Provider Notice Issued 08/08/2022

Date:    August 8, 2022          

To:       Enrolled Physicians, Advanced Practice Registered Nurses, Physician Assistants, Local Health Departments, Encounter Rate Clinics, Federally Qualified Health Centers, Rural Health Clinics, and Hospitals        

Re:      COVID-19 Vaccination and Booster Update

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This notice provides updates for coverage of COVID-19 vaccinations and boosters. The Illinois Department of Healthcare and Family Services (HFS) reimburses providers an administration fee for all federally allocated COVID-19 vaccines. These updates apply to claims for customers covered under traditional Medicaid fee-for-service (FFS) and the HealthChoice Illinois (HCI) managed care organization  (MCO) plans.

All COVID-19 vaccines should be given in accordance with Centers for Disease Control (CDC) guidance.

Pediatric Booster Dose for Children Aged 5-11 Years with Pfizer BioNTech Vaccine
Effective with dates of service beginning, May 17, 2022, the Food and Drug Administration (FDA) approved children aged 5-11 years to receive a booster dose at least five months after a child's second vaccine dose.
 
Pediatric Vaccinations for Children Aged 6 Months through 4 Years with Pfizer BioNTech Vaccine
Effective with dates of service beginning June 17, 2022, the FDA lowered the initial age for children eligible to receive COVID-19 vaccination to 6 months.

The Pfizer BioNTech vaccine is available for children aged 6 months through 4 years. It is given in a 3-shot regimen. The initial 2 doses are administered 3 to 8 weeks apart followed by a third dose administered at least 8 weeks after the second dose.

Pediatric Vaccinations for Children Aged 6 Months through 5 Years with Moderna Vaccine
 
Effective with dates of service beginning June 17, 2022, the FDA lowered the initial age for children eligible to receive COVID-19 vaccination to 6 months.

The Moderna vaccine is available for children aged 6 months through 5 years. It is given in a 2-shot regimen, administered 4 to 8 weeks apart. A third primary series dose is authorized for administration at least 1 month following the second dose to children aged 6 months through 5 years with certain kinds of immunocompromise.

New Novavax Vaccination for Adults Aged 18 and Older
The Novavax vaccine is effective with dates of service beginning July 13, 2022. It is given in a 2-shot regimen, 3 to 8 weeks apart. Adults who are moderately or severely immunocompromised should receive 2 doses, given 3 weeks apart.

The HFS COVID-19 Fee Schedule has been updated. Questions regarding vaccine administration may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for the FFS program, or the applicable HCI MCO plan.

 
Kelly Cunningham, Administrator
Division of Medical Programs