HHSC Does Not Cover Vaccines or Drugs That Do Not Have FDA Approval or Emergency Use Authorization

Key Details:

Texas Medicaid and CHIP do not cover vaccines or drugs that are not authorized or approved by the U.S. Food and Drug Administration (FDA).

HHSC will not cover procedure codes related to the COVID-19 vaccine or drugs administration as non-risk payments (NRP) if the COVID-19 vaccines or drugs no longer have FDA approval or authorization. As referenced in the notice titled “Update on Reimbursement for Non-Risk Criteria for COVID-19 and CHIP Copay Waiver” published on June 8, 2023, the NRP COVID-19 reimbursement criteria had an end date of service of August 31, 2023.

For information on COVID-19 vaccines and treatments currently authorized by the FDA, providers can visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html#recommendations and https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html.

Resources:

Coronavirus (COVID-19) Update: FDA Authorizes Changes to Simplify Use of Bivalent mRNA COVID-19 Vaccines | FDA

FDA Roundup: June 2, 2023 | FDA

FDA Takes Action on Updated mRNA COVID-19 Vaccines to Better Protect Against Currently Circulating Variants | FDA

Next steps for Providers:

Providers should share this communication with their staff.

Community First Resources: