This notice is to clarify coverage of the human papillomavirus (HPV) vaccine, also referred to as Gardasil, and how reimbursement for the vaccine may be impacted by changes to the vaccines covered by the Adult Safety Net (ASN) Program. The ASN program is administered by the Department of State Health Services to assist adults without health insurance in getting vaccinated. As of August 1, 2023, the ASN program no longer covers the HPV vaccine. However, as a reminder, individuals are not eligible to receive ASN vaccines if they are enrolled in Medicaid.
The HPV vaccine is a covered benefit under Texas Medicaid, as specified in Section 9.2.36.2 of the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook in the Texas Medicaid Provider and Procedure Manual. Community First is responsible for reimbursing all vaccinations covered by Texas Medicaid, including the HPV vaccine.
Resources:
- TMPPM: https://www.tmhp.com/resources/provider-manuals/tmppm
- DSHS Immunization News Webpage: https://www.dshs.texas.gov/immunizations/media/news
- DSHS ASN Program General Information: https://www.dshs.texas.gov/immunizations/what-we-do/programs/asn
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6294. You can also contact your Provider Relations Representative directly.
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter