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).
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.