1. North Carolina Immunization Program (NCIP) Overview
Good Morning!
I’d like to take a few minutes to provide a history lesson about the NC Immunization Program define our purpose and explain the most recent changes to our program and how those changes will effect you.

2. About the NCIP:
Our Purpose: To promote public health through the identification and elimination of vaccine-preventable diseases.
Our Goals:
To ensure age-appropriate vaccinations
To keep children in their medical homes, and
To remove cost as a barrier
Why we exist – to identify and eliminate vaccine preventable diseases through assuring vaccines are available and diseases are indentified, controlled and prevented.
Our goals are to
Ensure age-appropriate vaccinations, by removing cost as a barrier and keeping children their medical homes

3. About the NCIP: Who we serve: What we provide:
Children through 18 years of age
What we provide:
Federally funded vaccine provided by the CDC based on NC’s population
Where do we supply vaccine:
Local Health Departments
Federal and Rural Health Centers
95% of Private Providers
Hospitals
We provide vaccines - at no charge - for any child from birth through 18 years of age - present in the state of North Carolina - who qualifies for the federal VFC program.
We receive the vaccines from the CDC and distribute them to health care providers at no charge through our distributor – McKesson
Over 95% of health care providers who administer vaccines to children in NC participate in this program.

4. Change
If you’ve been associated with the Immunization Program for long – you know that change is inevitable. Change is often good and often scary.
Here’s a brief summary of our program history and the changes overtime
Health is the prize when you immunize was our first logo which focused more on children along with our program name – NC Universal Childhood Vaccine Distribution Program (UCVDP) – at this time we actually distributed vaccine
We continued to call the program UCVDP but tried to highlight that we provide vaccine services across the lifespan and changed the logo
Recently since we no longer “distribute” vaccine and didn’t provide vaccines “universally” we changed our name to the North Carolina Immunization Program – our current name.
Not only has our named changed but the business as we know it has taken a drastic turn.

5. Quick History of NCIP
1994 – The NC Universal Childhood Vaccine Distribution Program (UCVDP) launched
Using a combination of state and federal funding, ALL children in NC are able to receive ALL vaccines, free of charge
Life was good!
Transition from LHDs to private providers
Immunization rates increase!
In 1993 federal legislation was passed to provide funding to guarantee that vaccines would be available at no cost to providers to vaccinate eligible children. This became the Vaccines For Children Program. VFC
In 1993 the North Carolina General Assembly appropriated $3.5 million to the Immunization Program to establish the Universal Childhood Vaccine Distribution Program which allowed NC to distribute all required vaccines to providers at no cost.
Combing both funding sources established a seamless vaccine delivery system for providers reducing cost as a barrier, increasing immunization rates and keeping children in their medical home.

6. Quick History of NCIP 2000 – NC Becomes a Universal-Select Program
Cost of new vaccines
Prevnar
Required vaccines
Provided Universally
Complicated system
Public vs Private vaccine stocks
As new – more expensive vaccines became recommended the state was unable to continue providing ALL vaccines for all children which moved us from a Universal State – providing all vaccines - to a Universal-Select state - providing all required and some recommended vaccines. This began in 2000 with the introduction of Prevnar.
As I previously said we received $3.5 million in 1994 to purchase vaccines for non VFC eligible children.
Today it would cost approximately $45 million to ensure all non VFC eligible children received required and recommended vaccines
Due to increases in the number of vaccines available and the cost associated with fully immunizing every child – NC can no longer afford to provide every vaccine universally to every child
Only select vaccines (i.e., those required by law) are universal; others – like HPV, meningococcal, rotavirus, etc. – are available only for children who qualify for the federal VFC program
Life is still pretty good – but complicated for providers trying to sort out which child can receive state-supplied vs. private-stock vaccines.

