The California Department of Health Care Services (DHCS) recently announced it would no longer be reimbursing COVID-19 vaccine-only encounters provided by Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC) and Tribal RHCs.  

This payment policy will be effective retroactively to October 1, 2024, once the State Plan Amendment is approved by the Centers for Medicare & Medicaid Services (CMS).  

Claims already paid for vaccine-only encounters with dates of service on or after October 1 will be subject to recoupment.  

For COVID-19 vaccines administered during a qualifying office visit, FQHC, RHC, and Tribal FQHC providers are entitled to reimbursement at their individual PPS/APM rates.  

For more details, see the DHCS notice.