s Health Plan will reprocess affected claims and work with individual providers regarding recoupment. If reimbursement occurred for vaccines that do not have FDA approval or emergency use authorization.

Additional resources for providers:

Coronavirus (COVID-19) Update: FDA Authorizes Changes to Simplify Use of Bivalent mRNA COVID-19 Vaccines | FDA

FDA Roundup: June 2, 2023 | FDA

FDA Takes Action on Updated mRNA COVID-19 Vaccines to Better Protect Against Currently Circulating Variants | FDA

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.