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

2. 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

3. 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

4. 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.

5. 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.

6. 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

7. 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

8. 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

9. 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%

11. $0 in insurance reimbursement collected in pilot project before the ARRA grant . . .

12. Contact Information Patty Gast, M.S. Arizona Immunization Program Manager Arizona Department of Health Services (602)