9 June 2023
Tēnā koe, Clarification of out-of-hours definition - temporary uplift in immunisation fees between 20 February 2023 and 30 June 2023 – General Practice & Pharmacy
The National Public Health Service has implemented a temporary uplift to the Immunisation Administration Fee in order to support your teams and their continued efforts to improve childhood immunisations, and particularly MMR immunisation rates across the motu. This temporary uplift was outlined in a letter, dated 23 February 2023, to General Practice and Pharmacies that hold a Primary Health Organisation Service Agreement (PHOSA) or Integrated Community Pharmacy Service Agreement (ICPSA). Details in the table below.
Top up Standard hours Out-of-hours
All vaccines on the National Immunisation Schedule including influenza vaccinations administered to all children aged 12 years and under.
MMR vaccine administered to all those eligible for funded MMR
Top Up to Total Payment of $36.05
(ex GST)
Top Up to Total Payment of $36.05 (ex GST)
Top Up to Total Payment of $48.72 (ex GST)
Top Up to Total Payment of $48.72 (ex GST)
The letter did not provide a definition of out-of-hours. This letter is to clarify the definition of out-ofhours as relating to these top-up payments.
• The COVID-19 immunisation contract defines of out-of-hours for general practice as 8pm to 8am Monday to Thursday, 5pm Friday to 8am Monday and public holidays. The ordinary business hours for pharmacy are embedded in the ICPSA, defining out-of-hours for pharmacy as 6pm to 8am Monday to Friday, weekends, and public holidays.
• COVID-19 vaccines administered out-of-hours are the only vaccination event with an administration fee paid at a higher rate. This is possible because all COVID-19 vaccinations are recorded and claimed for in the COVID-19 Immunisation Register (CIR) which has the functionality to timestamp each vaccination. This allows the payment system to distinguish which vaccination events should be paid at the out-of-hours rate.
• Due to technical limitations in the National Immunisation Register (NIR), the top up payment system will only recognise out-of-hours immunisation services as those administered on weekends or national public holidays.
• If a provider administers immunisations out-of-hours on a weekday (as per immunisation contract definitions), the administration fee will be uplifted from $27.84 (ex GST) to $36.05 (ex GST), but not to the out-of-hours rate of $48.72.
For those providers who have delivered or plan to deliver a significant number of childhood (including influenza) and MMR vaccinations out-of-hours during the week, they are welcome to
contact the National Immunisation Programme regarding how these weekday out-of-hours events can be fairly compensated via an invoicing process.
The Programme can be contacted on immunisation@health.govt.nz.
Payment process
• Payment will be managed by Te Whatu Ora and no additional claiming process will be required.
• Te Whatu Ora Districts will continue to pay the base Immunisation Administration Fee via their standard mechanisms.
• Data will be extracted from Proclaim for the period 20 February 2023 to 30 June 2023 to allow top-up payments to be calculated.
• The first of these top-up payments will be made by May 19 (for the period 20 February to 30 April) and then on the 20th of every month as with previous uplifts.
o Te Whatu Ora will make the top-up payments directly to PHOs and payment will be passed on to respective General Practice providers.
o Te Whatu Ora will make the top-up payments directly to community pharmacy.
• Please ensure that vaccination information is entered into your PMS in a timely fashion to ensure that these details reflect through to payment
Ngā mihi, Astrid Koornneef Interim Director, Prevention National Public Health Service