Reimbursement Update for RSV Vaccine Administration

2/19/2024: To address provider concerns related to the increased number of RSV cases and maternal RSV vaccination, DCH is allowing reimbursement for the administration of RSV vaccines. The two RSV vaccines, Beyfortus and Abrysvo, are available to Health Check providers via the Vaccines For Children (VFC) program. Reimbursement is also allowed on claims submitted for members 19 through 20 years of age.

Click here to view additional information and coding guidance from Medicaid.

Missed it? Check out recent updates here:

• RSV Toolkit and KHF Addendum
• KHF COVID Reimbursement Grid
• AAP Nirsevimab Updated FAQ
• Data Shows Nirsevimab (Beyfortus) effective against RSV in infants
• Moderna Pediatric COVID Vaccines Purchased on or After January 9, 2024 Now 100% Returnable

Additional Cases of Measles Reported at Florida Elementary School***

In late January of 2024, the CDC issued a health alert as 23 cases of measles were identified across the United States. On February 28th, the state of Florida issued an additional warning as more measles cases were reported at a Florida elementary school in Broward County. Click here to read more.

Georgia Composite Medical Board Decisions Regarding Prescribing Via Telemedicine

The Georgia Composite Medical Board relaxed some teleprescribing rules during the COVID-19 pandemic. In December, 2023, the Board indicated that it would be removing some of those flexibilities as of January 1, 2024.  At its January 4, 2024, meeting, the Board deferred that action to May 1, 2024. In January, the Board posted an additional press release, available at https://medicalboard.georgia.gov/press-releases/2024-01-10/board-extends-tele-prescribing-flexibility-until-may-1.  

Neither this press release nor the prior release clearly resolves all circumstances under which providers may prescribe or not prescribe without seeing the patient in person. In the meantime, media coverage further confused the question. We are hopeful that the Board will address gaps and inconsistencies before May and will provide updates when available.

Check out the February issue for the latest updates!

2024 TCCN Primary Care Quality Program

The 2024 TCCN Primary Care Quality Program has launched this week. Please click here to view practice requirements for 2024.

CME Opportunity for Kids Health First Providers

Click here to learn more and register for a free, online, Pediatric-specific course that satisfies the DEA requirement mandated by the MATE Act. 

Humana Annual Update for 2024

Humana is currently experiencing a delay with their January 1, 2024 fee schedule. The last Humana fee schedule we received was for 2023 service. Each year CMS modifies the Conversion Factor and this can impact the timing of schedules. Additionally, with their planed exit out of the market, Humana has been less responsive than other payers.

We are checking with Humana on a weekly basis. Please stay tuned for updates.

KHF commercial payor fee schedules are found in the KHF intranet under the Financial Menu. 

• The Aetna fee schedule includes the First Health network.
• Humana and Cigna fee schedules experienced delays in 2023 due to missing/incomplete information from the payors. KHF is working diligently to publish these schedules as we receive the necessary data.

Check out the February issue for the latest updates!

*If you did not receive the latest newsletter, please be sure to also check your spam folder.

CDC Health Alert: Stay Alert for Measles Cases

• Recommendations for healthcare providers

Drug Use in Teens: A Guide for Pediatricians

KHF February Practice Administrator Meeting

• Meeting Recording
• Meeting Presentation
• Speaker Slides: Key Performance Indicators & Benchmarking

Update on Mental Health Parity Act

Click here to access the DCH's mental health parity portal for updates and resources

OSHA to publish details of workplace injuries under new reporting rules

Click here for the press release and here for required recordkeeping and recording requirements

ACIP updates Immunizations Schedule for Children and Adolescents Aged 18 Years or Younger

2024 Immunization Schedule Approved by the AAP

DEA Regulation on Pharmacy to Pharmacy Rx Transfer

Click here for the DEA site as well as an article by Holland & Knight on this new rule.

TCCN Webinar: New AAP Clinical Practice Guidelines for Obesity

Click here for the recording

TCCN OSHA Webinar Replay

Click here for the video presentation, slides and bloodborne pathogens test

TCCN Pediatric Coding Seminar Recording

Click for the recording and slides

TCCN Antibiotic Stewardship Webinar Series

Click to view recordings:

• Webinar #1: How to Access and Use the Website
• Webinar #2: Prescribing Guide
• Webinar #3: Antibiotic Dosing: Maximize antibiotic adherence, limit wastage, and promote antibiotic stewardship

Updated Resources on Screen Time and Social Media for Children

The "AAP's Bold Stance on the Value of Pediatrics" 

From Chip Hart: 2023 Telemedicine Requirement Grid

Developed by Jan Blanchard. Click on the link to download the pdf.

Practice Administrator Contact List

Kids Health First Who to Call List

Kids Health First Intranet Page