Arizona Immunization Billing Project Patty Gast, MS Program Manager Arizona Immunization Program Office

Background 15 county health departments (CHDs) provide immunization services Santa Cruz CHD provides services through a community health center AZ CHDs immunize all children <= 18 years old free of charge, including state Medicaid insured uninsured underinsured insured Santa Cruz county has subcontracted immunization services to Mariposa Community Health Center since the early 1990s since all primary care services are provided by Mariposa. underinsured/insured paid for with state/317 funds or VFC funds via CHC deputization

Background CHDs use taxpayer dollars, grants & other means to support immunization services 3 CHDs collect fees from parents when possible (do not deny immunization if unable to pay) 6 CHDs have own limited billing system Should note: Most of the CHDS that have their own billing system are located in smaller counties and have only 1-2 state Medicaid contracted health plans doing business in their county – having to bill only 1-2 health plans makes it much less cumbersome

Centralized Billing System Initiated 2008: the Arizona Immunization Congress recommended that TAPI* investigate developing a centralized reimbursement process Recent reductions in public health immunization budgets Growing population and need Increasing numbers of public and private insured children being seen by CHDs Recently: Health Care Reform will change public health’s models *The Arizona Partnership for Immunization (TAPI) is the state’s immunization coalition and is a nonprofit public and private partnership.

American Recovery & Reinvestment Act (ARRA) ARRA Grant awarded in September 2009 ADHS subcontracted with TAPI to provide resources to Cost Recovery Program (CRP) as a pilot project to develop a final statewide implementation plan Infused critical resources into CRP Hire staff to process claims More time/resources for planning, contract negotiation, data collection, etc.

Benefits of a CRP CHDs would avoid expense of setting up & managing their own billing system, including hiring knowledgeable staff complicated, timely contract negotiations with each insurer/health plan Capitalize on existing collaborative environment and relationships Sustainable revenue would allow for greater levels of service and outreach

Initial Questions Would a CRP be cost-effective? Start-up costs – billing system, contract negotiations with health plans, staffing, etc Are CHDs seeing sufficient numbers of insured children to bill insurance and be cost-effective? Would insurance reimbursement be sufficient? AZ CMS cap for administration fee is $15.43 Reimbursement amounts unknown – average amount is $10 but varies by health plan

CRP Pilot TAPI contacted all CHDs to determine interest in participating in a pilot program 3 CHDs expressed interest La Paz – small, rural CHD Graham – small, rural CHD Maricopa – largest CHD, urban

Data Collection Important activity of the CRP to assess cost-effectiveness Concentrated on Maricopa County Department of Public Health immunization clinics County population: 4,023,132 ~126,000 immunization visits annually Enrolled in 1 of 7 state Medicaid health plans: 36% Privately insured children: 8% Patients not covered: 56%

$0 in insurance reimbursement collected in pilot project before the ARRA grant . . .

Contact Information Patty Gast, M.S. Arizona Immunization Program Manager Arizona Department of Health Services (602)364-3639 Patty.Gast@azdhs.gov