CHILD Profile
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Immunization Program |
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Immunization Program CHILD Profile |
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A: The childhood vaccine program is transitioning from a universal system where the state supplied all vaccines for children to a system where the state supplies vaccine for only some children. Starting July 1, 2009, children with private health insurance will no longer be eligible for state-supplied HPV vaccine. Then, starting May 1, 2010, children with private health insurance will no longer be eligible for any state supplied vaccine.
The State Childhood Vaccine Program will still buy vaccine for children who are eligible for the Vaccines for Children (VFC) program and children in state-sponsored health plans, like the Basic Health Plan and the State Children’s Health Insurance Program. The VFC program provides vaccines to children who are Medicaid eligible, American Indian/Alaska Native, uninsured children, and children who are underinsured for vaccines.
The Immunization Guidelines for the Use of State-Supplied Vaccine have more information about who can receive state-supplied vaccines.
Q: If an adolescent girl with private insurance has started, but not completed the HPV vaccine series, can she finish the series with state-supplied HPV vaccine after July 1, 2009?
A: No, all privately insured children will need to be given HPV vaccine that has been privately purchased by the provider.
Q: What will the new program in Washington be called? How many other states are already using a similar program? (Added June 23)
A: Our new program will be called the Washington State Childhood
Vaccine Program. Beginning July 1, 2009, it will provide vaccine for all
children except HPV vaccine, which will not be provided to privately insured
children. Beginning May 1, 2010, the Childhood Vaccine Program will provide
vaccines for children who are VFC eligible (including children who are Medicaid
eligible, Alaska Native or Native American, uninsured for vaccines, and
underinsured for vaccines) and children enrolled in state-sponsored health plans
for low-income children.
The Centers for Disease Control and Prevention (CDC) has information on its Web
site about the various state childhood vaccine programs at
www.cdc.gov/vaccines/programs/vfc/projects/data/vacc-supply-public-2006.htm.
This information is somewhat outdated, as a number of universal states have
changed their programs. There is not a category on the CDC Web site that fully
describes what Washington will be starting on May 1, 2010, so we will probably
be listed as "other."
Q: How will the information about the changes to the Washington State Childhood Vaccine Program be communicated to the public? (Added June 23)
A: We are planning a news release for late June and will also incorporate this information in immunization mailings to schools. We are also looking at developing fact sheets for parents that will be available on our Web site and could be used in provider offices. During the second phase of the transition, when all childhood vaccines are affected, we are considering including information in the CHILD Profile Health Promotion mailings. We will also be providing information about the changes to Department of Social and Health Services' 1-800 number staff and private health insurance plan staff so that they have information to share with their enrollees and providers.
Q: How is the state going to measure the success and challenge of this transition? When will these measurements be taken? How will the results of these measurements be communicated to stakeholders? (Added June 23)
A: Performance measures that will be taken include:
We will communicate this information through all of our normal communication activities, including stakeholder meetings, advisory committees, coalition meetings, the Web site, newsletters, etc.
Q: Does this change impact the Vaccines for Children (VFC) program status screening?
A: No, VFC status screening requirements will not change. Health care providers will still need to screen children for VFC eligibility at every visit. More information about VFC status screening, including frequently asked questions, is available.
Q: Do I need to verify a parent report that their child is VFC eligible?
A: No, health care providers are not required to verify any information a parent reports about VFC eligibility. The program requirements are just that a provider asks about VFC eligibility, record that information in the patient chart, and if the parent reports they meet one of the criteria, then give the child state-supplied vaccine.
Q: Do I need to verify if a child is Native American?
A: No, health care providers are not required to verify Native American children’s status. These children, birth through 18 years of age, are eligible for VFC vaccine.
