ALERT!!
WEEKEND MAINTENANCE: The maintenance outage is scheduled for Friday night, December 2nd until Sunday, December 4th. The TRICARE Manuals web site may be available intermittently during this period but it's usage is not recommended.
We are aware of the issue with the 32 CFR 199 cross-references (Table of Contents links) and are working to resolve the issue. Thank you.
Providers
Chapter 11
Section 9.2
State Vaccine Programs (SVPs)
As TRICARE-Authorized Providers
Issue Date:
Authority:
32 CFR 199.6(d)(5), National
Defense Authorization Act for Fiscal Year 2017 (NDAA FY 2017), Public
Law (PL) 114-328Revision: C-15, November 30, 2017
1.0 ISSUE
Can State Vaccine Programs or State Vaccine
Program entities (SVPs) be certified under TRICARE and reimbursed
for supplied vaccines used to immunize TRICARE beneficiaries?
2.0 Background
2.1 SVPs are
state entities that supply vaccines at no cost to immunization providers
who use these vaccines to immunize children who reside in the state.
SVPs do not administer individual immunizations. Rather, these entities
simply supply the vaccines used in immunizations.
2.2 In order
for an SVP to be reimbursed for supplied vaccines used to immunize
TRICARE beneficiaries the SVP must be certified as a TRICARE-authorized
provider.
32 CFR 199.6(d) lists
those providers considered as “other providers” under the TRICARE
program. Furthermore,
32 CFR 199.6(d)(5) allows TRICARE-authorized
provider status for any firm, supplier, or provider that is an authorized provider
under Medicare or is otherwise designated as authorized by the Director,
Defense Health Agency (DHA).
2.3 On May 20, 2014, a Decision
Paper was signed by the Director,
DHA to
allow an SVP to be certified as a TRICARE-authorized supplier of
vaccines under
32 CFR 199.6(d)(5) when the SVP executes a
TRICARE Participation Agreement and agrees to comply with TRICARE
legal and program requirements.
These are known as
Dosage Based SVPs.
2.4 On December 23, 2016, based on
the authority provided in the NDAA FY 2017, Section 719, a Decision
Paper was signed by the Director, DHA to extend certification as
a TRICARE-authorized supplier of vaccines under 32 CFR 199.6(d)(5) to all other SVPs which
agree to be reimbursed on a per capita assessment without executing
a participation agreement. These are known as Per Capita Based SVPs.
3.0 Policy
3.1 A
Dosage
Based SVP may be certified as a TRICARE-authorized
provider under the “other” category of provider as a supplier of
vaccines when all of the following specific requirements are met:
3.1.1 The Dosage
Based SVP must hold a valid National Provider Identification
(NPI) number.
3.1.3 The SVP
must agree to accept the lesser of the TRICARE allowed amount or
the billed charge in accordance with
32 CFR 199.14 (i.e.,
the SVP-specific amount that is charged to other payers) as payment
in full for the vaccines supplied. The SVP must also agree to not
balance bill the beneficiary.
3.2 A Per Capita
Based SVP may be certified as a TRICARE-authorized provider under
the “other” category of provider as a supplier of vaccines.
3.3 Each contractor is the certifying authority
for SVPs located within their geographical jurisdiction, to include
obtaining the required participation agreement.
3.4 This policy applies to SVPs and SVP entities
located within the continental U.S. to include Alaska and Hawaii,
the Commonwealth of Puerto Rico, and all U.S. territories. Information
regarding Per Capita Based SVPs not apply to the TRICARE Dual Eligible
Fiscal Intermediary Contract (TDEFIC) or TRICARE Overseas Program
(TOP).
4.0 Reimbursement
Of SVP
sSee the TRICARE Reimbursement
Manual (TRM), Chapter 1, Section 38 for reimbursement of Dosage
Based SVPs and Per Capita Based SVPs.
5.0 Effective
Date
sAn SVP
that meets the requirements of this policy for Dosage
Based SVP may be certified as a TRICARE-authorized
supplier of vaccines on or after May 20, 2014. The effective date
for certification of a specific SVP, for the purposes of claims
reimbursement, is the date the required participation agreement
is signed. An SVP that meets the requirements of this
policy for Per Capita Based SVP may be certified on or after December
23, 2016.
- END -