Department of Managed Healthcare Issues an All Plan Letter Reminding Health Plans of Their Obligation to Cover Influenza Vaccines and Prepare to Provide COVID Vaccines for Children Aged 5–11

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By Yusra Serhan

On November 1, 2021, the Department of Managed Health Care (DMHC) issued an All Plan Letter to all full-service health care service plans regarding health care coverage of the influenza vaccines and COVID-19 vaccines for children aged 5–11. In the letter, DMHC reminds health plans of their obligation to cover influenza vaccines with no cost-sharing to enrollees, and also encourages health plans to proactively prepare for the administration of COVID-19 vaccines to children upon recommendation by the Centers for Disease Control and Prevention (CDC).

The first section of the letter directs health plans to take steps to provide easy access to the influenza vaccine by enrollees. It specifies that health plans should take steps to relax the use management requirements and similar policies to lessen barriers to receiving the vaccine. The letter also encourages health plans to conduct outreach activities that encourage enrollee vaccination.

The second section of the letter expresses DMHC’s belief that the CDC will likely issue an Emergency Use Authorization for the COVID-19 vaccine for those aged 5–11 within the next few days. In fact, on November 2, 2021, the day after DMHC issued this All Plan Letter, the CDC Advisory Committee on Immunization Practices met and recommended, by unanimous vote, the use of the Pfizer-BioNTech vaccine for children 5–11 years of age. In the recommendation, the FDA requires that vaccination providers “report vaccination administration errors, serious adverse events, cases of multisystem inflammatory syndrome, and cases of COVID-19 that result in hospitalization or death after administration of COVID-19 vaccine.” The CDC also reports that it has developed a smartphone-based tool where parents or guardians can register their children and communicate by text and online surveys to provide health check-ins after receipt of the COVID-19 vaccine.

DMHC’s All Plan Letter further explains that health plans should take immediate steps to prepare to provide access to the COVID-19 vaccine for pediatric plan enrollees as soon as the CDC authorizes its use. DMHC recommends that this be done by preparing the claims processing systems to avoid delays in reimbursement to providers and informing enrollees of the availability of the vaccine to pediatric enrollees.

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