Q: Many teens seen in our Family Planning clinic want to keep their visit confidential. We have been targeting these young women in our outreach efforts for HPV vaccine. Since they do not want their parents to know they are here, we cannot bill the parents’ insurance, if they have any. For some, Take Charge is their only insurance. Are these teens underinsured? (Added June 23)
A: Adolescents seen in Planned Parenthood clinics may be considered "unaccompanied minors," and their Vaccines for Children status is captured as uninsured for purposes of vaccination. They are eligible for state-supplied vaccine. If Take Charge is their state-sponsored health plan coverage, they are eligible for state-supplied vaccine.
Q: If we are screening for Vaccines for Children (VFC) eligibility and only providing state-supplied vaccine to those who qualify, do we need to document how they qualify? (Added June 23)
A: You do have to document the VFC status in the child’s chart, but you do not have to capture it on the doses administered report. We will ask for a practice profile at the end of the year from each clinic. The usage report that captures VFC patient counts is an optional method for providers to use to assist them (if needed) with providing their practice profile data at year's end. It is not required.
Q: Will the Healthy Options programs now be required to cover vaccines and reimburse us or will they fall under the category of state-supplied vaccine? (Added June 23)
A: Healthy Options is a Department of Social and Health Services Medicaid managed care insurance. These children are eligible for the VFC program and their VFC status is Medicaid. They should receive state-supplied vaccine.
Q: How should children on state-sponsored health insurance plans for low income be marked in VFC status screening? (Added June 23)
A: Children in state-sponsored health plans are in the category of “insured” for VFC status screening. They can receive state-supplied vaccine. The billing process for the state-sponsored health plans will not change with regard to the administration fees and office visit fees that are currently allowed. These plans cannot be billed for state-supplied vaccine, so the key issue is how to ensure state-supplied vaccine is used for these children and communicate that information to the person administering the vaccine.
Suggestions for communicating this information:
Q: Many providers are using the Patient Vaccines for Children Status Screening Form. Will this form be revised now that the underinsured are considered VFC eligible even when they are not being seen at a Rural Health Center or Federally Qualified Health Center? (Added June 23)
A: A new form will be available soon without the reference to Rural Health Centers and Federally Qualified Health Centers.
Q: Has the state developed a checklist for providers to use to verify if a patient is VFC eligible, underinsured, or privately insured? (Added June 23)
A: These tools are already available. The state began implementation of VFC Status Screening in January 2009. Several tools are available on online at www.doh.wa.gov/cfh/Immunize/vaccine/vfcstatus.htm. Providers may choose to use their own electronic or paper charting tools.
Q: Will the collection of VFC eligibility data no longer be optional on the provider's vaccine usage report? (Added June 23)
A: The provider will not have to report VFC eligibility on the usage report. They only need to include doses administered and inventory data on vaccine that is state supplied. The usage report that captures VFC patient counts is an optional method for providers to use to assist them (if needed) with providing their practice profile data at year's end. It is not a requirement.
Q: If clinics near the Oregon and Idaho borders serve children from these or other U.S. states, can they be given state-supplied vaccine if they are VFC eligible? (Added June 23)
A: Yes, if the child is from another state and is VFC eligible, they should receive state-supplied vaccine.
Q: If children are automatically covered by Medicaid while incarcerated in a state facility, are they eligible for state-supplied vaccine?
A: If the child is enrolled in Medicaid or a state-sponsored health plan, they are eligible for state-supplied vaccine while incarcerated.
Q: One of our county providers is a Juvenile Detention clinic. Nearly all of their patients are "unaccompanied minors," or kids whose insurance information is impossible to get. Can they automatically categorize all patients as unaccompanied minors?
A: If the child is incarcerated in a state facility, they may be automatically considered eligible for Medicaid. In that case, they are eligible for state-supplied vaccine. If the facility cannot determine the insurance status of the child, the child might be considered uninsured and state-supplied vaccines may be used based on that status. Incarcerated children literally are "unaccompanied minors," and may use state-supplied vaccine based on that status. The status of an unaccompanied minor was specifically designed with HPV vaccine in mind, but could be applied to other vaccines when appropriate.
