10 Colo. Code Regs. § 2505-10-8.815
Current through Register Vol. 47, No. 19, October 10, 2024
Section 10 CCR 2505-10-8.815 - IMMUNIZATION SERVICES8.815.1Definitions8.815.1.A. Advisory Committee on Immunization Practices (ACIP) means the group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States. ACIP was established under Section 222 of the Public Health Service Act (42 U.S.C. § 2l7a).8.815.1.B. Immunization means the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine.8.815.1.C. School District means any board of cooperative services established pursuant to article 5 of title 22, C.R.S., any state educational institution that serves students in kindergarten through twelfth grade including, but not limited to, the Colorado School for the Deaf and Blind, created in article 80 of title 22, C.R.S., and any public School District organized under the laws of Colorado except a junior college district. 8.815.1.D. Vaccine means a biological preparation that improves immunity to a particular disease.8.815.1.E. Vaccine Administration Services means the provision of an injection, nasal absorption, or oral administration of a vaccine product.8.815.1.F. Vaccines for Children (VFC) means the federally funded program administered through the Centers for Disease Control for the purchase and distribution of pediatric vaccines to program-registered providers for the Immunization of vaccine-eligible children 18 years of age and younger.8.815.2Client Eligibility8.815.2.A. All Colorado Medicaid clients are eligible for Immunization and Vaccine Administration Services. 8.815.3Provider Eligibility8.815.3.A. Rendering Providers 1. Colorado Medicaid enrolled providers are eligible to administer Vaccines and Vaccine Administration Services as follows: a. If it is within the scope of the provider's practice;b. In accordance with the requirements at Section 8.200.2.; andc. If the provider is administering Vaccines and Vaccine Administration Services to a client 18 years of age or younger, the provider is using Vaccines provided free of cost by the federal government, including through the VFC program.8.815.3.B. Prescribing Providers 1. Colorado Medicaid enrolled providers are eligible to prescribe Vaccines and Vaccine Administration Services in accordance with Section 8.815.3.A.1.a.-b. 8.815.4Covered Services8.815.4.A. Vaccines identified in the ACIP Vaccine Recommendations and Guidelines are updated routinely and are covered as follows:1. For clients 18 years of age and younger, Vaccines are either provided through the VFC program or are otherwise provided without cost by the federal government.2. For clients 19 years of age and older, Vaccines are covered by Colorado Medicaid.8.815.4.B. Administration of Vaccines identified in the ACIP Vaccine Recommendations and Guidelines is a covered service for all clients. 8.815.4.C. Immunization and Vaccine Administration Services that are provided by home health agencies, physicians, or other non-physician practitioners to clients at nursing facilities, group homes, or residential treatment centers are covered only as follows: 1. Immunization services for clients who are residents of nursing facilities and clients receiving home health services are covered only if ordered by their physician. The skilled nursing component for Immunization administration provided at a nursing facility is included in the facility's rate or part of a regularly scheduled home health service for clients receiving home health services. a. Administration of the COVID-19 vaccine will be reimbursed as specified at 10 CCR 2505-10, Section 8.443.7.A.5.a. 2. Clients who are residents of an Alternative Care Facility, as defined at Section 8.495.1, may receive Immunization services from their own physician. They may also receive Immunization services as part of a home health service in accordance with Section 8.815.4.C.1.8.815.5Prior Authorization Requirements8.815.5.A. Prior authorization is not required for this benefit.8.815.6Non-covered Services8.815.6.A. The following services are not covered by Colorado Medicaid: 1. For clients 18 years of age and younger, Vaccines that have been obtained from a source other than the federal government;2. Immunization and Vaccine Administration Services provided by a School District provider; and3. Travel-related Immunization and Vaccine Administration Services.46 CR 06, March 25, 2023, effective 2/10/202346 CR 13, July 10, 2023, effective 6/9/2023 (EMRGENCY)46 CR 19, October 10, 2023, effective 9/8/2023, exp. 1/6/2024 (Emergency)47 CR 05, March 10, 2024, effective 2/9/2024, exp. 6/8/2024 (Emergency)