VACCINE FOR CHILDREN (VFC) PROGRAM

1. Tennessee VACCINE FOR CHILDREN (VFC) PROGRAM VFC Highlights and Updates Robert H. Brown Vaccine For Children Program Manager 2010 Annual Immunization Spring Review 13-16 April 2010

2. Tennessee VACCINE FOR CHILDREN (VFC) PROGRAM VFC Protocol

3. VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section A - Enrollment/ Annual Re-Enrollment: • To enroll/re-enroll (annually) as a VFC program provider, the • following forms must be completed: • -VFC Provider Enrollment form (PH-3349, Revised 11/08), which has two pages • -VFC Provider Profile form (PH-3348, Revised 10/08) • -Emergency Vaccine Storage and Handling Plan form (PH-3800, Revised 10/08) • -Initial (One-Time Only) Varicella Order and Provider Survey (Enrollment Only) NOTE: PRACTICES WITH MULTIPLE SITES MUST ENROLL EACH SITE AS A SEPARATE VFC PROGRAM PROVIDER.

4. This area summarizes the VFC Protocol in which the provider acknowledges the program requirements and agrees to abide by them. VFC Provider Enrollment form (PH-3349, Revised 11/09), which has two pages

5. Identifies the status of the provider in the VFC Program The provider estimates the number of patients served in their facility for a one year period The provider indicates the source used to determine the number of VFC eligible children VFC Provider Profile form (PH-3348, Revised 11/09)

6. VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section B - Requirements to Participate in the VFC Program: • All provider changes must be communicated to the VFC Program: • - Change of address, telephone, or fax • - Change in VFC contact person • - Change in the number of VFC eligible children • - Additions/deletions of physicians to provider site All changes can be faxed or emailed to Becky Loveless

7. VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section C - Eligibility Criteria Categories: IN ALL VFC Sites: Persons who are 18 years of age or younger, and meet one or more of the following categories: • Uninsured • (b) Enrolled in or eligible for TennCare (Medicaid) • (c) American Indian or Alaskan Native Note: CoverKids are fully insured and NOT VFC eligible.

8. VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section C - Eligibility Criteria Categories cont: ONLY IN VFC FQHCs, RHCs and Health Departments Sites: • (d) Underinsured Children are eligible only in FQHCs, RHCs and Health Departments • The following conditions are defined as “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) • A child whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the child is categorized as underinsured.

9. VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section D - Vaccine Accountability: • Vaccine Doses Accountability Report (VDAR) (PH-3350 Rev 10/08): Submit monthly even if vaccines were not administered during month. • Report must be completely filled out with all the proper information. • The VFC Program no longer has the ability to ship vaccine as an “emergency” rush order but additional orders can be requested, if necessary.

10. VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section D - Vaccine Accountability: • As of January 1, 2010 Tennessee’s Vaccines for Children (VFC) • has fully adopted the CDC policy for “Two Directional Borrowing” • which means the borrowing of VFC vaccines for private patients • or privately purchased vaccines for VFC patients. • Borrowing should only occur when there is a lack of appropriate • stock vaccine due to unexpected circumstances such as: • Delayed vaccine shipment • New staff that calculated ordering time incorrectly • Vaccine spoiled in-transit to provider Note: VFC vaccine cannot be used as a replacement system for a provider’s privately purchased vaccine inventory.

11. VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section D - Vaccine Accountability: • When borrowing vaccines the provider must follow these • guidelines: • Providers must notify VFC Program • Document all borrowed vaccine on the CDC VFC • Vaccine Borrowing Report Form • The borrowing reports must be kept as part of the VFC • program records and be made available to the VFC staff • during the VFC Site Visit. Note: VFC-enrolled providers are expected to maintain an adequate inventory of vaccine for both their VFC and non-VFC-eligible patients.

12. The Guidelines and Direction for use of this form must be followed The provider must document all borrowed vaccine on the CDC VFC Vaccine Borrowing Report Form VFC Vaccine Borrowing Report

13. VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section E - Proper Vaccine Storage and Handling: • After January 1, 2009, all VFC providers can no longer use dorm style units or combination units with single thermostats as the primary storage unit. Providers may use separate refrigerators and freezers or combination unit with separate thermostats for refrigerator and freezer section.

14. VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section H- Non-Compliance with VFC Program Protocols: • TIP has adopted CDC guidelines for responding to provider non-compliance with VFC Program Protocol identified during VFC site visits. Section I - Request for Inactivation in the VFC Program: • A VFC provider may request to withdraw from the VFC Program at any time by submitting the request in writing along with a completed Vaccine Transfer Form (PH-4023). Vaccines will be picked up by a regional VFC representative.

15. Tennessee VACCINE FOR CHILDREN (VFC) PROGRAM Vaccine Management

16. Pre-filled (PF) syringe gives the provider a choice Allows provider to order the amount vaccine requested • Vaccine Doses Accountability Report (PH-3350, Rev 11/09) must be submitted monthly.

17. Section B for Health Department Staff Only Recipient must complete the transfer section and fax to the VFC Program • Vaccine Transfer Form (PH-4023)

18. Expired or Wasted Vaccine Report (PH-3589, Rev 11/09) This area was updated with the corrected NDC# for Flu Vaccine and New Vaccines Return to McKesson only spoiled or expired vaccines, in their original vials or pre-filled syringes.

19. VACCINE FOR CHILDREN (VFC) PROGRAM Updates Economic Order Quantity (EOQ) Vaccine Inventory Management (VIM)

20. VACCINE FOR CHILDREN (VFC) PROGRAM Economic Order Quantity (EOQ) • In 2010 the Tennessee Vaccines For Children (VFC) Program will began implementing the next phase of vaccine distribution, Economic Order Quantity (EOQ). EOQ is an effort by CDC to implement best practices for vaccine ordering. • It strives to balance order size, order frequency, and storage & handling costs with a goal of improving vaccine flow nationwide. • EOQ assigns ordering tiers for providers based on annual volume of publicly–funded vaccine ordered.

21. VACCINE FOR CHILDREN (VFC) PROGRAM Ordering Guidelines of EOQ The EOQ guidelines places providers in four categories based on their annual volume of doses ordered per year to determine the number of times a provider should order vaccine. High volume 6000 doses/year Monthly 12 times a year Med volume 800-5999 doses/year Bi-monthly 6 times a year Low volume 200-799 doses/year Quarterly 4 times a year Very low volume 0-199 doses/year As is no change

22. VACCINE FOR CHILDREN (VFC) PROGRAM Goals of EOQ • The goal of EOQ is to improve vaccine flow and NOT to run out of vaccines. • To help ensure you do not run out of vaccines. Note: No matter when your scheduled order date is, if you are running out of vaccines, place an order.

23. VACCINE FOR CHILDREN (VFC) PROGRAM Vaccine Inventory Management (VIM) • VFC vaccine Ordering • Inventory control and Reconciliation

24. Tennessee VACCINE FOR CHILDREN (VFC) PROGRAM VFC Program Operations Robert Brown (615) 532-8513 Robert.Brown@tn.gov Vaccine replenishment status requests Madelyn Ragland (615) 253-6915 Madelyn.Ragland@tn.gov Provider Enrollment and Short-Dated Vaccines Reporting Becky Loveless (615) 253-4072 Rebecca.Loveless@tn.gov