7. Quick History of NCIP Significant Milestones 2005 2009
NCIR is Launched
NC is one the top 10 states with the best immunization rates in the country!!
2009
State Budget Cuts Occur
What’s been happening in the last decade?
In 2005
the North Carolina Registry was expanded into a web based system that was implemented in Private Provider Offices after years of the legacy system being used in local health departments
North Carolina had great immunization rates – one of the top 10 states in the country!
In 2009
$10.5 million dollars were cut from the Immunization Budget
Reduced availability of universal vaccines
Since December 1, 2009 we have had 3 significant changes in the vaccines we could provide universally

8. Quick History of NCIP 2010 – More Cuts…
As of July 1, 2010 – NC is a VFC-only state
As of July 1, 2010 – North Carolina is a Vaccines for Children only State
This means that NC will no longer provide “state funded” vaccines
All vaccines provided through the state program are federally funded

9. Who Decides?
The North Carolina General Assembly made up of House of Representatives and Senators make the financial/budget recommendations/decisions with the Governor having the final approval.
The Immunization Program was recently receiving approximately $22 million to purchase vaccines off the federal CDC vaccine contract to provide all required and some recommended vaccines for all children.
As the state budget began to erode the General Assembly decided that the Immunization Program was a good budget line to begin reducing and now has eliminated.
The reasoning behind this is because the children receiving state-supplied vaccines are insured children and their insurance should be paying for the cost of vaccine.

10. Piggy Bank is Empty
Now that the piggy bank is empty and there are no state dollars to purchase vaccine – what will happen?
There is no money to provide vaccines at no cost to providers for INSURED children.
The Immunization Program’s Advisory Committee helped make the programmatic decisions about what vaccines to provide and what should be eliminated during our budget cut phases.

11. What Now? North Carolina = VFC only Providers – Public and Private
Order vaccine for VFC eligible children
No more ordering vaccine for ALL children
Providers will purchase vaccine for insured patients
NC will now only have access to federally funded (VFC) vaccine for both public and private providers. This vaccine is allocated to NC from the CDC.
In NC it is estimated that 67% of all children birth through 18 years of age (that’s up to their 19th birthday) are eligible to receive VFC vaccine.
Approximately 33% of the same aged children are privately insured and cannot receive federal VFC vaccine.
That’s a good thing for NC because more children can receive vaccine at no cost.
Providers can only order vaccine from the state for their VFC eligible patients.
Providers will have to purchase vaccine for insured patients.

12. Who is Eligible for VFC Vaccine?
Children
Birth through 18 years of age
Must be:
Medicaid eligible: Medicaid eligible and Medicaid enrolled are the same
Uninsured: No health insurance coverage
American Indian or Alaska Native
Underinsured
We’ll go into more detail about all of this later today...
Children through age 18
Medicaid Eligible
Uninsured
American Indian or Alaska Native
Underinsured
At this time since all of our providers are “deputized” they can provide VFC vaccine to underinsured children.
In many states underinsured children must go to a Federally Qualified Health Care Center (FQHC) or Rural Health Center (RHC) to receive VFC vaccine.

13. Fees and Charges Providers CANNOT bill for cost of vaccine
Administration Fee
CANNOT Deny
Providers cannot bill VFC-eligible patients/parents or Medicaid for the cost of vaccine
They can bill an administration fee to Medicaid, the patient/parent or insurance company
Fee must not exceed the Medicaid reimbursement rate
Must give the VFC-eligible patient vaccine even if they state they cannot pay the administration fee

14. Vaccine Ordering Help Desk Monitors orders closely
Assess VFC population based on provider profile
Last month’s usage
Administered during last 3 months
Inventory on hand
It will be extremely important for providers and the helpdesk to monitor vaccine orders very closely to ensure that providers are only ordering quantities of vaccine for their VFC eligible children seen in their practices.
We can’t continue allowing practices to order what they “want” but most put our inventory control practices into place with every vaccine order.
The Immunization Program obtains the VFC population based on information provided when providers report “patient eligibility” when reporting doses administered either through the NCIR or on VAL forms
To determine needed vaccine the following are considered:
VFC population
Usage – last month and in the past 3 months
Inventory on hand

