1. Immunization Update Call 7/17/2012
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/School Law Assessment Data
Potential Changes in 317 Policy
317/VFC Vaccine Dose Tracking
OIG Audit

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. Opportunities for collaboration
Walgreen’s voucher program

6. VFC 2012-2013 Flu Order Confirmations
VFC’s On-line flu order confirmation launched on June 18th 2012
Providers will have until July 18 (tomorrow!) to review, modify and submit allocated influenza doses for their practice.
Allocations are based on total influenza doses received from August May 2012.
Products offered are the same as product available 2011/2012
Providers with limited allocations (i.e. providers with increased VFC eligibles) will have the opportunity to request additional doses during supplemental ordering.

7. VFC Vaccine Supply :
Pre-booking our 2012/2013 VFC supply with CDC happened in March.
Products: .25 Fluzone, Fluzone MDV, Fluarix Syringes, FluMist
VFC solicited provider feedback/input prior to booking doses this year, through a short survey.
Providers will confirm allocated doses by mid-July.
Providers cannot order additional doses beyond their allocation, but can shift between presentations.
Supplemental Ordering will again be available for providers that need more doses than their initial allocation.

8. Flu Communications 2012-13 Flu ID Guide Provider Mailing
Updated Flu Resources on EZIZ.org
Materials Order Deadline, 8/10
EZIZ.org Messages
Early Messages for Providers:
Make room for flu vaccine.
Start scheduling appts and clinics.
Promote flu vaccination.
“Give it, once you get it.”

9. 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

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

11. Working with schools ahead of Fall
Are you receiving requests from schools for Tdap or vaccinators?
Supplies of 317 vaccine at back to school variable
Check your existing inventory, especially for vaccine that will be expiring in 2012 – avoid wastage.
No Maxim vaccinator support available

12. Reports yet from year-round schools?

13. 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)
Bi-weekly s to Providers
Potential Back-to-School Press Release

14. 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

15. 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

16. 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

17. 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. 17

18. 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.

19. New CDC Guidance: 317 Vaccine
317 vaccine funds may be used to vaccinate the following:
Underinsured children (until a deputization agreement is in place)
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

20. 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).

21. Implementation of Policy
Initial letter sent to Health Officers on Friday.
Eligibility Tables, and Insured Policy will be revised.
Communication to provider organizations
Outreach to physicians (from state and local)
Revisions of policies at LHD level
Training of staff on new 317 guidelines

22. 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.

23. CAIR Changes Verify VFC/317 eligibility for every session in CAIR.
New reporting will provide vaccine administration data needed for vaccine ordering.
Launched on July 1st.
What is 317 vaccine?
What if I don’t use inventory?

24. Online Ordering: Draft Changes

25. Help us Verify LHD PINs
A LHD PIN verification page has been developed within the “State Supplied Vaccines” page (AKA State supplied flu site)
All VFC PINs self identified as LHDs have been loaded in the page for you to log-in and confirm
Indicate if PINS marked as LHDs are incorrectly categorized
Add PINs that are LHD sites and are not listed as such in our system
Upon verification, LHD PINs will be linked to the detailed On-line Ordering page
If you haven’t already done it, please do so ASAP!

26.  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 to proposed rule based on comments?

27.  Reimbursement for administration MediCal beneficiaries, 2013-2014
Current reimbursement - $9
For 2013 and 2014, increase to the lesser of
Medicare reimbursement for immunization
$25-33 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

28.  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

29.  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
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