Q: If all children in a state run facility are considered Medicaid, do they need to enter that information into the CHILD Profile Immunization Registry or just collect the number of kids vaccinated each month? Currently, they are entering the information on each individual.
A: The data could either be entered into the CHILD Profile Immunization Registry or the number of doses administered captured on a monthly basis. Remember, Vaccines for Children status needs to be documented in the child’s chart, so if they are using CHILD Profile, that would be an easy way for them to include the information in the child’s chart. The key is to allow them to choose an option that is easiest for them and the best fit for their business practice. Recording the vaccines administered in CHILD Profile also helps assure the child’s vaccination history is accurate for any providers caring for the child in the future.
Q: Doesn’t the state have many different types of insurance for kids, such as Medicaid and Apple Health? Are these children eligible for state-supplied vaccine?
A: All children in a state-sponsored health plan are eligible for state-supplied vaccine. If a child has a DSHS Medical Assistance Card or is on the state’s Basic Health Plan (BHP), they can receive state-supplied vaccine. Check the child’s medical assistance card at every visit. Please refer to DSHS for specific information about DSHS Medicaid eligibility. The DSHS Web site has information about the various child health insurance programs and may be a useful resource.
Q: What if a child is covered by both Medicaid and private insurance?
A: Any child that has Medicaid coverage is eligible for state-supplied vaccine, even if they also have private insurance. The provider should check with DSHS or the insurance plan to determine how to bill the administration fee.
Q: What does underinsured mean?
A: Underinsured means children have private health insurance that doesn't cover vaccines, or covers only selected vaccines or the insurance has a limit on vaccine coverage. Children who are underinsured can receive state-supplied vaccine for non-covered vaccines or for all vaccines once the coverage limit has been met.
Q: Where can underinsured children be vaccinated?
A: Underinsured children can be vaccinated in their medical home by their regular provider. The state is putting a strategy in place to support this. Providers may need to sign an agreement that allows them to receive state-supplied vaccine for this group.
Q: Where can underinsured children be vaccinated and which vaccine should be used? (Added June 23)
A: Underinsured children can be vaccinated in their medical home and state-supplied vaccine can be used. Initially, the vaccine will be available through federal discretionary funds, and eventually by having providers and local health jurisdictions (LHJs) sign an agreement to have authority to vaccinate underinsured children using VFC vaccine delegated to them. The Department of Health will be contacting all providers and LHJs about this process later this summer. Underinsured children do not need to be referred out to a Federally Qualified Health Center or Rural Health Clinic for vaccination.
Q: How will a provider know if a child is underinsured?
A: Providers may not know a child is underinsured until they have billed the insurance and have been notified that the vaccine is not covered, unless they contact the insurance company prior to the visit. Providers may be able to look up the child’s benefit package online or call the insurer to determine their status as underinsured at the time of the visit. Health plan contact information for billing and coverage questions is available on the Department of Health Web site. It is important to note that the vaccine administration fee for the underinsured child is limited to the Centers for Medicare and Medicaid Services cap of $15.60.
Q: What if the child or their parents/guardians don’t know if the child is underinsured and the provider finds out only after the claim is submitted and payment is denied?
A: Once the insurance responds and payment is denied, the child's status can be changed to underinsured in the record. The child should only be billed the maximum Centers for Medicare and Medicaid Services allowed amount for an administration fee (currently $15.60).
Q: If a provider gives private-purchase vaccine to a child and later finds out the child was eligible for VFC vaccine (for example, because they are underinsured), what happens then?
A: Providers should document the child’s VFC status in the chart and transfer VFC vaccine to their private stock, replacing the private purchase vaccine given to the VFC child. The provider should document the transfer on the provider’s monthly accountability report and record it as a public dose administered.
Q: If a child’s VFC status is underinsured, can the provider bill the child for the portion of the administration fee that the insurance won’t pay?
