1. Immunization Update Call 8/14/2012
CDPH Immunization Branch
These slides are posted on the
Immunization Coordinators’ website

2. Topics Covered on Today’s Call
Flu Season
State-Purchased
VFC
AB 354
Legislation Update
IZ Coordinator Survey Results (I&E)
317 Policy
317/VFC Vaccine Dose Tracking

3. 2012-2013 Flu Season Vaccine influenza virus strains
A (H1N1) California/7/2009-like (same)
A (H3N2) Victoria/361/2011-like (new)
B Wisconsin/1/2010-like (new)
Manufacturers expected to bring million doses to the market for season
FDA maintains a webpage where information on lot releases are posted once a week

4. State-purchased flu vaccine
Final allocations released and LHDs have confirmed allocations
Product
Number of doses
Fluzone MDV
186,000
Fluvirin MDV
Fluvirin syringes
164,000
Flumist sprayers
78,000
Fluzone Intradermal
9,000
Total
623,000

5. Flu Vaccine Shipping

6. Update on CA Flu Program
Packet will be released shortly
All materials will be posted on the IZ Coordinators page
Working with CAIR to generate Accountability Report

7. Pediatric 0.25 Fluzone
Because we don’t purchase pediatric Fluzone with state dollars, it is purchased with a combination of VFC/317 funds.
Like other pediatric vaccines, this allows LHDs to immunize anyone that comes to their clinics.
Like other pediatric vaccines, VFC screening must be done.
October policy change will not affect pediatric Fluzone for this year.

8. VFC 2012-2013 Flu Order Confirmations
On-line order confirmations
All confirmed orders have been approved
A notification was sent to the provider of record on July 31, 2012
3,072 providers have confirmed
536 provider have not confirmed
Providers who did not confirm orders by the July deadline or providers who may need additional flu doses may submit a supplemental vaccine request once supplemental ordering becomes available this fall.
All confirmed orders will sent to McKesson as soon as sufficient doses are available to fulfill provider orders. Orders will be filled in the order received, and will likely arrive in multiple shipments.

9. Flu Vaccine Supply Vaccine Supply
It is anticipated that 50% of our expected flu doses will become available by late September, with the remaining balance available by late October.
FluMist doses: 50% of doses are expected mid August and the balance at the end of August.
Limited doses are already at McKesson for:
0.25mL fluzone
Fluzone MDV
FluMist

10. Vaccine Distribution Plan
Depending upon vaccine supply, it is likely that orders for each flu product will be shipped in 2-3 shipments.
Orders less than 100 doses will be shipped in full
Orders will be processed per product, and based on available doses.
Ex: if only doses for 0.25mL Fluzone become available to fulfill orders in queue, we will process orders only for this product
Need doses available at McKesson to fulfill at least 25% of the majority of provider orders

11. Distribution Timeline
Estimated distribution timeline
Mid-Late August: Initial shipments for available products
LHD orders, followed by small orders
~25 % of orders >100 doses
Timeframe for flu order shipment by McKesson is 1-2 business days
Due to accelerated distribution timeline, influenza orders cannot be marked as urgent.
Initial provider shipments will include a set of influenza materials, including the Flu ID Chart.

12. VFC-Provider Communications
VFC Letter in the approval stages and likely to go out this week.
ACIP recommendations are not out yet. If not out by this week, VFC provider letter will only reference location where recommendations will be posted (ACIP’s page)
Product will not ship until a letter is sent to providers
FluMist Replacement Program Information will be included in the letter
Provider FAX Blast
Heads up on flu vaccine shipments, program letter and reminder on flu vaccine returns to go out this week

13. FluMist® 2012-2013 Replacement Program
The Replacement Program allows for the replacement of unused, expiring FluMist doses
MedImmune has a separate contract with McKesson Specialty Health Distribution the Replacement Program.
Program structure remains the same as in previous years:
FluMist doses must be purchased through the CDC contract and must expire between August 2012 and January 31, 2013 to be eligible for the Replacement Program.
Providers have from 15 days prior to the exp date until January 31, 2013 to request replacement doses. Any doses sent prior to 15 days of expiry will not be replaced.
All requests should be placed with McKesson Specialty Health by calling
All expired/expiring doses must be received by 2/15/2013.
Replacement product will not be shipped until expired/expiring doses are received.

