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MI Adult Vaccine Program MIAVP
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Billing
A provider cannot charge for the vaccine itself. However, MI-AVP providers may charge an uninsured/underinsured patient for an administration fee if they wish, which cannot exceed $23.03 per vaccine (not per antigen in combination vaccines).
Providers who choose to bill for the vaccine administration fee of an uninsured/underinsured AVP-eligible adult after the date of service may issue only ONE bill to the patient, and this one bill must be issued within 90 days of vaccine administration. Unpaid administration fees may not be sent to collections, and the provider may not refuse to vaccinate an eligible patient who has unpaid administration fees. The provider must establish a process to waive the fee if the patient remains unable to pay the vaccine administration fee. This does NOT apply to vaccine administration fees billed to Medicaid. This is effective as of January 1, 2020.
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Costs associated with MI-AVP program vaccinations
Only the vaccines and indications listed below may be provided to uninsured and underinsured adults 19 years of age or older, who meet certain risk factors listed below.
Adults with vaccine insurance coverage or Medicaid do not qualify. For these patients, providers must use privately purchased vaccine. However, adults with Medicaid spend down are considered uninsured and eligible until the spend-down is met.
Adults with a complete documented vaccine series are considered up to date for that vaccine and not eligible for MI-AVP vaccine. Special considerations may be indicated such as when serologic testing is indicated and shows a patient needs additional doses of vaccine (e.g., PrEP serology testing for hepatitis B indicating additional doses of vaccine needed, despite having completed a 3-dose hepatitis B vaccine series previously). If the patient is AVP-eligible, MI-AVP vaccine can be used in such an instance.
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Screen and Document
Screening for eligibility must occur at each vaccination visit. See criteria listed below within “Vaccines Available & Criteria for Eligibility”.
Document AVP vaccination appropriately in MCIR as “MI-AVP” within the eligibility drop-down field for vaccine administration.
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Vaccines Available and Criteria Eligibility
The vaccines listed below are provided for uninsured and underinsured adults 19 years or older, who have risk factors listed below and are seen at LHDs, FQHCs, MHCs and THCs. For additional resources, see “Helping Your Adult Client Pay for Vaccines.”
MI-AVP Vaccines Available
The following MI-AVP vaccines are available with vaccine-specific detailed indications below:
Hepatitis A
MMR
PPSV23
Zoster
Hepatitis B
PCV15
Td
9vHPV
PCV20
Tdap
For access to the CDC Adult Vaccine Schedule, visit this website. For MDHHS Vaccine Quick Looks and other vaccine education resources, visit www.michigan.gov/vaccinequicklooks.