Benefit Criteria to Change for Vaccine Services

Date: August 11, 2022Attention: All Providers   Effective date: September 1, 2022Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: The purpose of this communication is to inform providers that the Health and Human Services Commission (HHSC) has completed a comprehensive review of vaccine-related services for Medicaid clients. The following is a summary of changes in scope for this policy review:

• The following policies have been combined into one comprehensive Vaccine Services policy:
• Bacille Calmette-Guérin (BCG) Vaccine
• Hepatitis Prophylaxis (Hepatitis B Immune Globulin and Hepatitis B Vaccine, Dialysis)
• Rabies Postexposure Treatment
• Vaccines and Toxoids
• Vaccine and Toxoid Administration
• Benefit coverage updated to align with Advisory Council on Immunization Practices (ACIP) recommendations
• Policy language updated to clarify which vaccines are usually distributed by Texas Vaccines for Children (TVFC) for clients age 18 and under

How this impacts providers: Effective for dates of service on or after September 1, 2022, vaccine services benefits will change for Texas Medicaid. For more information, please reference the resource titled “Vaccine Services Benefits Changes – Sept. 1”. Next steps for providers: Providers should share this communication with their staff.If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.