A L k into the VFC World and the 2014 Changes

1. Audio: 1-877-668-4490 Access Code: 572 532 472 A L kinto the VFC World and the 2014 Changes Presented By: Lori Hutchinson Vaccine Manager 444-0277 lhutchinson@mt.gov Katie Grady-Selby VFC Quality Specialist 444-1613 Kgrady@mt.gov

2. House Keeping We are muting all participants upon entering the presentation We do have the chat option that will allow you to type a question in that can be sent to just the host or the entire group if necessary This presentation will be posted to www.immunization.mt.gov under the VFC Training and Resource Page Let’s get started!! 2014 Regional Workshops

3. Objectives: • Remind VFC providers of current requirements • Summarize new requirements for 2014 2014 Regional Workshops

4. Topics: • Eligibility Screening • Screening and Document • Vaccine Storage and Handling • Vaccine Storage Units • Monitoring Temperatures • Data Loggers/Paper Temperature Logs • Inventory Management • imMTrax inventory • Reconciliation • Ordering Vaccine • Receiving Vaccine • Transferring Vaccine to another clinic • Short dated vaccines • 2014 Changes and New Requirements • Handbook Updates • Borrowing 2014 Regional Workshops

5. Fast Facts about the Vaccines for Children (VFC) Program • The VFC program improves vaccine availability nationwide by making federally purchased vaccine available to both public and private providers. • The program was implemented in October 1994 as part of the President’s Childhood Immunization Initiative. • Benefits to VFC Providers: • Reduces referrals of children to local health departments allowing them to stay in their “medical home.” • Saves VFC-enrolled providers out-of-pocket expenses for vaccine • Eliminates or reduces vaccine cost as a barrier to immunizing eligible children 2014 Regional Workshops

6. VFC Eligibility • VFC providers are required to screen ALL patients for VFC eligibility and document the results at EVERY immunization visit. • Basic Eligibility Criteria • Medicaid Eligible: A child who is eligible for the Medicaid Program • Uninsured: A child who has no health insurance coverage • American Indian/Alaska Native: As defined by the Indian Health Care Improvement Act • Underinsured: A child who has commercial (private) health insurance, but the coverage does not include vaccines. (ONLY APPLIES to FQHC and RHC) Reminder: Healthy MT Kids Plus children are Medicaid eligible. Healthy MT Kids children are privately insured. 2014 Regional Workshops

7. Documenting VFC eligibility • You must document VFC eligibility screening results at EVERY immunization visit. • Acceptable Methods of Documenting VFC Eligibility Include • imMTrax- Document when recording patient immunization (Integrated Providers only). If you do not manage your private vaccine in imMTrax, you must document eligibility screening for privately insured patients outside of imMTrax. • State-Supplied Eligibly Form- Paper based eligibility tracking logs (Found on our website) • Clinic Computer-Generated Report- For clinics on an EHR or electronic billings system • Comprehensive Screening Form- For providers that serve 100% American Indian/Alaskan Natives 2014 Regional Workshops

8. Methods of Documenting VFC Eligibility Cont. 2014 Regional Workshops

9. Resources to assist with Eligibility Screening • Eligibility Cheat Sheets • Know who you can & can’t serve and the proper eligibility designation • VFC Provider Handbook • Section 4 - Eligibility • HMK Plus and HMK Eligibility Portal • Billing Extract in imMTrax • (integrated providers only) 2014 Regional Workshops

10. Vaccine Storage and Handling • Dormitory-Style Storage Units are Prohibited. • Any provider obtaining new or replacement equipment is required to follow CDC recommendations and obtain stand-alone units: • When commissioning new unit(s): Monitor temps for one week, send data to IZ Program, wait for approval before placing VFC vaccine in that unit. 2014 Regional Workshops

11. Monitoring Temperatures • Record temperatures twice a day on the IZ Program paper temp logs: • Record current, min, and max temps each morning • Just current temp in the evening • Download data loggers once a month (or as needed), review and archive data • Update cold chain in imMTrax from paper temp logs • Don’t ignore out-of-range temps or REDlights on the data loggers!!1 2014 Regional Workshops

