1. Immunization Update Call 11/13/2012
CDPH Immunization Branch
These slides are posted on the
Immunization Coordinators’ website

2. Topics Covered on Today’s Call
Influenza
Legislation Update
Medi-Cal Reimbursement,
Tdap
317 Vaccine
MMRV

3. State-purchased influenza vaccine Initial Orders Filled
Fluzone multi-dose vials
Fluvirin multi-dose vials
Fluvirin single dose syringes
Flumist nasal
sprayers
Fluzone Intradermal
Fluzone
0.25 ml
Ordered
186,000
155,000*
78,000
9,000
6,080
Still Available
5,710
2,610
1,950
*Syringe order reduced slightly to purchase 6,080 doses of Fluzone 0.25 ml for mass vaccination clinics

4. VFC Flu 2012-2013 Initial Orders Filled
Fluzone
0.25mL Syringes
Fluarix
0.5mL syringes
FluMist
Nasal Sprayers
10 Dose Vials
Ordered
590,000
370,000
380,000
500,000
McKesson
590,000 (100%)
370,000 (100%)
380,000 (100%)
483,630 (97%)
Initial Orders Shipped
All

6. Supplemental Flu: Orders to Date
Formulation category
Total doses requested
Total doses requested LTE 100
Doses filled
Doses pending
Doses pending LTE 100
Filled PINS
Unfilled PINS
adult
30210
15270
29430
780
280
416 6
pediatric
18320
9330
18010
310
110
pfree
17580
10310
16980
600
321 2
flumist
18500
10520
18430 70
300

7. 2012-2013 LAIV Replacement Program
Doses must be purchased through the CDC contract.
Doses must expire by 1/31/2013.
Providers have from 15 days prior to the lot expiration date until 1/31/2013 to request replacement doses.
Doses sent prior to 15 days of expiry will not be replaced.
Place requests by calling
Expired/expiring doses must be received by 2/15/2013.
Replacement doses shipped after expired/expiring doses are received.

8. LHD eligibility screening
Screening necessary when using
VFC: multidose vials, single dose-syringes, LAIV
317-purchased vaccine: 0.25 ml syringes
No screening needed for State-purchased supplies
3 years and older: multidose vials, single dose-syringes
2-49 years, healthy, not pregnant: LAIV
6-35 months: 0.25ml syringes for <3 years of age - NEW

9. Examples for mass vaccination clinics
Vaccine
supplies
Who may be vaccinated?
Eligibility screening needed?
County A
State-purchased
> 6 months No
County B
State-purchased + VFC, 317
Yes
County C
State-purchased + VFC/317 for 0.25 mL syringes
Only recipients of 0.25 mL syringes

10. Flu Communications 2012-13 Influenza Template Messages
Press Release Template
NIVW: Dec 2-8

11. Walgreen’s Voucher Program
Walgreens is planning on offering vouchers at designated vaccination clinics and other venues
Would like to offer vouchers deliver vaccine to uninsured who are unable to afford influenza vaccination themselves.
Interested in working with local health departments who could give these to uninsured adults, for example, and these vouchers could then be redeemed at a Walgreens.
Health departments interested Walgreens may contact: Jeff Ackerman

12. Review of Legislation -AB 2109 (Pan)
Starting in 2014, parents seeking PBEs need to document for schools:
Receipt of info about immunizations and communicable diseases from health care practitioners, who are also required to document providing of such information.
Documentation may not be signed >6 months prior to when immunization is required (typically, start of school year).
Authorized health care practitioners will include licensed physicians, nurse practitioners, physician assistants, naturopathic doctors and credentialed school nurses.
Which required immunizations the student has received and not received.

13. Review of Legislation -AB 2109 (Pan) Begins in 2014
In signing the bill, the Governor stated that he will direct CDPH to allow for a separate religious exemption. 
Additional information about the implementation of his law will become available in 2013 and 2014.
CDPH to develop form, link to basic materials (e.g., VISs)

14.  Reimbursement for administration MediCal beneficiaries, 2013-2014
March, 2010: Provision in the Affordable Care Act (ACA) increases Medicaid payment rates to at least 100% of Medicare rates in 2013 and 2014 for certain primary care services and immunizations.
May 11, 2012 Federal Register - Proposed Rule
June Supreme Court upholds ACA
November 6, 2012 – Final Rule issued
Amendments to Proposed Rule
January December 2014: Rule in effect

