913.1 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 administering Medicaid-covered immunizations, vaccines, and emergency anaphylaxis agents.

913.2 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.

913.3 To be eligible for Medicaid reimbursement, pharmacists who provide the services described in § 913.2 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.) 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

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

7. (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;
8. (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;
9. (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;
10. (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
11. (i) Notify the beneficiary's primary care physician of any vaccine administered to a child under nineteen (19).913.4 Medicaid reimbursement shall be available for the administration fee for vaccines and immunizations covered under the VFC program. Medicaid reimbursement shall not be available for the cost of the VFC program vaccines and immunizations.913.5 Pharmacists shall comply with the requirements of § 6512 of Title 17 DCMR, as described in § 913.3, which are under the purview of the Department of Health in accordance with Chapter 19 of Title 22-B DCMR.913.6 DHCF shall reimburse administration services described in § 913.2 to a pharmacy in which the pharmacist, described in § 913.3, administers the services.913.7 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) Administration of injectable coronavirus (COVID-19) vaccines shall be reimbursed at 100% of the Medicare fee schedule;

(c) Administration of monoclonal antibody infusions shall be reimbursed at one hundred percent (100%) of the Medicare fee schedule;

(d) Pharmacies receiving reimbursement for administration of immunizations, vaccines, and emergency anaphylaxis agents shall not receive the professional dispensing fee, described in §§ 2710 – 2711 of Title 29 of the DCMR;

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

(f) 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 Chapter 27 of Title 29 DCMR.

913.8 Medicaid reimbursement shall be available to screened and enrolled DC Medicaid providers for COVID-19 vaccination (once the federal government discontinues purchasing the vaccine), COVID-19 vaccine administration, and administration of monoclonal antibodies at one hundred percent (100%) of the Medicare fee schedule.

913.9 Screened and enrolled providers in the DC Medicaid program that administer COVID-19 vaccines to beneficiaries of intermediate care facilities for individuals with intellectual disabilities (ICFs/IID) and nursing facilities shall be eligible to receive reimbursement, in accordance with § 913.8, which shall be separate and apart from the ICF/IID facility rates and the nursing facility per diem rates, described in Chapters 41 and 65 (respectively) of Title 29 of the DCMR. The administration of COVID-19 vaccines in FQHCs shall not be reimbursed separate and apart from the FQHC rate methodology described in Chapter 45 of Title 29 of the DCMR.

913.10 Medicaid fee-for-service rates shall be posted on DHCF’s website at https://www.dc.medicaid.com/ in accordance with the requirements of § 988 of Title 29 of the DCMR.

913.99 For the purposes of this section, the following terms shall have the meanings ascribed:

Administer - The direct application of a prescription drug to the body of the beneficiary by injection, inhalation, ingestions, or any other means to the body of a patient.

Administration fee - A fee reimbursed to a pharmacy that employs or contracts a pharmacist that directly applies an immunization, vaccine, or emergency anaphylaxis agent by injection or inhalation to the body of a Medicaid beneficiary.

Anaphylaxis - A rapidly progressing, life-threatening allergic reaction.

Immunization - The act of inducing antibody formation, thus leading to immunity.

Vaccination - Administration of any antigen in order to induce immunity; is not synonymous with immunization since vaccination does not imply success.

Written protocol - A specific written plan for a course of medical treatment containing a written set of specific directions created by the physician for one or more patients, consistent with requirements set forth under Chapter 65 of Title 17 DCMR.

SOURCE: Final Rulemaking published at 70 DCR 011626 (September 1, 2023).