12. imMTrax Reconciliation • Reconcile your imMTrax inventory monthly. • DON’T reconcile if your amounts are incorrect. • Examples: • If your inventory on hand column dose not match what you have in your storage units. • Fractional dose quantity in the IOH column • Missing doses and not sure why?…Run the Transaction Report. 2014 Regional Workshops

13. imMTrax Ordering • Order online NOT on paper order forms. • Order by the 15th of the month. • Order by the dose, NOT by the box or package • Example: • Order so you have a three-month supply on hand (including current inventory). • Don’t order vaccine each month to replenish the stock you used in the last month. • What’s your three-month supply? • Integrated providers can run the “Vaccine Usage Report.” • Aggregate providers can use doses administered or imMTrax transaction reports . 2014 Regional Workshops

14. Receiving Vaccine • You will receive an e-mail from the IZ Program the morning vaccine shipments are due at your facility. • We are not able to send e-mails for varicella containing shipments. • Must accept orders in imMTrax within 24 hours of receiving vaccine at your facility. • Check the packing slip against what is in the box AND imMTraxbefore accepting order. • ALWAYS…….accept all vaccine orders and transfers before reconciling your inventory!!! 2014 Regional Workshops

15. Short Dated Vaccines • Actively manage your inventory to avoid expired vaccine!!! • Contact other VFC providers within driving distance that could use the vaccine before it expires. • If they can take the vaccine, coordinate the transfer. • Submit a transfer approval form to the Immunization Program before physically exchanging the vaccine. • We will respond within 24 hours of receiving the form. • Transfer the vaccine to the receiving provider in imMTrax under Manage Transfers. • If you are the receiving site, accept the transfer immediately after physically receiving the vaccine. • VFC provider list by county: • http://www.dphhs.mt.gov/publichealth/immunization/documents/ProviderList.pdf 2014 Regional Workshops

16. VFC Transfers Continued Sending Site will see… Receiving Site will see… 2014 Regional Workshops

17. Wasted, Expired, and Spoiled Vaccine • Wasted and Expired Form 205.2. Must be filled out for ALL wasted, expired, and spoiled vaccine. Instructions are on the form. • Only spoiled and expired vaccine should be returned to McKesson. • Any vaccine where the vial/syringe seals have not been opened or compromised. • Examples: expired doses, doses spoiled due to temperature issues. • Wasted vaccine should be recorded on the form, but NOT returned to McKesson. Use Reason 10 and dispose of according to your policy. • Wasted vaccine is any dose were the vial/syringe seal has been broken or compromised. • Examples: Opened multi-dose vials, vaccine drawn up but not administered. • The number of doses should be total doses not total number of boxes. 2014 Regional Workshops

18. 2014 Regional Workshops • Steps for returning Wasted and Expired Vaccine • Fax the form to the Immunization Program. • We will email a print screen that must be printed and included in the shipping container with the returned vaccine. • You should receive a shipping label from McKesson within7-10 business days. • The vaccine listed on the print screen MUST match the vaccine you are sending back in the box. If it is do not, contact the Immunization Program to correct the print screen. • If print screen doesnot match DON’T send the vaccine back…. • Return the vaccine!!!

19. Changes for 2014 2014 Regional Workshops

20. Change Management: • The Immunization Program is required to implement new requirements within 90 days of release from the CDC. • Provider notification of new requirements: • Update the VFC Provider Handbook/Vaccine Management Plan • Changes highlighted in yellow • Distribute to VFC providers: • Post to website • All VFC-Provider email • Paper copy to all VFC providers: • Distributed at Regional Meetings or • Certified mail (combined with mandatory Hot Topic webinar repeating regional presentation) 2014 Regional Workshops

21. Provider Responsibilities: • Discard previous version (in with the green!) • Understand and implement any new requirements. 2014 Regional Workshops

