According to a recent survey by the Connecticut Association of Directors of Health (CADH), over 79% of health departments and districts with a full-time health director provide vaccine services. Yet of all U.S. health department clinics, 70% do not bill private health insurance plans for the immunization services they provide. Barriers include the inability to be recognized as providers by public and private insurance providers and the daunting nature of the reimbursement process. Accordingly, local health departments are missing a significant opportunity to generate revenue in a time of shrinking resources.
The National Vaccine Advisory Committee (NVAC), a group which studied the financing of child and adolescent vaccinations in the U.S., recommended that procedures be developed to bill public entities for vaccinations. NVAC further recommended that the Centers for Disease Control and Prevention (CDC) fund these efforts and provide support to states and localities by disseminating best practices and providing technical assistance to develop billing mechanisms.
CDC has indeed funded 14 program grantees to develop plans that will enable them to begin billing for vaccine services. The Connecticut Department of Public Heath in collaboration with CADH and the Connecticut Influenza and Pneumococcal Coalition has been awarded a portion of this funding to develop a plan for a statewide comprehensive billing system to capture reimbursement from public (Medicaid and Medicare) and private insurers.
CADH will work with one local health department--the Pomperaug District Department of Health--to develop consistent, comprehensive billing processes with public (Medicare and Medicaid) and private payees. CADH will work with five additional health departments--Hartord Department of Health and Human Services, New Britain Health Department, Waterbury Department of Public Health, West Hartford-Bloomfield Health District, and Westport-Weston Health District--that will (1) provide data on current vaccination and billing practices and (2) pilot the model comprehensive billing systems developed over the course of the project. The ultimate goal of this project is to develop a system by which local health departments can capture revenues for services provided to their residents.