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Maryland program will lean on hospitals to get COVID vaccines to vulnerable populations

With pockets of people not able or willing to be vaccinated for COVID-19 around the state, Maryland plans to tap hospitals for specific, targeted outreach efforts.

The program, approved by a state panel Wednesday, will allow dozens of hospitals regulated by the state to redirect about $12 million collected from patients’ bills to pay for mobile vans or community clinics and even door knocking.

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“Mass vaccination sites are terrific for most of the population, but some folks in the state aren’t in a position to get access to those sites,” said Tequila Terry, an official at the state agency that regulates hospitals rates and oversees such spending, the Health Services Cost Review Commission.

The program will provide funding to reach people where vaccinations “are lower than the state average and designated as vulnerable.”

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The Hogan administration has come under scrutiny for inequitable levels of vaccination, with more than three times as many white people being vaccinated as Black people, for example. There are also other groups that now qualify for vaccine that have little means of getting themselves to a large clinic, such as the homeless, housebound and developmentally disabled.

Officials at the commission, as well as the state health department and hospitals, saw the state’s unique rate setting system as a means to raise money to reach people who don’t have cars, computers or otherwise the ability to get a vaccine appointment. It also is aimed at people who are hesitant to get the vaccine.

They largely will be identified by ZIP codes designated by a state equity task force.

Such programming through hospitals isn’t new, as the commission has the authority to raise patient rates to pay for extra services deemed worthy in the state. In this case, the funds already were baked into hospital rates charged this fiscal year, ending June 30.

Many hospitals already have been seeking to vaccinate people outside their walls after initially vaccinating their health care workers. They have administered about 700,000 doses so far and continue to get allotments from the state.

The $12 million in funding likely would pay for no more than 150,000 people being vaccinated with two doses each, commission officials said. But they hope it will be a “deep dive” to get the hard-to-reach.

The funds are equal to a reimbursement rate of $40 a shot that Medicare and Medicaid, the health programs for seniors and low-income Americans, now allow hospitals to bill to administer the vaccine. Other insurers followed suit.

Patients are not permitted to be directly charged for vaccine or administration when insurers don’t pay.

And the amount doesn’t cover the costs of administering vaccine because of staffing, information technology and other administrative costs, said Bob Atlas, president and CEO of the Maryland Hospital Association. Costs are even higher for vulnerable or hesitant people.

He said hospitals would welcome extra money given the huge financial hit they endured during the pandemic because elective procedures were curtailed and the facilities had to buy more protective gear and other equipment.

Applications from hospitals to the program could be accepted as soon as Thursday. The hospitals will have to show such things as how many people they would aim to vaccinate and where, and which groups they would work with on their programs, such as faith-based entities and local health departments.

Atlas said if the hospitals can show success in vaccinating people then the commission might allow the hospitals to raise rates to pay for more programming in the next fiscal year.

That can be controversial when so much money is flowing into the state from federal sources to help pay for vaccination programs, and one state commissioner said there should be care taken to ensure programming wasn’t paid for twice.

There has been federal funding allocated to vaccine rollout, including in minority and at-risk populations, but state officials, including acting health secretary Dennis Schrader, embraced the idea of turning to hospitals.

Atlas said there are no specific programs to help offset costs for these kinds of community vaccination programs through hospitals, and some hospitals weren’t always charging insurers the vaccine administration fee.

“We consider this an all-hands-on-deck effort,” Atlas said. “The $12 million is a nice allotment, though it’s a fraction of what we need to reach everyone who needs a vaccination. But it’s work the hospitals are already doing and will continue to do.”

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