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Department announces SL modifier for VFC billing and timelines; several rate-related SPAs remain pending with CMS
Summary
The department said providers will use an SL modifier that pays $0 for Vaccines for Children (VFC) vaccines billed to the state and that several state plan amendments and an inpatient rebasing request are still pending CMS approval.
The department provided several operational and regulatory updates for hospitals, including a billing change affecting vaccines acquired through the federal Vaccines for Children (VFC) program and the status of multiple pending state plan amendments.
Billing update: Sean, the department’s outpatient hospital rates analyst, said providers will bill vaccines acquired through the VFC program using an SL modifier in an upcoming module update. "These will pay $0 for the modifier, and their billed amounts [will] not be considered as part of their bill redistribution logic," Sean said. The department said the SL modifier will apply only to patients age 18 or younger and that the module update is expected before July 2026. Sean also said the vendor grouping module is scheduled for general availability on 06/25/2026 and the state expects interchange to be updated the same week.
Regulatory status: Andrew Abelos said the department has outstanding approvals with the Centers for Medicare & Medicaid Services for several state plan amendments tied to recent rate actions, including a 3 40 b rate reduction effective 07/01/2025 and a 1.6% temporary increase that applied from July 1 to Sept. 30 and was rolled back Oct. 1; the inpatient rebasing request is also pending CMS action. Jessica Short, hospital policy specialist, said the department is reviewing emergency and permanent rules adopted during the public health emergency to ensure temporary emergency rules expire and that permanent rules remain reflected correctly in current regulations and the state plan.
What hospitals were told to do: providers were asked to send any feedback about the VFC billing logic or other operational issues by email; the department will notify stakeholders via the engagement newsletter and Constant Contact when module and table updates are published.
Next steps: the department will publish the timing of the module update and the draft APR-DRG tables, solicit written feedback, and revisit rule changes with the Medical Services Board as needed.