14. Flu Communications 2012-13 Flu ID Guide (mix-up/vial chart)
Updated Flu Resources on EZIZ.org
CDC “FluView” App –
Early Messages for Providers:
Make room for flu vaccine.
Start scheduling appts and clinics.
Promote flu vaccination.
“Give it, once you get it.”

15. AB 354 - 2012-13 and future school years
Pupils needing proof of a Tdap booster shot before starting school:
All entering or advancing into 7th grade
All transferring from out-of-state or country into 8th through 12th grades
Exclusion if haven’t met requirement
Applies to all public and private schools
About 500,000 students affected
As of July no extension periods

16. What’s your back-to-school plan?
LHD Schools Vaccinators

17. Reports yet from year-round schools?

18. AB 354 Communications
Weekly s to CA Private and Public Schools serving 6th and/or 7th Grade Students
Suggested checklist for schools (Spring – Autumn 2012) (see also checklist for providers)
Bi-weekly s to Providers
Back-to-School Press Release - NIAM
School & Childcare IZ Assessment Results Posted on ShotsForSchool.org

19. Current Legislation AB 2109 – Pan
Parents seeking PBEs would submit to schools a form signed by the parent and a health care practitioner who has provided information about vaccines and the diseases they prevent.
Similar law in Washington State
decrease in kindergarten PBEs in 2011
Senate Appropriations Committee 8/6

20. Current Legislation SB 1318 - Wolk Would require
Who: All employees, medical staff, contractors, students, volunteers
Where: All clinics and health facilities
What: Worksites with HCW influenza immunization rates <90% subject to masking policy TBD by CDPH and stakeholders.
Assembly Appropriations Committee

21. Current Legislation AB 2009 – Gagliani
CDPH’s influenza vaccine for LHDs – CDPH may provide guidance on prioritizing doses, based upon ACIP recommendations or other criteria
Passed Senate – back to Assembly for reconciliation
SB Negrete McLeod
Permit inclusion of TB testing data in CAIR
Assembly Appropriations Committee

22. IZ Coord Communications Capacity & Preferences
Conducted online May-June 2012
57 responses

23. Capacity for IZ Activities
Only me
25% FTE or less
100% FTE
3 + staff

24. How Many Annual Campaigns are Realistic?1 2 3 4

25. Can You Make Enough Copies?
YES 52%
YES—but
only B&W
35%
NO 26%

26. Resources/Capacity Conclusions & Interventions
LHDs vary greatly in resources and capacity
Hard copy, color materials appreciated!
I&E Possible Interventions
Expectations for IZ education to be adjusted by capacity of each LHD
Campaigns can be geared to 3 tiers to allow different levels of effort

27. Where LHDs DO NOT Have Contacts
4. pharmacies
1. non-ER urgent care
3. IHS clinics
2. Local med assns

28. Who Helps You Distribute IZ Information?
More contacts helpful

29. Outreach Capacity Conclusions & Interventions
Some gaps in provider contacts and community partners
I&E Possible Interventions
IZB can facilitate certain partnerships from the state level
IZB can develop a list of recommended groups for LHDs to support IZ outreach and distribution

30. Websites Not Known to All
vacunasYMiSalud
MyBestShot
WhyIChoose
GetImmunizedCA
(CDPH)
ShotByShot

31. What I&E Support is Helpful?
Health Ed/
graphics
Messaging help
Translation
New Media
Campaign teleconfs

32. IZB Communication Support Interventions
I&E Possible Interventions
Improve orientation/promotion of lesser known resources
Ensure graphics, plain writing, translations, teleconference support shared with all
Explore barriers/need for social media

33. Interest in More Training Topics
Parent
Vacc. Safety
Forums
Prenatal
classes
HCW
IZs
None

34. Blended Learning for ISI
20% use BL approach now.
Many more would if guidance was available
Yes
unsure No

35. IZB Help to Support Local Training
Blue: I could
use help
Orange: I’m
confident
PPTs
Promotion
Handouts
Speaking skills
Webinars
Evaluation
Curriculum
Talking Points

36. IZ Coord. Training Support Interventions
I&E Possible Interventions
Package guidance for ISIS blended learning approach
Be a resource for LHD training assistance requests.
Webinars on training skills

37. Section 317 Immunization Program Vaccine Funding: National
317: Discretionary funding through Section 317 grant funds. This funding has historically allowed the State to expand eligibility for vaccines. 317 vaccine funds are made available to states to use according to local needs. The use of 317 varies from state to state, but was historically used for non-VFC eligible children in public clinics and limited vaccines for adults. 37

38. New CDC Guidance: 317 Vaccine
CDC has announced that effective October 1, 2012, 317 vaccine can no longer be used on privately insured individuals.
Implications: LHDs would have to either bill private insurances or refuse service to insured clients and refer them to their medical home.

