N.J. Admin. Code § 10:54-8.5
Current through Register Vol. 56, No. 24, December 18, 2024
Section 10:54-8.5 - New Jersey Vaccines for Children program(a) The New Jersey Vaccines for Children (VFC) program provides free vaccines for administration to beneficiaries under 19 years of age who are eligible for New Jersey Medicaid and NJ FamilyCare-Children's Program services. Medicaid and NJ FamilyCare-Children's Program will not provide reimbursement to providers for administering these vaccines exclusive of the VFC program. 1. The Center for Disease Control (CDC) is expected to periodically add vaccines to the approved list for the VFC program. This list, "VFC Resolutions," effective March 9, 2009, is hereby incorporated by reference, as amended and supplemented. The VFC Resolutions lists the vaccines provided by the VFC Program for individuals under age 19. The Medicaid/NJ FamilyCare-Children's Program shall not reimburse for any vaccine so added to the VFC Resolutions that are not obtained from the VFC Program. Providers can access the VFC Resolutions on the CDC website at http://www.cdc.gov/vaccines/. i. Any change to the reimbursement amount for the administration of vaccines administered under the VFC Program and/or the reimbursement amounts for such vaccines that are also appropriate for and administered to individuals who are not under age 19 and are, therefore, ineligible to receive them under the VFC Program, will be made by rulemaking in accordance with the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq.2. Providers shall receive an administration fee for the administration of vaccines ordered directly from the VFC Program. The Medicaid/NJ FamilyCare program shall not provide reimbursement to providers for administering vaccines that are not obtained from the VFC Program.(b) The vaccines described in (a)1 above may be provided to any child without health insurance and those children who are American Indian or an Alaskan Native.(c) Providers shall bill the HCPCs procedure code 90471, 90472, 90473 or 90474 to receive reimbursement for administering vaccines under this program, as appropriate. See N.J.A.C. 10:58A-4.5(c).(d) Vaccines administered to beneficiaries 19 years of age and older shall be billed with the appropriate procedure code. See N.J.A.C. 10:54-9.4.N.J. Admin. Code § 10:54-8.5
New Rule, R.2001 d.51, effective 2/5/2001.
See: 32 N.J.R. 3929(a), 33 N.J.R. 555(a).
Amended by R.2004 d.334, effective 9/7/2004.
See: 36 N.J.R. 312(a), 36 N.J.R. 4136(a).
Amended by R.2006 d.237, effective 7/3/2006.
See: 38 N.J.R. 907(a), 38 N.J.R. 2803(a).
In introductory paragraph of (a), substituted "FamilyCare-Children's Program" for "KidCare"; and substituted "FamilyCare-Children's Program will" for "KidCare programs shall" throughout.
Amended by R.2012 d.124, effective 7/2/2012.
See: 43 N.J.R. 1477(a), 44 N.J.R. 1884(a).
Rewrote (a) and (c); and in (b), substituted "described" for "listed".