H1N1 Benefit Program for the Uninsured

Filed Under

In response to the 2009 H1N1 influenza outbreak this spring, the Wisconsin Department of Health Services recruited a state-wide network of health care providers to participate in a limited benefit program to provide flu-related care to the uninsured. The Department chose not to implement the benefit program in the spring. However, due to the resurgence of H1N1 influenza during the fall, the Department implemented the benefit effective Monday, November 2.

Establishing the Provider Network:
In late April 2009, the Department contacted health care providers across the state to request their participation in the H1N1 benefit program for the uninsured. The Department targeted larger health care systems, FQHCs, and individual providers. Those providers wishing to participate signed a Memorandum of Agreement with the Department and identified clinics at which the uninsured could receive care. As of November, the provider network consists of 75 participating providers who have identified over 450 participating clinics across the state.

Benefit Description:
Through the H1N1 benefit program for the uninsured, uninsured individuals with flu-like symptoms can schedule a free outpatient visit for flu-related care at one of the participating providers' clinics. All flu-related services provided during the visit are provided at no cost to the individual. Any non-flu related services provided during the visit and any follow-up visits are not covered and remain the individual's responsibility.

Participating providers receive a bundled reimbursement rate totaling $48.00 for each outpatient visit. The bundled reimbursement rate was prospectively set to cover all flu-related services potentially provided during the outpatient visit, including, but not limited to, the office visit, lab and radiology services, intravenous hydration, and administration of antiviral medication. Through a separate distribution process, participating providers also received a supply of antiviral medications at no cost for use in the treatment of uninsured individuals.

To maximize vaccine availability, the Department also chose to reimburse participating providers an administration fee totaling $15.00 to administer the H1N1 vaccine to asymptomatic uninsured individuals who did not also receive flu-related care at the same visit.

Billing the Department:
Participating providers use a Roster Billing Form developed by the Department to receive both the $48.00 bundled treatment fee and the $15.00 vaccine administration fee. Providers can submit the Form either electronically as an encrypted email attachment or on paper.

Public Messaging and Communication:
The Department has corresponded regularly with the provider network through email to inform them of updates and important notices. The Department has also provided Local Public Health Agencies and the 2-1-1 information system with a list of all participating providers and clinics.

The Department issued a press release publicly announcing the benefit. Uninsured individuals with flu-like symptoms will be instructed to contact their Local Public Health Agency or the 2-1-1 information system to learn more about the benefit program and to locate a participating clinic in their area. The Department provided Local Public Health Agencies and 2-1-1 with instructions for referring uninsured callers to participating clinics for either treatment or vaccination as appropriate.

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