Insurance companies to get bill for childhood vaccines

By Mary Manning

Friday, Aug. 29, 2008 | 1:13 p.m.

Due to changes in federal funding, the Nevada State Health Division announced today it will begin billing health insurance companies for vaccines given to children covered by health care plans effective Jan. 1.

A federal entitlement program has provided vaccines for all Nevada children younger than 18, but the state said the policy change was necessary because of a dramatic increase in the number of federally recommended vaccinations coupled with no increase in federal funds.

Children who are uninsured, under-insured -- those who have health insurance but the policy doesn't cover vaccines -- those eligible for Medicaid, American Indian or Alaska natives, will continue to receive free vaccines through the state's Vaccines for Children's program, the state said.

"We regret being forced into the position we must take to protect the financial stability of the Vaccines for Children program, especially in light of the fact that vaccinating our children is extremely important," acting state health officer Dr. Mary Guinan said.

However, the strain already is showing at regional health districts, including the Southern Nevada Health District, officials said. Other health departments in the state include the Carson City Health District and the Washoe County Health District.

The increase in required vaccinations continued this year. In May, the Nevada State Board of Health required all seventh-grade students to be vaccinated against whooping cough, effective June 30.

In August alone, the Southern Nevada Health District estimates vaccinations were given to 20,000 children before school opened Monday, director of nursing Bonnie Sorenson said.

"That may be the back-to-school surge," she said. "We may not be feeling the full effects of the increased requirements yet."

The state's medical societies and the Nevada State Medical Association are concerned that pediatricians and clinics will be unable to provide the necessary vaccines.

The state gave "no consultation or time" for physicians or pediatric clinics to make other arrangements to provide children necessary immunizations, wrote NSMA President Richard Seher in a letter sent July 22 to Richard Whitley, the state health division administrator.

"Nevada's status at the bottom of the nation for immunizing pre-school children is embarrassing and dangerous to this state's children," Seher said.

In response, representatives of the state health division began meeting weekly with representatives of physicians and others, said Martha Framsted, spokeswoman for the state health division.

Sorenson said the Southern Nevada Health District is looking at all options for protecting Nevada's children with vaccinations to prevent a disease outbreak in the community. Proposals include providing vaccinations to all children up to 1 or 2 years old, she said.

The Southern Nevada Health District scheduled a meeting for health care providers at 5:30 p.m. Sept. 17 at the District Health Center, 625 Shadow Lane, to discuss ways to cover as many children as possible.

By changing immunization policy, the state may have created major headaches for physicians, clinics and health districts, Sorenson said. Children under state coverage already are in the system, but those covered by private insurance must prove it, and that requires two separate tracking systems, she said.

"In a way, it's cost shifting," Sorenson said.

Pediatric clinics or physicians must become federally qualified to give immunizations, and if they qualify, they pay full price for purchasing vaccines, but may not receive full reimbursement by insurance companies, Sorenson said.

She said with layoffs among hotel and restaurant workers as Southern Nevada's economy continues to sour, children may lose their coverage under a parent or guardian's insurance plan.

A lot of insurance plans don't pay for vaccines or high deductibles fail to cover immunizations, Sorenson said.

"We fear that parents aren't getting the vaccines for their children at all," she said.