A: This is a difficult question to answer. Since the child’s insurance policy does not cover vaccines, the insurance company most likely will not cover the administration of a vaccine. It is permissible to bill the child’s parent or guardian for the administration fee. However, the underinsured child can only be billed the maximum of the Centers for Medicare and Medicaid Services administration fee cap. Currently, the Washington State cap is $15.60.
Q: If a health plan covers most vaccines, but not all, is the child underinsured for only the uncovered vaccines? For example, if a health plan covers all vaccines but HPV vaccine, can that child receive state-supplied HPV vaccine? (Added June 23)
A: The patient is only considered underinsured for the vaccine (or vaccines) that are not covered by the health plan. Children with health insurance that does not cover HPV vaccine would be underinsured for HPV vaccine and eligible to receive state-supplied HPV vaccine.
Q: Do we need a denial from an insurance company before we can consider a client underinsured? (Added June 23)
A: No, patient report is enough.
Q: What if a child has a high deductible or co-pay for their insurance?
A: Children with private health insurance with a high deductible or high co-pay will need to be vaccinated with private purchase vaccine. State-supplied vaccine is only for children eligible for the VFC program or in a state-sponsored health plan. High deductibles and high co-pays do not mean the child is underinsured, according to the federal guidelines for the VFC program. These children should be vaccinated in the private provider’s office and not referred elsewhere, as they are not eligible for state-supplied vaccines in any setting.
Q: What if insurance covers vaccines, but pays less than the cost to the provider for purchasing them?
A: Providers will need to negotiate with individual insurance companies regarding the reimbursement for vaccines. Insured children are not eligible for state-supplied vaccine in any setting.
Q: What about private insurance that pays for only part of the cost of HPV vaccine? (Added June 23)
A: If a patient has a private insurance plan with vaccine coverage for HPV vaccine, but the amount that is reimbursed for the vaccine is less than the provider's acquisition cost, the patient is considered privately insured and not eligible for state-supplied vaccine. The reimbursement rate the provider receives for any vaccine is based on the terms of the provider's contract with the health plan. Whether or not the provider is reimbursed the full acquisition cost also depends on what price they negotiate for privately purchasing the vaccine.
Q: Are children with TRICARE health insurance eligible for state-supplied vaccine? (Added June 23)
A: No, TRICARE is private health insurance and they are not eligible for state-supplied vaccine. Children with TRICARE insurance need to be vaccinated with private purchase vaccine and TRICARE should be billed for the vaccine, administration fees, and office visit fees.
Q: How is the state working with insurance companies to communicate this information and help ensure providers are aware of benefit coverage by plan? (Added June 23)
A: Health Plan
Contacts for Coverage and Billing Questions (PDF, 24 KB) is available
for patients and providers to find out about plan benefits. Most insurance
companies have multiple benefit packages that are patient specific. We have
asked insurance plans how they will communicate with providers, and most
indicate they will use their normal channels of communication with providers.
We are in contact with insurers to determine how children in state-sponsored
health plans can be identified in the provider office so that they can receive
state-supplied vaccine. A reference sheet on how to identify children enrolled
in Medicaid or enrolled in state-sponsored health plans is being developed by
the Department of Health and will be available online.
Q: Are any groups forming vaccine purchasing groups?
A: Providers may want to check with local hospitals or larger pediatric practices as volume ordering typically allows providers to purchase at a lower cost. Providers may also want to check with the provider professional organizations about other opportunities.
Q: How is the amount of HPV vaccine a health care provider will get from the state being determined?
A: The Centers for Disease Control and Prevention determines the maximum number of doses of HPV vaccine Washington can receive for VFC eligible children each month. Each health care provider will be given an allocation based on the number of children seen in the practice who are eligible for state supplied vaccine.
The Department of Health is using data from a number of sources to ensure that providers’ vaccine needs for children who are not privately insured are met. Specific steps we are taking include:
Q: How will providers know how much state-supplied vaccine they can get?
