Rep. Gomez Leads Letter with Rep. Barragán and California Delegation Urging Swift Reimbursement to Community Clinics for Monkeypox Vaccine Administration
This letter follows a public report that the first death caused by monkeypox in the United States was a resident of Los Angeles, CA.
Los Angeles, September 23, 2022 | Gomez Press Office (202-770-6934)
LOS ANGELES – Today, Congressman Jimmy Gomez (CA-34) led a letter with Congresswoman Nanette Barragán (CA-44) and members of the California Congressional Delegation urging the Center for Medicare and Medicaid Services (CMS) to swiftly approve reimbursement of community clinics in California for administering monkeypox virus (MPV) vaccines.
The letter, signed by 39 Members of Congress including Senators Dianne Feinstein (D-CA) and Alex Padilla (D-CA), expressed concern that federally qualified health centers (FQHCs), Rural Health Centers, and Tribal Health Programs—which have administered tens of thousands of MPV vaccines across California—may be forced to curtail efforts to combat the monkeypox outbreak without additional reimbursement from the federal government.
As the Los Angeles County Public Health Department reported the first death caused by monkeypox in the U.S. earlier this month, it is vital for providers to have the support they need to continue providing critical services to keep our communities healthy.
“Community clinics and other providers work tirelessly to ensure access to timely, affordable care for all individuals, regardless of ability to pay,” wrote the lawmakers. “Providers including community clinics have already distributed tens of thousands of MPV vaccines without reimbursement for vaccine administration. These safety net providers rely on adequate reimbursement to continue providing these critical services vaccinating our communities...Your rapid and urgent attention to these requests will help to ensure that critical providers and community clinics in our districts are able to continue their vital work vaccinating the residents of California and combating the MPV outbreak.”
“California’s community health centers spearheaded the state’s efforts to wage a massive monkeypox vaccination campaign and bring an end to the outbreak as quickly as possible,” said APLA Health CEO Craig E. Thompson. “Clinics like APLA Health did not think twice when asked to take on this work because it is critical to the health and wellbeing of the LGBTQ+ patients we serve. Now, we need the federal government to quickly approve the state's request to reimburse community health centers for the thousands of vaccines administered since the beginning of the outbreak and to continue efforts to vaccinate all communities at risk for MPX, especially Black and Latino gay and bisexual men and transgender individuals who are not currently being reached.”
Earlier this month, Congressman Gomez sent a letter with 10 members of the Los Angeles County Congressional Delegation to U.S. Health and Human Services Secretary Xavier Becerra highlighting the urgent need to increase the supply of the monkeypox virus vaccine.
In July, Congressman Gomez co-sponsored H.Res.1286 - Expressing the sentiment of Congress that the Department of Health and Human Services (HHS) should declare the monkeypox outbreak a public health emergency. Following the introduction of this resolution, HHS Secretary Xavier Becerra declared the ongoing spread of monkeypox virus in the United States a Public Health Emergency on August 4, 2022.
The Honorable Chiquita Brooks-LaSure
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244
Dear Administrator Brooks-LaSure:
As Members of Congress representing California, we write to ask for your assistance in bolstering monkeypox (MPV) vaccination distribution at community clinics in our districts. We request the Centers for Medicare and Medicaid Services (CMS) expeditiously review and approve requests from California to establish a Medicare rate and allow for reimbursement of community clinics for MPV vaccine administration.
As you know, monkeypox has rapidly spread across the country while disproportionately impacting certain areas and communities. In California alone, the state Department of Public Health has reported 4,140 cases as of September 8, 2022—the highest total in the country—and nearly 60% of statewide cases are concentrated in just two jurisdictions: Los Angeles and San Francisco. MPV has disproportionately affected members of the LGBTQ+ community, even though anyone is susceptible to acquiring and transmitting the virus.
Community clinics and other providers work tirelessly to ensure access to timely, affordable care for all individuals, regardless of ability to pay. Many of these clinics have historically provided services to the LGBTQ+ community and are serving on the frontlines of the MPV response in our districts. Community clinics are adjusting clinical operations to meet this growing public health challenge while navigating the toll COVID-19 pandemic has caused in loss of workforce and revenue. While MPV vaccines are currently being distributed by the federal government at no cost, federally qualified health centers (FQHCs) and Tribal Health Programs are not currently receiving reimbursement for vaccine administration when the vaccination is administered outside of a billable encounter. FQHCs and Tribal Health Programs often administer vaccinations utilizing non-billable providers. Clinics are seeing a significant increase in vaccinations above the anticipated rates included in their Prospective Payment System or All-Inclusive encounter rates due to MPV Public Health Emergency. This increase in demand results in additional cost pressures on these critical partners.
The California Department of Health Care Services (DHCS) recently proposed State Plan Amendment 22-0062 to establish Medi-Cal payment rates for MPV vaccine administration and allow for supplemental reimbursement for MPV vaccine only visits for FQHCs/Tribal FQHCs, Rural Health Centers, and Tribal Health Program providers. DHCS previously requested guidance from CMS to establish a Medicare rate for MPV vaccine administration so that a corresponding Medi-Cal rate can be set.
Providers including community clinics have already distributed tens of thousands of MPV vaccines without reimbursement for vaccine administration. These safety net providers rely on adequate reimbursement to continue providing these critical services vaccinating our communities. We appreciate the confidence the Biden Administration has placed in community clinics to deliver the MPV vaccine to the most vulnerable communities. However, it is critical that they have the resources and staff they need to keep our communities healthy. Your rapid and urgent attention to these requests will help to ensure that critical providers and community clinics in our districts are able to continue their vital work vaccinating the residents of California and combating the MPV outbreak.
Thank you for your consideration of our request and continued attention to this pandemic. We look forward to your response and working with you to safeguard our communities and fight the spread of MPV.