15. Transition Plan $3 million one time funding
Ensure children are up to date for school entry
Kindergarten through 8th grade
Local Health Departments
Private Providers
To assist with the transition of going to a VFC only state the General Assembly provided one time funding of 3 million dollars to be used to purchase vaccines for students entering school for Kindergarten through 8th grades who are not up to date.
The Immunization Branch determined how much of the required vaccines (DTaP, Polio, MMR, Tdap) could be purchased.
Then determined what percentage of vaccines were provided by local health departments to “insured” children not up to date within the appropriate age ranges
Asked the local health departments what percentage of the vaccine they wanted
Divided the remainder to physicians in the county that wanted all 4 vaccines and had appropriate clientele
We’re hoping that these transition vaccines will provide local health departments and private providers a little time to purchase vaccine. We realize these program changes happened quickly and will take time to adjust to – and we thank you for your patience.
Now we will review some of the most common questions we’ve received about the program changes.

16. NCIP Changes Will I still be able to get vaccine from you?
What if I don’t see Medicaid kids?
Can I continue to use NCIR?
These changes to our program have generated a lot of questions – here are some of the most common ones we get:
Yes, for VFC eligible clients
Consider your entire population – uninsured, underinsured, Alaska Native or American Indian
Yes – you will need to submit a new NCIR contract

17. More Questions? Can I use inventory for insured kids?
Do I have to keep a private supply?
How do I purchase private vaccine?
Can I borrow VFC vaccine?
How do I report doses administered?
Will vaccines for adults still be available?
Only if was in your refrigerator/freezer before July 1, 2010
It is recommended that you keep a supply of private vaccine for insured children. You don’t want to refer your patients’ out of their medical home
Visit the NC Pediatric Society Website for information on vaccine purchasing groups
Borrowing VFC vaccine for insured children should be a rare occurrence and should not happen more than once a year. You must document any borrowing of VFC vaccine and keep on file for 3 years.
You will continue to report doses administered – we hope that you will continue to document insured clients into the NCIR and document them on VAL forms. However, only VFC eligible children must be reported.
We plan to continue to use federal funds to purchase adult vaccines that are currently provided to local health departments, federally qualified health centers, rural health centers and hospitals.

18. What are the providers’ responsibilities?
NCIP Vaccine Agreement- All providers have to stay in compliance with the agreement that is signed. Failure to do so may result in termination from the program.
North Carolina Immunization Laws- Provide every child present immunizations required by state law
I’m going to provide you reminders of some of the Providers’ Responsibilities as participants in the NC Immunization Program. These responsibilities have not changed due to the program changes they are the same as they’ve always been.

19. What are the providers’ responsibilities?
Vaccines for Children (VFC) – Verify the client’s eligibility to make sure that they qualify for VFC vaccines.
Site Visits – Required to allow periodic VFC educational site visits and inspection of vaccine supplies and records as requested by the Immunization Branch.

20. Quick Tips
New Address – The facility needs to report the new address at least ten (10) days before the move to the Help Desk.
Changes that might occur at the provider level that the Immunization Branch needs to know about immediately
New Address
No vaccines should be ordered or placed at the new address until the Help Desk has received one week of temperatures for the refrigerator and freezer at the new location.

21. Quick Tips
Staff Turnover – If there are any changes in immunization staff (such as the lead physician, health director who signed the provider agreement, main point person for vaccine deliveries, etc.) – please notify the Help Desk within 10 days!
Staff Turnover
This will help us ensure that all memos, phone calls, and site visits are addressed to the appropriate person.

22. Quick Tips
Joining Satellite Clinics – If the satellite clinic is more than an hour away from the main site, it is best to have the clinic set up as its own individual site in the NCIP.
Joining Satellite Clinics
This helps ensure the viability of the vaccine and prevents the facility from having to pay for wasted/unviable vaccines.

23. Quick Tips
Leaving the Program – If you want to leave the NCIP or if your office closes – please call the Help Desk ASAP.
No longer want to receive VFC vaccines
Allow at least ten (10) minutes for an exit-interview. You will be asked about the reason for closing/withdrawal and where you will transfer your facility’s vaccines.

24. What Are Your Questions?

25. On to the fun…