39. New CDC Guidance: 317 Vaccine
317 vaccine funds may be used to vaccinate the following:
Underinsured children
Uninsured or underinsured adults
Fully insured individuals seeking vaccines during public health response activities including:
Outbreak response
Post-exposure prophylaxis
Disaster relief efforts
Mass vaccination campaigns or exercises for public health preparedness

40. New CDC Guidance: 317 Vaccine
Fully Insured: Anyone with insurance that covers the cost of vaccine, even if the insurance includes a high deductible or co-pay, or if 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.
Underinsured: A person who has health insurance, but the coverage does not include vaccines or a person whose insurance covers only selected vaccines. Children who are underinsured for selected vaccines are VFC-eligible for non-covered vaccines only through a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC).

41. Implementation of Policy
Initial letter sent to Health Officers on July 13th.
Presentation to CCLHO on 8/2
Eligibility Tables, and Insured Policy under revision.
Templates for provider communications under revision
New signs for LHDs in development.
Outreach to physicians (from state and local)
Revisions of policies at LHD level
Training of staff on new 317 guidelines

42. 317/VFC Tracking Requirement went into effect July 1, 2012.
LHDs will be required to track doses in the registry, through their EHR, or with a manual system.
LHDs will be required to submit vaccine administration with the VFC/317 breakdown for their first ordering period after July.
e.g. monthly providers would submit breakdown with August order (30 days after launch), bimonthly providers would submit with September order, quarterly providers would submit with October order.

43. CAIR Changes & Tracking
Verification of VFC/317 eligibility must occur for every session in CAIR.
New reporting will provide vaccine administration data needed for vaccine ordering.
State-Supplied Vaccine Report-Technical issue with the report not displaying 317 doses administered is now resolved.
LHD orders must be submitted through MYVFCVaccines
Resources available include webinar, FAQ.

44. LHD PIN Verification & Order Form
All PINs identified as LHDs clinics or specially authorized clinics in June have been linked to the detailed on-line ordering page

45. Order Processing
All orders (317 vs non-317 reporting) are processed utilizing the same procedure.
Inventory and total doses administered are looked at when reviewing order accountability
Order Corrections: An issue with the system not saving corrections on returned orders has been corrected.

46.  Reimbursement for administration MediCal beneficiaries, 2013-2014
May 11, 2012 Federal Register: Proposed rule implementing a provision in the Affordable Care Act that increases Medicaid payment rates to at least 100% of Medicare rates in 2013 and 2014 for certain primary care services and immunizations.
June 2012: Supreme Court upholds ACA.
January 2013: In effect
Any amendments for final rule based on comments?

47.  Reimbursement for administration MediCal beneficiaries, 2013-2014
Current reimbursement - $9
For 2013 and 2014, increase to the lesser of
Medicare reimbursement for immunization
>$25 in California, depending on region
New proposed maximum for VFC immunization
$26.03 in California
States will receive 100 percent federal funding to cover the increase in payments ($25-26 minus $9).
Applies to immunization at any age, not just VFC
Applies to managed care as well as fee-for-service

48.  Reimbursement for administration MediCal beneficiaries, 2013-2014
VFC: Same for combination as individual vaccines
Services must be delivered by practitioners supervised by qualifying physicians:
Family medicine
General internal medicine
Pediatric medicine, including subspecialists
>60% of MediCal payment claims for primary care
Reimbursement policy separate for other VFC categories: Uninsured, Underinsured, Amer. Indian
Also separate for FQCHCs/RHCs

49.  Reimbursement for administration MediCal beneficiaries, 2013-2014
Potential source of funding in 2013 and 1014 for immunization in your LHD
Additional >$16 per each immunization
1-2 million doses of VFC vaccine given by LHDs in 2011
MediCal population will increase – Healthy Families, ACA
Are you ready to bill MediCal?
Where in your system will MediCal reimbursement go?
Brainstorming – How might this funding assist local immunization capacity? Possibilities include augmented
Staffing, School-located immunization, Other
Possibility of CAIR assisting in billing