Traditional MedicareAdministrativeMedium impact
Influenza Vaccine
Illinois Medicaid - HFS·IL · Pharmacy, Geriatrics·Provider Notice
Effective date
Sep 27, 2005
We identified it
Jun 21, 2026
Summary
Long-term care facilities must now purchase influenza vaccines directly from pharmacies and bill Medicare Part B themselves for Medicare-eligible residents, while pharmacies can only bill Medicaid for non-Medicare Part B eligible residents. The policy clarifies billing responsibilities when vaccines are not administered on-site by the pharmacy.
Action Required
Immediately: Long-term care facilities must establish direct purchasing agreements with pharmacies for influenza vaccines for Medicare Part B eligible residents. Set up Medicare roster billing enrollment via CMS website. Update billing workflows so LTC facilities bill Medicare Part B directly for vaccines while pharmacies only bill Medicaid for non-Medicare Part B eligible residents.