Effective October 1, 2009, pharmacies and pharmacists can begin enrolling in Texas Medicaid to administer immunizations to Texas Medicaid clients.

To enroll in Texas Medicaid, a pharmacist must obtain and provide proof of Texas Board of Pharmacy licensure and certification to administer vaccinations. A criminal background check will be performed on all pharmacists who enroll as individuals or as performing providers under a group. All providers who enroll in Texas Medicaid must first be enrolled in Medicare.

Pharmacists participating in Medicaid must adhere to all state and federal regulations, including the Texas Occupations Code, Section 554.052, “Immunization and Vaccinations; Physician Supervision.”

A pharmacy with at least one performing provider (pharmacist) who is certified to administer immunizations can enroll in Texas Medicaid as a group provider. Pharmacies that are currently enrolled as durable medical equipment (DME) providers can use a shortened enrollment application called the Texas State Health-Care Pharmacy Deeming Form to enroll as a pharmacy that administers vaccines.

A pharmacist who is directly employed by a pharmacy that is enrolled as a DME provider with Texas Medicaid can also enroll as a performing provider using the Texas State Health-Care Pharmacy Deeming Form.

Certified individual pharmacists and pharmacies with participating certified pharmacists using the deeming process will need to submit a full application within 6 months of the deeming date. The deeming process will be available through January 31, 2010. In order for a deemed provider to continue to be reimbursed by Texas Medicaid, a fully completed application must be submitted to TMHP before the end of the 6-month deeming period.

The Medicaid enrollment application  and Texas State Health-Care Pharmacy Deeming Form are available on this website.

Enrolled pharmacies and pharmacists can submit claims with dates of service on or after October 1, 2009. These claims may initially be processed as “Informational Only” or be denied as “procedure not covered for this provider type.” The claims will be reprocessed at a later date, and no action on the part of the provider is required. Providers must submit claims within the 95-day filing deadline.

Additional information about provider enrollment is available on this website and will be published in the January/February 2010 Texas Medicaid Bulletin, No. 227. Providers can also refer to the 2009 Texas Medicaid Provider Procedures Manual, Appendix H, “Immunizations,” on page H-1 for additional information.