California Vaccines for Adults (VFA) Program - Year 2 Program … · 2017. 12. 13. · California Department of Public Health 3 CA Vaccines for Adults (VFA) New program implemented

California Department of Public Health 1

Immunization Branch, California Department of Public Health December 13, 2017

California Vaccines for Adults (VFA) Program

- Year 2 Program Requirements -


Session Outline

• VFA Program Overview • Patient Eligibility • Storage and Handling • VFA Resources • VFA Program Requirements – Year 2 • Questions


CA Vaccines for Adults (VFA) New program implemented in June 2016. VFA Program Goals and Objectives To provide vaccines at no cost to eligible adults

Expand access to 317-funded vaccines to Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) in California

To integrate the standards for adult immunization practice into routine adult

clinical care ASSESS immunization status of all adult patients at every visit Strongly RECOMMEND vaccines that adult patients need ADMINISTER needed vaccines or REFER to a provider who can

immunize DOCUMENT vaccines received by your adult patients


VFA Program Participation Eligibility

Federally Qualified Health Centers, FQHC Look-Alikes, and Rural Health Centers that can demonstrate: Participation in the California Vaccines for Children

Program (VFC); Experience providing a safety net for uninsured and

underinsured adults; Participation in an Immunization Information System

(e.g., California Immunization Registry - CAIR) or use of an Electronic Health Record (EHR) system.


VFA Program Enrollment • Year 1: Selected 457 clinical sites for enrollment: - 440 sites that belong to 108 FQHCs and FQHC lookalikes - 17 RHC, Indian Health Services (IHS) or tribal health sites • Year 2 Enrolled 61 additional clinical sites from VFA participating health center organizations - Sites belong to 24 FQHC and lookalike organizations

http://eziz.org/vfa-317/vfa-resources/


VFA program data Doses administered during Year 1

775 2043 2147 2340 3078 3747

5731 6123 6389 8032

28314

8,682

20,785

14,925

24,664

Q1 Q2 Q3 Q4

Quarterly Administration Data 68,719 vaccine doses administered during Year 1


VFA Year 1 Accomplishments

During July 2016-June 2017: • Enrolled and provided program support and technical assistance to 457 clinical

sites • Developed educational materials and program resources for participating clinics

and conducted 3 webinars attended by 500+ participants • Developed system to collect quarterly reports of vaccine administration and

program qualitative data • Conducted key informant interviews to identify facilitators and barriers to

program implementation; synthesized and presented findings at state and national meetings

• Conducted program survey to inform planning for Year 2


VFA Year 1


Population eligibility to receive 317 VFA vaccines

• Eligible to receive 317 vaccines Uninsured and underinsured adults, 19 years of age and older, served by the clinic.

– Uninsured: A person without any health insurance coverage (public or private coverage).

– Underinsured: A person who has health insurance, but the coverage does not include vaccines or a person whose insurance covers only selected vaccines.


Population eligibility to receive 317 VFA vaccines

• Not eligible to receive 317 vaccines Fully insured adults whose insurance covers the cost of vaccine, even if: The insurance includes a high deductible or a co-pay; A claim for the cost of the vaccine and its administration would be denied for

payment by the insurance carrier because the plan’s deductible had not been met;

The insurance has cost-sharing; these individuals must pay out-of-pocket for immunizations.

Notes: • Unlike the VFC Program, adults with full scope Medi-Cal are considered

insured, and therefore not eligible to receive 317 vaccines. • Seniors without Medicare Part D, and who do not have Medi-Cal or other

insurance that covers vaccines, are considered underinsured and are therefore VFA eligible and may receive the vaccines that would be covered under Part D.


Vaccines available through VFA

Most ACIP-recommended adult vaccines are available through the program: • Hepatitis A vaccine • Hepatitis B vaccine • HPV vaccine • MMR vaccine • MCV4/MenACWY • Pneumococcal conjugate (PCV13)

vaccine • Pneumococcal polysaccharide (PPSV23)

vaccine • Tetanus, diphtheria, and acellular

pertussis (Tdap) vaccine • Tetanus and diphtheria toxoids (Td) • Zoster


Vaccine Shipments

Label vaccines received according to their funding source, and store them in the pre-designated shelf/area of the vaccine storage unit.


Key Elements in Storage and Handling

Skilled and trained staff

Written Vaccine Management Plans

Appropriate vaccine storage

units

Accurate temperature monitoring equipment

Proper temperature

monitoring AND documentation


Program Resources bit.do/VFAresources

http://bit.do/VFAresources


VFA Program FAQs bit.do/VFAresources http://eziz.org/assets/docs/pharmacy/2017

Dec-VFAFAQs.pdf



http://eziz.org/assets/docs/pharmacy/2017Dec-VFAFAQs.pdf






Program Resources VFC Store

http://rhu169.veracore.com/v5fmsnet/OeCart/OeFrame.asp?PmSess1=349211&Action=LOGIN&pos=CDPHOM&v=2&OfferID=&sxref=

