California Vaccines for Adults (VFA) Program - …

1 California Vaccines for Adults (VFA). Program - Year 2 Program Requirements - Immunization Branch, California Department of Public Health December 13, 2017. California Departm ent of P ublic Health 1. Session Outline VFA Program Overview Patient Eligibility Storage and Handling VFA Resources VFA Program Requirements Year 2. Questions California Departm ent of P ublic Health 2. CA Vaccines for Adults (VFA). New Program implemented in June 2016. VFA Program Goals and Objectives To provide Vaccines at no cost to eligible Adults Expand access to 317-funded Vaccines to Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) in California To integrate the standards for adult immunization practice into routine adult clinical care ASSESS immunization status of all adult patients at every visit Strongly RECOMMEND Vaccines that adult patients need ADMINISTER needed Vaccines or REFER to a provider who can immunize DOCUMENT Vaccines received by your adult patients California Departm ent of P ublic Health 3.

2 VFA Program Participation Eligibility Federally Qualified Health Centers, FQHC Look-Alikes, and Rural Health Centers that can demonstrate: Participation in the California Vaccines for Children Program (VFC);. Experience providing a safety net for uninsured and underinsured Adults ;. Participation in an Immunization Information System ( , California Immunization Registry - CAIR) or use of an Electronic Health Record (EHR) system. California Departm ent of P ublic Health 4. VFA Program Enrollment Year 1: Selected 457 clinical sites for enrollment: - 440 sites that belong to 108 FQHCs and FQHC. lookalikes - 17 RHC, Indian Health Services (IHS) or tribal health sites Year 2. Enrolled 61 additional clinical sites from VFA participating health center organizations - Sites belong to 24 FQHC and lookalike organizations California Departm ent of P ublic Health 5. VFA Program data Doses administered during Year 1. Quarterly Administration Data 68,719 vaccine 24,664 doses 28314.

3 20,785 administered 14,925 during Year 1. 8,682. Q1 Q2 Q3 Q4. 8032. 5731 6123 6389. 3078 3747. 2043 2147 2340. 775. California Departm ent of P ublic Health 6. VFA Year 1 Accomplishments During July 2016-June 2017: Enrolled and provided Program support and technical assistance to 457 clinical sites Developed educational materials and Program resources for participating clinics and conducted 3 webinars attended by 500+ participants Developed system to collect quarterly reports of vaccine administration and Program qualitative data Conducted key informant interviews to identify facilitators and barriers to Program implementation; synthesized and presented findings at state and national meetings Conducted Program survey to inform planning for Year 2. California Departm ent of P ublic Health 7. VFA Year 1. California Departm ent of P ublic Health 8. Population eligibility to receive 317 VFA. Vaccines Eligible to receive 317 Vaccines Uninsured and underinsured Adults , 19 years of age and older, served by the clinic.

4 Uninsured: A person without any health insurance coverage (public or private coverage). Underinsured: A person who has health insurance, but the coverage does not include Vaccines or a person whose insurance covers only selected Vaccines . California Departm ent of P ublic Health 9. Population eligibility to receive 317 VFA Vaccines Not eligible to receive 317 Vaccines Fully insured Adults whose insurance covers the cost of vaccine , even if: The insurance includes a high deductible or a co-pay;. 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;. The insurance has cost-sharing; these individuals must pay out-of-pocket for immunizations. Notes: Unlike the VFC Program , Adults with full scope Medi-Cal are considered insured, and therefore not eligible to receive 317 Vaccines . Seniors without Medicare Part D, and who do not have Medi-Cal or other insurance that covers Vaccines , are considered underinsured and are therefore VFA eligible and may receive the Vaccines that would be covered under Part D.

5 California Departm ent of P ublic Health 10. Vaccines available through VFA. Most ACIP-recommended adult Vaccines are available through the Program : Hepatitis A vaccine Hepatitis B vaccine HPV vaccine MMR vaccine MCV4/MenACWY. Pneumococcal conjugate (PCV13). vaccine Pneumococcal polysaccharide (PPSV23). vaccine Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine Tetanus and diphtheria toxoids (Td). Zoster California Departm ent of P ublic Health 11. vaccine Shipments Label Vaccines received according to their funding source, and store them in the pre-designated shelf/area of the vaccine storage unit. California Departm ent of P ublic Health 12. Key Elements in Storage and Handling Skilled Written vaccine and trained staff Management Plans Accurate Appropriate temperature vaccine storage monitoring units equipment Proper temperature monitoring AND. documentation California Departm ent of P ublic Health 13. Program Resources California Departm ent of P ublic Health 14.