22. 2014 Handbook Updates - Vaccine Transport: • The CDC is revisiting vaccine transport guidance. • CDC current position – “The CDC discourages regular transport of vaccine.” Instead, encourages good inventory management so that transport is not necessary. • Transport definition: the movement of vaccine between VFC providers using private vehicles or couriers where the expected duration of transport is less than eight hours or a regular business day. • Two updates in the VFC Handbook: • Section 12 – Packing and Transporting Vaccine – Includes the latest from the CDC Vaccine Storage and Handling Toolkit • Preference for transporting in electric coolers • Caution against using frozen cool packs for refrigerated vaccine. • Section 16 - Transfers – Includes language about discouraging transports and encouraging good inventory management. • IZ Program still allows transfers. Must be pre-approved. 2014 Regional Workshops

23. 2014 Handbook Updates: • Section 1 – Introduction - Document Retention • VFC-related is still 3 years • Added other State laws pertaining to retention of records: • Medical Records: • Hospitals – 10 years • Other Providers – 6 years • Medicaid Billing Records (HMK Plus) – 6 years and 3 months • Section 4 - Eligibility Screening • Included CDC table summarizing insured scenarios • Clarified that screening of privately insured patients must be documented at each visit and reported in Provider Profiles, • Section 5 – ACIP • Included “for the child” • Section 12 – Vaccine Management Plan (VMP) Update and Review • Added columns for date and signature of preparer (updater) 2014 Regional Workshops

24. 2014 Handbook Updates: • Section 13 and Section 14 • Added that the IZ Program will randomly request temperature monitoring information (data logger data and temperature logs) • Section 19 – Provider Education Requirements • Added Data Logger Basics Webinar • Added that information on annual provider education will be distributed in October each year (completion deadline January 1) 2014 Regional Workshops

25. 2014 Handbook Updates: • Vaccine Borrowing • Definition: The temporary transfer of vaccine between public and private stock at a VFC provider facility in order to avoid a missed opportunity to vaccinate. • The CDC is scrutinizing borrowing practices and tightened the requirements. • Administering VFC vaccine to an ineligible child is against the law and constitutes program fraud and abuse. • “Borrowing” is one exception. • You MUST have borrowing (and payback) documented on a Borrowing Form. Otherwise, it is ILLEGAL. 2014 Regional Workshops

26. Section 16 (page 71) Vaccine Borrowing • Allowed Borrowing Circumstances • Borrowing should not be a routine vaccine management practice and is only allowed under the following circumstances: • Lack of stock due to delayed vaccine shipment • Vaccine spoiled in-transit to provider • New staff who calculated ordering time incorrectly • VFC seasonal influenza vaccine is not yet available or is delayed at the beginning of influenza season (any other borrowing of influenza vaccine is prohibited) • For providers with a small number of privately insured patients, short-dated private vaccine can be administered to VFC-eligible patients and replaced with VFC stock. • To repay private stock when insurance billing reveals that the patient is uninsured or underinsured (FQHC/RHC only) in respect to the vaccine given (See Section 4, page 15 for VFC definitions of uninsured and underinsured). • Borrowing VFC vaccine must not prevent a VFC-eligible child from receiving a needed vaccination. 2014 Regional Workshops

27. Vaccine Borrowing Resources and Forms Report Form 206.2 Borrowing and imMTrax Diagrams imMTrax Extract for Billing(For integrated sites only) 2014 Regional Workshops

28. 2014 Regional Workshops • VFC Monthly Hot Topics • Twice a month • 4th Tuesday at Noon and 4th Thursday at 8 :00 a.m. • Same presentation offered twice to accommodate schedules • Schedule and past presentations are located:http://www.dphhs.mt.gov/publichealth/immunization/vfctraining.shtml • If you want a topic presented, please notify Katie Grady-Selby or Lori Hutchinson and we will make that happen

29. 2014 Regional Workshops Katie Grady-Selby VFC Quality Specialist 444-1613 kgrady@mt.gov Lori Hutchinson Vaccine Manager 444-0277 lhutchinson@mt.gov MTVFC Montana Immunization Program 444-5580 hhsiz@mt.gov