1. Immunization Update Call 9/11/2012
CDPH Immunization Branch
These slides are posted on the
Immunization Coordinators’ website

2. Topics Covered on Today’s Call
317 Policy
Flu Season
State-Purchased
VFC
Legislation Update
Medi-Cal Increased Reimbursement
AB 354

3. 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. 3

4. 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.

5. 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
Influenza vaccine, Season

6. 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).

7. Implementation of Policy
Initial letter sent to Health Officers: Sent 7/13
Presentation to CCLHO: Done on 8/2
Eligibility Tables, and Insured Policy: Sent 8/31
Templates for provider communications: Sent 8/31
New signs for LHDs: Sent 8/31
Outreach to physicians: s to EZIZ, provider organizations: Sent 9/4-5
Revisions of policies at LHD level
Training of staff on new 317 guidelines

13. 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 updated once a week

14. Flu Vaccine Shipping

15. Status of state-purchased vaccine shipments
Fluzone multi-dose vials
Fluvirin multi-dose vials
Fluvirin single dose syringes
Flumist sprayers
Fluzone Intradermal
Order
186,000
164,000
78,000
9,000
Available at McKesson
Shipped to LHDs
100%
Shipping Shortly
Doses still available
6,000

16. VFC 2012-2013 Fluzone - Sanofi 0.25mL Syringes
Fluarix - GSK 0.5mL syringes
FluMist - MedImmune Nasal Sprayers
Sanofi MDV Fluzone 10 Dose Vials
VFC Ordered
560,500
370,000
380,000
500,000
VFC Received
202,490
298,890
Percentage Received
36%
100%
60%
Shipped to Providers
Orders under 100 doses=Filled
Orders over 100 doses = 20%
Orders over 100 doses = 50%
To be processed the week of September 10th
???
Fill remainder of orders

17. VFC-Provider Communications
VFC Letter with ACIP Recommendations: Sent
Initial Provider FAX Blast: Sent
Heads up on flu vaccine shipments, program letter and reminder on flu vaccine returns.
2nd Provider FAX Blast: To be sent this week
Heads up on flu vaccine shipments
Supplemental Ordering Notification: When site is launched.
Site will be likely to be live at the end of the month.

18. 2012-2013 Replacement Program Unused, Expiring LAIV
Doses must be purchased through the CDC contract
Doses must expire by January 31, 2013.
Providers have from 15 days prior to the lot expiration 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 by calling McKesson Specialty Health Distribution at
All expired/expiring doses must be received by 2/15/2013.
Replacement doses will not be shipped until expired /expiring doses are received.

19. Pediatric 0.25 Fluzone
Currently available vaccine was purchased with combination of VFC and 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.
317 policy change will not affect eligibility to receive pediatric Fluzone for this year.

20. 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
Survey sent to measure LHD demand for state-purchased 0.25ml syringes for <3 years of age
Investigating option for this season to reduce screening

21. Examples for mass vaccination clinics
Vaccine
supplies
Who may be vaccinated?
Eligibility screening needed?
County A
State-purchased
TIV > 3 years
LAIV years No
County B
State-purchased VFC, 317
> 6 months
Yes
County C
State-purchased + VFC/317 for 0.25 mL syringes
Only recipients of 0.25 mL syringes

22. Flu Communications
Flu Dosing Guide for children 6 mos through 8 years of age
Flu Vial ID Guide
CDC flu kick-off press briefing – September 27
National Influenza Vaccine Week (NIVW) – December 2-8
CDPH flu press release - October?

23. Flu Communications
Seasonal flu messages for the public: Promote universal flu recommendation. “Flu is a serious disease that can lead to hospitalization and sometimes death.” “The flu vaccine is not just for seniors. Anyone can get sick from the flu.” “Everyone over 6 mos. of age should get immunized.” “Flu seasons are unpredictable. Get vaccinated today to have protection throughout the flu season.”

24. Flu Communications
Free hard copies of flu materials available by CDC:

25. 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

26. 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
Governor’s Desk

27. Current Legislation SB 1318 - Wolk
Who: All onsite healthcare workers, and staff with privileges; can also apply to contract workers
Where: All clinics and health facilities
What: Worksites with HCW influenza immunization rates <90% subject to masking policy TBD by CDPH and stakeholders in 2015 and beyond.
Governor’s Desk

28. 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
Governor’s desk
SB Negrete McLeod
Permit inclusion of TB testing data in CAIR
Signed by Governor

29.  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
Autumn 2012 – Final Rule to be issued
Amendments to Proposed Rule?
January 2013-December 2014: Rule in effect

30.  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
Nov 2012 – 2103 Medicare rates will be posted
New proposed maximum for VFC immunization
$17.55  $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

31.  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

32.  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

33. 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 Sept no extension periods

34. AB 354 Communications
Weekly s to CA Private and Public Schools serving 6th and/or 7th Grade Students
Bi-weekly s to Providers
7th Grade Assessment Report due November 1, 2012 – See CDPH Memo

35. AB 354 Efforts In Your Schools – How Did it Go?
Reporting Reminders for Local Schools:
Child Care Assessment Due 10/1/2012
Kindergarten Assessment Due 10/15/2012
7th Grade Tdap Assessment Due 11/1/2012