CDC’s Adult IZ Resources

http://www.cdc.gov/vaccines/hcp/adults/index.html

http://www.cdc.gov/vaccines/hcp/adults/for-patients/adults-all.html










Immunization Action Coalition’s Adult IZ Resources

http://www.immunize.org/handouts/adult-vaccination.asp







http://www.immunize.org/subscribe/

http://www.immunize.org/guide/



http://www.immunize.org/guide/


Program Requirements Changes for Year 2 VFA vaccine-related charges, including fees for administering

(injecting) vaccines

To ensure that VFA-eligible patients will not incur additional costs outside of any routine copay for the clinic visit, VFA program sites shall: • Not charge eligible patients or third party payers for the cost of the 317-funded

VFA vaccines. • Not charge a vaccine administration fee to eligible patients for 317-funded VFA

vaccines. • Prominently post a sign clearly visible to patients which states that: “FREE vaccines are available to adult patients who are uninsured or have insurance that doesn’t cover (certain) vaccines. We do not charge these patients for getting the vaccine or for the cost of the vaccine.”


Program Requirements Changes for Year 2 VFA Ordering and Reporting

Year 1 • Quarterly reporting of inventory and doses

administered, and program implementation-related information

• No pre-determined schedule for ordering • Ordering and reporting done at the clinical site

level (vs. organization-level)


Program Requirements Changes for Year 2 VFA Orders

• Orders will be submitted quarterly during a two-week period at the beginning of each quarter

• Ordering periods for year 2: - January 2-16, 2018 - April 2-16, 2018 - July 2-16, 2018 - October 1-15, 2018


Program Requirements Changes for Year 2 Reporting/Evaluation

• Required to submit two evaluation reports: Midyear interim report, due July 2018 Final report, due January 2019

• Reports to be submitted at the FQHC/RHC organization level (vs. clinical site).

• The data that you will need to report on: immunization coverage rates of VFA eligible patients, for three vaccines, and data on progress of implementation of evidence-based interventions related to the standards for adult immunization practices.


Program Requirements Changes for Year 2 Documenting vaccine administration or declination

Year 1: • Required to document vaccine

administration using an Immunization Registry, Electronic Health Record (EHR), or 317 Adult Vaccine Daily Usage Log.



Year 2 All VFA providers must have a system in place to ensure all vaccine doses administered are documented electronically. The system must be designed to include options to access the data in the event that the platform used for documentation is down. The backup plan/alternate method may include entering doses administered in the 317 Adult Vaccine Daily Usage Log, in addition to the patient’s medical record.

http://eziz.org/assets/docs/IMM-1053-317.pdf

http://eziz.org/assets/docs/IMM-1053-317.pdf



You may document VFA vaccine doses administered using one of the following options:

1. Enter doses directly into your Electronic Health Record (EHR) and transmit data to the immunization registry If your clinic is in one of the California Immunization Registry (CAIR) regions using CAIR2

software, consult with your EHR vendor and visit the CAIR IZ Portal Registration Page to learn about setting up electronic data exchange to automatically populate CAIR with EHR data

If you are NOT in a CAIR2 region, consult your EHR vendor and contact your local representative for instruction regarding electronic data exchange through the San Diego Immunization Registry (SDIR), Healthy Futures (San Joaquin and nearby counties), OR Imperial County Immunization Registry.

OR 2. Enter doses directly into your immunization registry (in CAIR2, as 317 LHD HDAS doses). Contact your Local CAIR Representative if you have any questions.

http://cairweb.org/docs/cair2map.pdf


https://igs.cdph.ca.gov/cair/


http://cairweb.org/dataexchange-contacts/

http://cairweb.org/dataexchange-contacts/

http://cairweb.org/lcrs/



Patient declination of immunization should also be documented in the patient’s medical record. The Department of Healthcare Services requires that Medi-Cal Managed Care plans document in an adult patient’s record immunization declination in the form of a signed statement.

http://eziz.org/assets/docs/PrenatalTdapInfluenzaVaccineDeclinationForm.pdf


VFA Program Requirement

1. Vaccine ordering 2. Reporting inventory and doses administered

3. Evaluation reports

4. Documenting vaccine administration 5. Documenting vaccine refusal

6. Vaccine administration fee

Year 1

As needed, by clinical site

Quarterly (or before next order), as part of progress report. By clinical site.

Quarterly, by clinical site; qualitative data only.

Immunization Registry, Electronic Health Record (EHR), OR 317 Eligibility Screening Form.

Not specified Charge patients an

administration fee of no more than $26.03 per vaccine dose; waive the fee if the patient is unable to pay.

Year 2

Quarterly only, by clinical site.

Quarterly only, by clinical site, at the time of order submission.

Biannually, by organization; quantitative data required.

Electronically – EHR (data exchange sites) or CAIR2.

Need to have options to access the data in the event system is down

Document in the patient’s medical record.

Not charge for the cost of the 317-funded VFA vaccines

Not charge a vaccine administration fee Post a sign with IZ Branch-provided language


Next steps and important dates

• Next ordering period: Jan 2-16, 2018 • Webinar slides and recording to be posted

on the VFA webpage • Program evaluation Year 2: gather baseline

data (IZ coverage rates)


• [email protected]

Documents

California Vaccines for Adults (VFA) Program - Year 2 Program … · 2017. 12. 13. · California Department of Public Health 3 CA Vaccines for Adults (VFA) New program implemented