2715 PHARMACISTS' ADMINISTRATION SERVICES

2715.1 Medicaid reimbursement for pharmacists' administration services, provided consistent with the requirements set forth in 42 CFR § 440.60(a) and the provisions set forth in this section, shall be limited to:

1. (a) Administering Medicaid-covered immunizations, vaccines, and emergency anaphylaxis agents to adults; or
2. (b) Administering Medicaid-covered immunizations, vaccines and emergency anaphylaxis agents that are not covered under the Vaccines For Children ("VFC") Program.

2715.2 The Department of Health Care Finance ("DHCF") shall reimburse a pharmacy when a pharmacist administers to a Medicaid beneficiary any of the following covered drugs:

1. (a) Immunizations;
2. (b) Vaccines; and
3. (c) Emergency anaphylaxis agents required to treat an emergency anaphylactic reaction that is caused by an immunization or vaccine.

2715.3 In order to be eligible for Medicaid reimbursement, pharmacists who provide the services described in § 2715.2 must meet the following requirements:

1. (a) Be licensed and practicing within the scope of practice authorized under the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq. (2016 Repl. & 2019 Supp.)) and Chapter 65 of Title 17 of the District of Columbia Municipal Regulations ("DCMR") or the applicable professional practices act within the jurisdiction where services are provided;
2. (b) Be certified by the D.C. Board of Pharmacy to administer immunizations and vaccines in accordance with § 6512 of Title 17 DCMR or the applicable professional practices act within the jurisdiction where services are provided;
3. (c) Administer immunizations and vaccines that are covered under the District's Medicaid State Plan for Medical Assistance ("State Plan");
4. (d) Administer emergency anaphylaxis agents that are:
5. (1) Specified in a written protocol, as required under § 6512 of Title

17 DCMR or the applicable professional practices act within the jurisdiction where services are provided, and covered under the State Plan; and

(2) Required to treat an emergency anaphylactic reaction that is caused by an immunization or vaccine;

(e) Administer immunizations and vaccines pursuant to a written protocol, valid prescription, or physician standing order as required under § 6512 of Title 17 DCMR or the applicable professional practices act within the jurisdiction where services are provided;

(f) Administer emergency anaphylactic agents if emergency anaphylactic reaction treatment is deemed appropriate by a delegating physician as set forth in a written protocol, consistent with the requirements set forth under § 6512 of Title 17 DCMR or the applicable professional practices act within the jurisdiction where services are provided;

(g) Ensure all written protocols are current and reviewed annually with the delegating physicians, consistent with the requirements set forth under § 6512 of Title 17 DCMR or the applicable professional practices act within the jurisdiction where services are provided;

(h) Practice at a pharmacy that is an enrolled DC Medicaid provider in compliance with provider screening and enrollment requirements set forth under Chapter 94 of Title 29 DCMR; and

(i) Notify the beneficiary’s primary care physician if a flu vaccine or a vaccine that is not covered under the VFC Program is administered to a child under nineteen (19).

2715.4 Except for flu vaccines, Medicaid reimbursement shall not be available if an immunization or vaccine that is covered under the VFC Program is administered to a child.

2715.5 Pharmacists shall comply with the requirements of § 6512 of Title 17 DCMR, as described in § 2715.3, which are under the purview of the Department of Health in accordance with Chapter 19 of Title 22-B DCMR.

2715.6 DHCF shall reimburse administration services described in § 2715.2 to a pharmacy in which the pharmacist, described in § 2715.3, administers the services.

2715.7 DHCF shall reimburse pharmacist-administered immunizations, vaccines, and

emergency anaphylaxis agents in accordance with this section as follows:

(a) DHCF shall provide separate administration fees for injectable products and for nasal products;

(b) Pharmacies receiving reimbursement for administration of immunizations, vaccines, and emergency anaphylaxis agents shall not receive the professional dispensing fee, described in §§ 2710 – 2711 of this chapter;

(c) The fees may be updated annually, and changes to the fee shall be published on the Medicaid website at www.dc-medicaid.com, subject to the requirements governing the Medicaid Fee Schedule as set forth under § 988 of Title 29 DCMR; and

(d) DHCF shall reimburse the pharmacy separately for the cost of the immunization, vaccine, and/or anaphylaxis agent, in accordance with the requirements set forth under the State Plan, Attachment 4.19-B (“Payment for Services”), Part 1, pages 2 through 3c of the State Plan and the requirements of this chapter.

SOURCE: Final Rulemaking published a 67 DCR 6826 (June 5, 2020).