1. 2012 PROPOSED VACCINE POLICY TISWG December 8, 2011

2. Increase in Cost Decrease in Funds

3. Reasons include program expansion, vaccine development, and vaccine price increases. July 2011: CDC distributed a Cost and Affordability Tool to each of its grantees (states, cities, territories) Reassessment of vaccine finance policies funding available for fiscal year 2012 populations served = (TVFC and adult eligibility) Ensure Funding to support state policies CDC expected implementation of new policy by October 2011

4. 1. Federal Vaccines for Children (VFC) Program- covers federal VFC eligible populations 2. Federal Section 317 - discretionary funding from the CDC, may support state policy for children or adults (reduced over $7 million to about $12.3 Million) 3. State General Revenue used to support state policy for children, adults, and emergency biologicals (estimated $6.3 million) 4. State CHIP Reimbursement is received from the CHIP program and passed directly through to the CDC (22.7 million) Amount to support policy expansion (estimated at 18.6 million)

5. Policy Implications Fully Insured Children Underinsured Children Adults

6. Texas policy currently allows insured children to receive TVFC vaccines in public health clinics. Safety net for Medicaid children Support higher coverage levels Under federal policy, fully insured children are not eligible for VFC vaccines.

7. Fully Insured Children: Proposed Changes All fully-insured children presenting at a public health clinic will be redirected to their medical home for immunizations (save $9 million) LHD/HSR work with schools and other community partners to refer children appropriately LHD/HSR identify providers as referral sources DSHS tools and referral protocol

8. TVFC definition of underinsured is broad and includes patients with insurance that has high copays and deductibles. Texas VFC policy allows underinsured children to be seen in any TVFC provider office. Federal VFC The federal definition of underinsured does not include high copays and deductibles. All underinsured children must be immunized in an FQHC or RHC

9. Underinsured Children: Proposed Changes Change the definition of underinsured to be consistent with the Federal VFC. Eliminate high copays and deductible from definition Any covered vaccine is considered fully insured and must be referred to provider that accepts insurance. Underinsured children (by new definition) continue to be served in their medical home (not required to be referred to FQHC or RHC) Deputize local health department and State health service regional clinics to operate as FQHCs/RHCs (allow all underinsured children served with VFC- funded vaccines).

10. Delegation of Authority (DOA) a.k.a. Deputization The DOA process was established to allow the FQHC/RHC to delegate their authority to vaccinate this [underinsured] population to other VFC providers. Non-FQHC/RHC VFC providers who have a DOA are able to vaccinate the underinsured population using VFC funds.

13. Adult Safety Net Safety-net program intended to serve the uninsured adult seeking services at local health department clinics, Health Service Region clinics and STD clinics. Adult program has expanded both in the number of vaccines and the types of providers A hepatitis B initiative grant in 2008 allowed for recruitment of family planning facilities, FQHCs, jails, HIV clinics and substance abuse clinics. Estimated cost to support adult program at current level is $15 million

14. Adult Safety Net: Proposed Changes Expanding MCV4 temporarily to support legislation for first time college students (through January 2012) Retain all adult safety-net sites, but restrict the vaccines offered based on available funding. Adults who started a series while TVFC- eligible may finish the series using ASN until their 20 th birthday.

15. Communication Plan Dates for all the changes not yet determined Public Message Community Partners Regional and Local Health Departments TVFC and Adult Safety Net Providers

16. QUESTIONS