1. Dose by Dose Accountability and CAIR
Robyn Davis, MPH, State Billables Coordinator
Maria Volk, MPA, Chief Field Services

2. Vaccine Financing Background
VFC Program: Entitlement Program for eligible children through age 18.
Medicaid eligible
Uninsured
American Indian or Alaska Native
Underinsured: a child who has commercial (private) health insurance but the coverage does not include vaccines, a child whose insurance covers only selected vaccines (VFC-eligible for non-covered vaccines only), or a child whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the child is categorized as underinsured. Underinsured children are eligible to receive VFC vaccines only through a Federally Qualified Health Centers (FQHC) or Rural Health Clinics (RHC)].
Note: Healthy Families Program participants and commercially insured children (private insurance coverage) are NOT eligible to receive VFC vaccines

3. General Overview of Section 317
Section 317 is a discretionary federal program distributed to the states to provide money for vaccine purchase and to develop vaccine infrastructure.
Section 317 vaccine purchase (DA) grants are intended to allow grantees to provide vaccine for populations at greatest risk for under-vaccination and disease.
While most of the 317 funds for vaccine purchase are used for childhood vaccines, especially for children whose health insurance does not cover immunizations (under-insured ), some funds are used to promote adult vaccination programs.

4. Use of Section 317 Funds in CA
317 funds are used to supplement vaccine purchase for public providers.
Public providers receive vaccines purchased with a combination of VFC and 317 funds.
VFC makes up the majority of funds, 317 is a small proportion
The small portion of 317-purchased vaccines currently allows local health departments to vaccinate non-VFC eligible children that present to their clinics, including:
Under-insured children*
Fully insured children*
Adults- for selected vaccines
*NOTE: Current policy for vaccinating fully-insured children at LHD clinics: Not missing an opportunity for vaccination. Vaccinate the child and refer back to the medical home.

5. Federal Vaccine Budget
VFC Budget: 500 million
317 Budget: 20 million
State Budget: 7.3 million (influenza vaccine)

6. Facilities Receiving 317 Supplied Vaccines & Use of Vaccines
Non-VFC eligible children
Selective adult vaccines ONLY unless a local Health Officer, in consultation with CDPH, decides that vaccination is needed for a particular population as part of outbreak control.
LHDs
Non-VFC eligible clients (Underinsured) years of age ONLY. Exception: Special permission granted by the State IZ Branch for CHCs in areas of limited or no County Immunization Clinics.
Community Health Centers
VFC-Eligible Children Only. No longer eligible to receive 317 vaccines.
Schools/School-based Clinics
Non- VFC eligible inmates (19-25 years of age).
CDPH provided vaccines are intended for inmates of youth authorities and not staff.
Juvenile Correctional Facilities

7. LHD Eligibility Table
1 No strict upper age limit, though most persons born before 1957 are already immune to these diseases and don’t need MMR.
Outbreak situations: Vaccine can be provided to adults in outbreak situations if the local Health Officer in consultation with CDPH decides that vaccination is needed for a particular population as part of outbreak control.
Health departments and a limited number of CDPH approved clinics receive vaccine from a combination of funding sources. This allows them to administer vaccine to all clients who fall within the above criteria, despite pay source.
When the health department or CDPH approved clinic has the capacity to bill insurance and an insured client presents for vaccination, privately purchased vaccines should be administered and the insurance company billed (including Healthy Families). If the health department or CDPH approved clinic does not have the capacity to bill, the patient should be immunized and referred back to their medical home for future immunizations. For further guidance regarding immunization services to privately insured children including those with Healthy Families coverage, see “Policy for Provision of State Funded Vaccine to Privately Insured Patients by Local Health Department Jurisdictions” document. Funds for the purchase of adult vaccines are limited and therefore the CDPH, Immunization Branch is unable to make all vaccines available to adults. In LHD settings, CDPH provided vaccines are intended for clients only and not health department staff. Finally, state provided vaccine should not be used in travel clinic settings.

8. 317/VFC Tracking: LHDs
Dose by dose accountability is a new requirement from CDC.
For LHDs that can immunize both VFC and non-VFC clients:
Need to determine how many doses are given for VFC Eligibles and 317 (non-VFC).

9. Vaccine Supplies: LHDs
LHDs order vaccine through our VFC Program.
Vaccine they receive is funded through a combination of funding streams.
The vaccine is not shipped or stored separately by funding source. It is “state supplied” vaccine (VFC/317).

10. Vaccine Supplies: LHDs
Q. How do I know what is VFC versus 317 when it arrives?
You don’t! The vaccine is not labeled VFC versus 317.
Q. But, huh?
All of the vaccine comes from McKesson in one shipment.

11. State Immunization Program
Vaccine Supply
State Immunization Program
VFC Office.
McKesson We
Pack
‘em
Order is placed by vaccine type
Provider
Submits a vaccine request
Reviews, approves, and submits vaccine order to CDC & distributor
Dose of State supplied vaccine
vaccines’ funding source is not indicated in the order, shipment packing slip or vaccines. Until the vaccine dose is administered, it remains a dose of state-supplied vaccines.

12. Vaccine Supplies: LHDs
Q: So how do you know how much VFC or 317 vaccine is being used?
A: Ahh, by implementing the new tracking requirement.
LHDs administer vaccine according to the Eligibility Table.
The vaccine dose is ‘tracked’ as VFC or 317 once it is administered.

13. Identity of a Vaccine Dose
Dose of State supplied vaccine
State Supplied Vaccines
Shipment of Vaccines received from the State (State Supplied Vaccines)
Patient meets VFC eligibility criteria
Patient meets 317 eligibility criteria
Only until a vaccine dose is administered it becomes a VFC funded dose or a 317 funded dose (based on a patient meeting a set of eligibility criteria (VFC/317).
Dose becomes a VFC dose
Dose becomes a 317 dose

14. Vaccine Supplies: LHDs
Q: So I really don’t have to keep the supplies separate?
A: No, you just have to track each dose as it is administered and report that information when you order vaccine. Everything else about how you order and store vaccine remains the same.

15. 317/VFC Tracking
e.g. You order and receive 20 doses of Tdap. You administer to patients as they come in. When it is time to order, you run your report and it shows that 14 doses were given to VFC eligible children and 6 doses were given to non-VFC (317 eligible) patients. You report that on your next order.
CDPH, IZ Branch takes the aggregate information and this determines what vaccines we make available on the Eligibility Tables.

16. So what is really changing?
Order Vaccine: Order state supplied vaccines (VFC/317) through VFC Program for LHD clinics
Available Vaccines: Given according to Eligibility Table
Screen: For VFC eligibility at every visit
Document: Electronic or Manual System
Inventory: Report inventory by vaccine type
Track Administration: Electronic or Manual System
Summarize Administration: For each vaccine order reporting period.
Report Administration with Each Order: Through MYVFCVACCINES.

17. CAIR Changes
Introduction of “state supplied” terminology. Refers to the fact that this vaccine is ordered through the state IZ Branch. Supplied, not purchased (All)
Verify VFC/317 eligibility for every session in CAIR (All)
New report on vaccine administration to provide breakdown by VFC/317 (LHDs)

18. CAIR Changes
Demonstration of changes-Robyn Davis

19. Online Ordering: Draft Changes

20. 317/VFC Tracking Requirement goes 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 begin in August (30 days after launch).