TISWGDecember 8, 2011

Increase in Cost

Decrease in Funds

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

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)

Fully Insured Children

Underinsured Children

Adults

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.

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

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

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).

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.

Rural Health Clinic (RHC) or

Federally Qualified Health Center (FQHC)/ Local Health Department or Health Service Region

DELEGATION OF AUTHORITY LETTER OF AGREEMENT

For Immunization Purposes The__________________________________________ Rural Health Clinic delegates authority to: ____________________________________________________________________________ (Local Health Department) to provide federally funded ‘Vaccines For Children’ (VFC) vaccine to underinsured children. This delegation of authority to the above-named Local Health Department (LHD) or Health Service Region (HSR) allows the LHD/HSR to administer VFC vaccine to children who are underinsured. Underinsured is defined as a child who has commercial (private) health insurance, but coverage does not include vaccines; a child whose insurance covers only selected vaccines (VFC-eligible for non-covered vaccines only); or a child whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the child is categorized as underinsured. _____________________________Rural Health Clinic has no legal responsibility for the supervision of immunization services delivered by the authorized LHD/HSR. This delegation of authority will remain in effect until either party notifies the other that it would like to end the agreement. FOR AND ON BEHALF OF RURAL HEALTH CLINIC: _______________________________________ ____________________________ Authorized Signature Date _______________________________________ ____________________________ Typed or Printed Name of Signatory Title FOR AND ON BEHALF OF LHD/HSR: _______________________________________ ____________________________ Authorized Signature Date _______________________________________ ____________________________ Typed or Printed Name of Signatory Title

“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

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 20th birthday.

Dates for all the changes not yet determined

Public Message Community Partners Regional and Local Health

Departments TVFC and Adult Safety Net Providers