The D.C. Minor Consent for Vaccinations Amendment Act

Posted on 2021-09-09
Updated on 2021-09-09 15:55:49

CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst) have implemented the D.C. Minor Consent for Vaccinations Amendment Act of 2020 (the Act). This legislation allows minors, 11 years of age or older, to receive a vaccine, if the minor is capable of meeting the informed consent standard and the vaccination is recommended by the United States Advisory Committee on Immunization Practices (ACIP) and provided in accordance with the United States Advisory Committee on Immunization Practices’ recommended vaccinations schedule.

The Act applies to all age-appropriate vaccines including COVID-19. Vaccine(s) given under the Act must be administered in Washington, D.C.

Providers are not required to administer vaccines to minors without parental consent. However, should they elect to do so, the Act requires that providers notify CareFirst as well as seek reimbursement directly from the insurer for vaccinations given without parental consent, pursuant to the Act.

To support the Act, CareFirst developed the following process so we can suppress the Explanation of Benefit (EOB) statement normally sent to the parent/guardian.

To ensure proper reimbursement and suppression of the corresponding EOB for vaccines administered under this Act, providers must complete both the D.C. Minor Consent Notification Form and the appropriate paper claim form. Note: Claims for vaccines administered under this Act should not be sent electronically and must be sent on one of the paper forms below:

  • Professional claims – please use the current version of the CMS-1500 form (version 02/12) on original-red-ink-on-white-paper.
  • Institutional claims – please use the current version of the UB-04 form on original-red-in-on-white-paper.

Providers must submit both the completed notification form and correct paper claim form by mail to the following address:

CareFirst BlueCross BlueShield Privacy Office
P.O. Box 14858
Lexington, KY 40512

Please note: Providers must follow this process exactly as outlined, or CareFirst will not be able to suppress the EOB.

For a copy of the notification form, along with Frequently Asked Questions, please refer to the materials below.

For questions, please reach out to provider service.