A: In mid-June 2009, providers will receive a letter with their HPV allocations for the months of July, August, and September 2009. Providers should review their allocation to be sure it is enough vaccine to cover children eligible for state-supplied vaccine. If the provider has data that shows their allocation should be different, they can get in touch with the Department of Health to determine if an adjustment can be made, and the Department will determine the final allocation based on that discussion.
Q: How will local health jurisdictions know how much vaccine providers in their counties can order?
A: Local health jurisdictions will receive a list of providers in their jurisdictions and the monthly allocations of HPV vaccine for each provider for the months of July, August, and September 2009.
Q: How will provider orders be monitored to ensure they are within the allocation?
A: Local health jurisdictions will still receive provider orders for HPV vaccine (and all other childhood vaccines) and review those orders for accuracy based on the allocation. The Department of Health will monitor each provider order against the allocation as well, to ensure that Washington stays within its allocation amount.
Q: What will I do with existing inventory of state-supplied HPV vaccine starting July 1, 2009?
A: Any existing state-supplied HPV vaccine inventory a provider has on July 1, 2009 should be marked as state supplied and used only for children who meet the new guidelines for state-supplied vaccine that will start on July 1, 2009. Specifically, this is children who are VFC eligible or have state-sponsored health insurance.
Q: Will the order minimums change?
A: Currently, the target order amount is 110 doses, which will not change. However, it is a target number, and if a provider can’t meet the target for orders, they can order less frequently (quarterly or twice a year). Exceptions can be made if providers are still not able to meet the minimums even with less frequent ordering.
Q: What if our HPV allocation doesn't meet the needs of our kids that are VFC eligible (Medicaid, uninsured, underinsured, American Indian and Alaska Native) and in state-sponsored health plans (SCHIP, CHP, BHP)? (Added June 23)
A: Your office should contact the state Department of Health and show them the data you have on the number of children you see that fit into these categories. State staff will work to adjust your allocation so that all eligible children can receive state-supplied vaccine.
Q: Do I have to order all of my HPV vaccine allocation? (Added June 23)
A: No, the allocation is the maximum limit and you can order less. Order what you need to cover children seen in your practice who are VFC eligible or in state-sponsored health plans.
Q: What are the allowable administration fees for vaccine administration?
A: The allowable administration fee depends on a child's health insurance:
Q: What can you tell us about reimbursement rates from the Department of Social and Health Services (DSHS), Regence, and Premera for the cost of the vaccine purchase and storage?
A: DSHS patients less than 19 years of age are eligible for
state-supplied vaccine, and DSHS will not reimburse the vaccine cost for them.
DSHS doesn’t allow a storage fee, but does reimburse for the administration fee.
Vaccine for DSHS patients aged 19 and 20 years will be reimbursed at the
acquisition cost of the vaccine.
We do not have specific information about reimbursement by Regence and Premera
or other health plans. Providers should contact Regence, Premera, and other
insurers they contract with to find out which costs will be reimbursed and the
amount of reimbursement. Health Plan
Contacts for Coverage and Billing Questions (PDF, 24 KB) is available
online.
Q: How can a local health jurisdiction contract with a private insurance company to bill them for services to patients for whom they cover? What about children with health insurance from DSHS?
A: Local health jurisdictions may need to independently contract with health insurers to provide and bill for vaccine services to those who are privately insured. We are not aware of any “blanket” allowance from all health plans that could be used for local health to see patients covered by their plans. Since the state-sponsored health plans and programs are managed by private insurers and not paid for directly by DSHS (unlike the DSHS fee-for-service program), local health may have to contract directly with health plans to receive payment for services to these children as well.
Q: Does "Medicaid eligible" include Columbia United Providers (CUP) and Molina patients?
A: CUP and Molina health insurance both serve Medicaid eligible patients, as well as other children in state-sponsored health plans. Children enrolled in Medicaid and other Department of Social and Health Services-sponsored plans will all have a green and white Medical Assistance Identification coupon. The coupon identifies them as eligible for state-supplied vaccine. The Basic Health Plan may be identified on insurance cards from the individual plans. The provider may contact the health plan if they are unsure whether the child is in Basic Health.