6 VFA Program FAQs Program Resources VFC Store California Departm ent of P ublic Health 16. CDC's Adult IZ Resources for- /hcp/ Immunization Action Coalition's Adult IZ Resources California Departm ent of P ublic Health 18. California Departm ent of P ublic Health 19. Program Requirements Changes for Year 2. VFA vaccine -related charges, including fees for administering (injecting) Vaccines To ensure that VFA-eligible patients will not incur additional costs outside of any routine copay for the clinic visit, VFA Program sites shall: Not charge eligible patients or third party payers for the cost of the 317-funded VFA Vaccines . Not charge a vaccine administration fee to eligible patients for 317-funded VFA. Vaccines . Prominently post a sign clearly visible to patients which states that: FREE Vaccines are available to adult patients who are uninsured or have insurance that doesn't cover (certain) Vaccines . We do not charge these patients for getting the vaccine or for the cost of the vaccine .

7 California Departm ent of P ublic Health 20. Program Requirements Changes for Year 2. VFA Ordering and Reporting Year 1. Quarterly reporting of inventory and doses administered, and Program implementation- related information No pre-determined schedule for ordering Ordering and reporting done at the clinical site level (vs. organization-level). California Departm ent of P ublic Health 21. Program Requirements Changes for Year 2. VFA Orders Orders will be submitted quarterly during a two- week period at the beginning of each quarter Ordering periods for year 2: - January 2-16, 2018. - April 2-16, 2018. - July 2-16, 2018. - October 1-15, 2018. California Departm ent of P ublic Health 22. Program Requirements Changes for Year 2. Reporting/Evaluation Required to submit two evaluation reports: Midyear interim report, due July 2018. Final report, due January 2019. Reports to be submitted at the FQHC/RHC organization level (vs. clinical site).

8 The data that you will need to report on: immunization coverage rates of VFA eligible patients, for three Vaccines , and data on progress of implementation of evidence- based interventions related to the standards for adult immunization practices. California Departm ent of P ublic Health 23. Program Requirements Changes for Year 2. Documenting vaccine administration or declination Year 1: Required to document vaccine administration using an Immunization Registry, Electronic Health Record (EHR), or 317 Adult vaccine Daily Usage Log. California Departm ent of P ublic Health 24. Program Requirements Changes for Year 2. Documenting vaccine administration or declination Year 2. All VFA providers must have a system in place to ensure all vaccine doses administered are documented electronically. The system must be designed to include options to access the data in the event that the platform used for documentation is down. The backup plan/alternate method may include entering doses administered in the 317 Adult vaccine Daily Usage Log, in addition to the patient's medical record.

9 California Departm ent of P ublic Health 25. Program Requirements Changes for Year 2. Documenting vaccine administration or declination You may document VFA vaccine doses administered using one of the following options: 1. Enter doses directly into your Electronic Health Record (EHR) and transmit data to the immunization registry If your clinic is in one of the California Immunization Registry (CAIR) regions using CAIR2. software, consult with your EHR vendor and visit the CAIR IZ Portal Registration Page to learn about setting up electronic data exchange to automatically populate CAIR with EHR data If you are NOT in a CAIR2 region, consult your EHR vendor and contact your local representative for instruction regarding electronic data exchange through the San Diego Immunization Registry (SDIR), Healthy Futures (San Joaquin and nearby counties), OR Imperial County Immunization Registry. OR. 2. Enter doses directly into your immunization registry (in CAIR2, as 317 LHD.)

10 HDAS doses). Contact your Local CAIR Representative if you have any questions. California Departm ent of P ublic Health 26. Program Requirements Changes for Year 2. Documenting vaccine administration or declination Patient declination of immunization should also be documented in the patient's medical record. The Department of Healthcare Services requires that Medi-Cal Managed Care plans document in an adult patient's record immunization declination in the form of a signed statement. California Departm ent of P ublic Health 27. VFA Program Year 1 Year 2. Requirement 1. vaccine ordering As needed, by clinical site Quarterly only, by clinical site. 2. Reporting Quarterly (or before next Quarterly only, by clinical site, at the time of inventory and doses order), as part of progress order submission. administered report. By clinical site. 3. Evaluation reports Quarterly, by clinical site; Biannually, by organization; quantitative qualitative data only.