15.  Reimbursement for administration MediCal beneficiaries, 2013-2014
Reimbursement - $9 ~$26 per injection in California
100% federal funding to cover increased payments
Applies to
Patients of any age, not just VFC
Managed care as well as fee-for-service
Does not apply to
Non-Medi-Cal VFC: Un– or Under-insured, Am. Indian
FQCHCs/RHCs
Clinics reimbursed on encounter or per diem basis rather than by physician fee schedule

16.  Reimbursement for administration MediCal beneficiaries, 2013-2014
Must be given directly or under supervision of practitioners supervised by:
Family physicians
General internists
Pediatricians
Pediatric subspecialists
Excludes Ob/Gyns, Adult Specialists, Pharmacists OR
>60% of MediCal payment claims for primary care
Self-attestation of above to Medi-Cal – state will then audit sample of clinicians to verify
Services may billed under supervised practitioner

17.  Reimbursement for administration MediCal beneficiaries, 2013-2014
VFC: 1 fee per dose regardless of whether single-antigen or combination
Non-VFC: may use billing code for combo vaccines
CMS is “concerned by the comments that this policy could result in additional shots for children if providers were to use single component vaccines where a combination vaccine exists.” (p. 59) …Section 1903(i)(15) of the Act provides that no payment shall be made “with respect to any amount expended for a single-antigen vaccine and its administration in any case in which the administration of a combined-antigen vaccine was medically appropriate (as determined by the Secretary) . . .”

18.  Reimbursement for administration MediCal beneficiaries, 2013-2014
Administration fee that providers may be charged to to California VFC patients increased from $17.55 to $26.03
However, providers cannot deny administration of VFC vaccines to a vaccine-eligible child due to the inability to pay the administration fee.

19.  Reimbursement for administration MediCal beneficiaries, 2013-2014
Impact Assessment
“A new [Section] (d) has been added to require that states collect and report to CMS data on the impact of the higher rates on physician participation. That data will assist Congress in determine whether or not to extend the provisions of this rule beyond the end of CY 2014.” (pp. 78, 114)

20.  Reimbursement for administration MediCal beneficiaries, 2013-2014
Potential source of immunization funding in 2013 and 1014 for budget-strapped LHDs
Additional >$16 per each immunization
<2 million doses of VFC vaccine given by LHDs in 2011
Medi-Cal population will increase – Healthy Families, ACA
LHDs ready to bill Medi-Cal?
Via Physician fee schedule or Encounter basis or CHCs?
Where in local government will MediCal reimbursement end up?
Brainstorming – How might this funding assist local immunization capacity?

21.  Reimbursement for MediCal - Updates
CAIR enhancement to bill Medi-Cal/CHDP
Work in progress – stay tuned for updates
New checklist on how to begin billing Medi-Cal
Posted Coordinators’ website
Update your LHD fee schedule to bill Medi-Cal at new increased rate
Continue sliding scale & waiver for those unable to pay
Billing Project staff available for consultation
Details posted at Coordinators’ website

22. 2012-13 7th Grade Tdap Reporting, - 11/6/12
Students
Status
Number
Percent
Tdap
460,459
97.2%
Permanent Medical Exemption
756
0.2%
Personal Beliefs Exemption
12,451
2.6%
Total
473,666
100.0%
Keep Contacting Schools Who Haven’t Reported Yet

23. Tdap / AB 354 Some LHD Tdap stock expiring by early 2013
Check expiration dates!
How much inventory is expiring soon
Special exception granted from CDC to use these doses at mass clinics this year only to avoid wasting doses. No screening required, can be given to all clinic attendees if they need a Tdap.
Flu
6th graders subject to requirement in 2013
Disease/outbreak control
Contact field reps as needed.

24. 317 Policy
As of October 1st LHDs may no longer provide 317 vaccine to fully-insured children or adults.
Includes patients insured by Medi-Cal
Local health departments either referring back to medical home or purchasing vaccine.
During VFC QAR’s if any providers indicate they refer patients to LHDs, the new policy will be discussed with them.
Reminder message sent from EZIZ listserv
How is it going?

25. Vaccine Supply: MMRV
Merck Proquad (MMR-V): Merck has indicated Proquad™ is now back on market (November 1, 2012).
A VFC Program letter will notify providers of MMRV’s availability, ACIP recommendations and ordering instructions.
Ordering of MMR, VZ and MMRV
Providers will be encouraged to determine how the vaccine will be incorporated into the practice prior to placing MMRV, MMR and VZ orders.