Q: Will there be a contract/provision for local health to provide just vaccines to children enrolled in the State Children’s Health Insurance Program (SCHIP) and Basic Health? Our local health jurisdiction only bills Medicaid/Medicare, so how would we get permission to vaccinate?
A: Whatever authority you are using now to vaccinate these children will still be used. State-supplied vaccine is going to be made available for these children, so it shouldn't change from how you provide services to them now. If you are not currently seeing them because they are being vaccinated in the provider office, you may not be seeing them later because providers will still be able to get state-supplied vaccine for them.
Q: Our local health jurisdiction does not have a contract with the Basic Health and SCHIP plans. Where can they be seen now?
A: They are seen in private doctors' offices throughout the state and are managed by the insurance companies that cover them. State-supplied vaccine will continue to be available for these groups, so many will continue to be seen in their provider office. Any contracts for local health will probably have to be with individual insurance companies.
Q: Are children with state-sponsored Public Employee Benefits Board (PEBB) health insurance eligible for state-supplied vaccine?
A: No, these children are considered privately insured and need to be vaccinated with private purchase vaccine.
Q: How can the CHILD Profile Immunization Registry be used to help determine if a child is eligible for state-supplied vaccine?
A: The CHILD Profile Immunization Registry can be used to record a child’s Vaccines for Children (VFC) status, and the status may already be recorded in the registry for some children. In the future, there may be additional ways that CHILD Profile can help with determining what kids are VFC eligible.
Q: In the CHILD Profile Immunization Registry, can a lot of vaccine be identified that are both public and privately purchased?
A: Yes, private and public vaccines can be identified in the registry by supply source (public or private), even if the lot numbers are the same.
Q: What recommendations do you have for providers regarding documentation in the CHILD Profile Immunization Registry for a child who is underinsured for some but not all vaccines? (Added June 23)
A: It is acceptable for the child to be identified as underinsured in the CHILD Profile Immunization Registry. It may also be possible for children to be screened for VFC Status for each vaccine in CHILD Profile; however, we do not yet have that functionality in place as it would require all providers to note VFC status by vaccine for every child. We will look into this further, but for now, the provider should mark the child underinsured for vaccines in the CHILD Profile Immunization Registry.
Q: How can you document transferring vaccine from public purchase to private purchase in the CHILD Profile Immunization Registry? (Added June 23)
A: We are working out this process and will make information available soon.
Q: In the past we have been given permission to provide state-supplied MMR vaccine to all students needing the vaccine regardless of age, or for high risk students over age 19 to get hepatitis B vaccine. Have the budget cuts changed this policy? I want to make sure we are following the appropriate guidelines.
A: We do not know exactly how vaccination for these groups will be managed after May 1, 2010, and will take that into consideration in planning for the May 1, 2010 changes. It will depend on the available funding at that time. Vaccines for Children vaccine cannot be used for anyone over age 18 years, so that is not an option.
Q: How will influenza vaccine be managed in the 2009-2010 season?
A: State-supplied influenza vaccine will be available for all children aged 0 through 18 years during the 2008-2009 influenza season. Approximately the same total number of doses will be available this year as last year, but the product mix will be slightly different this year with more FluMist available.
Q: Do health care providers need to track Vaccines for Children (VFC) vaccine separate from other state-supplied vaccine?
A: No, the tracking and accountability is the same for all state-supplied vaccine. Providers are required to screen and document VFC eligibility.
Q: How do I get additional questions answered?
A: You have many options. You can contact your local health jurisdiction or the Washington State Department of Health Immunization Program CHILD Profile. You can submit questions to the program by e-mailing universalquestions@doh.wa.gov or you calling 1-866-397-0337 (toll free).
Last Update: 01/21/2010 11:29 AM