Resources on the NCIP Change

for Providers

Memos

• All NCIP Memos
• (8/27/10) For Birthing Hospitals - Hepatitis B Birth Dose Universally Available
• (8/26/10) For LHDs only - Additional Transitional Vaccine Availability and Criteria Change
• (8/2/10) Transition Plan for Non-participating Providers
• (8/2/10) Transition Plan for Participating Providers
• (7/16/10) One-time Universal Vaccination Allocation
• (6/28/10) NCIP Programmatic Change

coverage Criteria

• Coverage Criteria Webpage
• Transition Coverage Criteria (8/23/10)
• 7-1-10 Coverage Critiera version 2 (8/27/10)
• 6-14-10 Coverage Criteria

Resources to share

• VFC flier for parents
• FAQ for parents (8/20/10)

Frequently Asked Questions

The following is a list of common questions from local health departments and health care providers regarding the recent NCIP program changes. You may print this resource by downloading this PDF document.

This page is divided into the following sections:
I. NCIP Program Change
II. Transition Plan (updated 8/20/10)
III. VFC Program
IV. Health Insurance
V. NCIP Program Participation
VI. Purchasing Vaccine
VII. Definitions

Section I.                      NCIP PROGRAM CHANGE

1. What change has occurred in the NCIP?
The North Carolina Immunization Program (NCIP) has changed to a Vaccines for Children (VFC)-only program.  This means only children who qualify for the federal VFC program may receive vaccines at no cost from the state.  To assist in the transition this change will cause, the state legislature has approved $3 million in one-time funding to ensure all children will be appropriately vaccinated before the start of the 2010-2011 school year. 

Prior to this change, the N.C. Immunization Branch provided vaccines for children eligible for the federal Vaccines for Children (VFC) program with federal funds, and it provided vaccines for children who were not eligible for the VFC program with state funds.  With the phase out of state funding, the N.C. Immunization Branch will no longer provide vaccines for children who are not eligible for the federal VFC program.  This change does not impact the VFC program.  The NCIP will continue to exist and serve the approximately 67% of children in North Carolina who qualify for VFC vaccine.

Funds for the purchase of certain vaccines provided by the NCIP for adults come from federal funding. Availability of these vaccines is not affected by the change in the program. Select adult vaccines are generally provided at local health departments.

2. What is the impact of this change?
Beginning July 1, 2010 health care providers who typically contact the N.C. Immunization Branch to order vaccines for all the children they serve will only be able to order vaccines for the VFC-eligible children they serve.  This already has been the case for certain vaccines (including rotavirus, pneumococcal conjugate, hepatitis A, human papillomavirus, meningococcal, and combination vaccines that include DTaP (Kinrix, Pediarix and Pentacel)).  Providers will need to privately purchase vaccines for the non-VFC-eligible patients they serve. This affects insured children, including those covered by N.C. Health Choice. 

Availability of certain federally-funded, state-supplied adult vaccines (generally provided at local health departments) is not affected by the change in the program at this time.

There will be a short period of transition to ensure all children will be appropriately vaccinated before the start of the 2010-2011 school year.  Please refer to the Section II for details on the transition plan.
 
3. When did the change take place? 
The change became effective July 1, 2010.  Providers may continue to use the state-funded, state-supplied vaccines on hand on June 30, 2010 following the June 14, 2010 NCIP Coverage Criteria until that supply is exhausted.  Any state-supplied vaccine (not included in the transition plan; see Section II) received on or after July 1, 2010 must be labeled VFC-only and used for VFC-eligible children only.

There will be a short period of transition to ensure all children will be appropriately vaccinated before the start of the 2010-2011 school year.  Please refer to the Section II for details on the transition plan.

4. Will providers need to keep a private supply of all vaccines?
Providers are not required to keep a private supply of all vaccines; however providers should continue to follow the National Vaccine Advisory Committee’s Standards for Child and Adolescent Immunization Practices, which can be found online at: http://www.cdc.gov/vaccines/recs/vac-admin/rev-immz-stds.htm.  These standards advise those who provide primary care to children and adolescents to always include routinely recommended vaccines as part of the care they deliver in a medical home.  The Standards for Child and Adolescent Immunization Practices focus on making vaccines readily available by reducing barriers, minimizing cost, coordinating vaccinations with other healthcare services, and providing vaccinations in a medical home when possible.

It is not advisable to refer patients to other practices for vaccines because this can often lead to missed opportunities for vaccination and leave children vulnerable to vaccine preventable diseases.  The Branch urges providers to stock all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).  A list of ACIP recommendations can be found here: http://www.cdc.gov/vaccines/pubs/ACIP-list.htm  

If a provider wishes to vaccinate insured patients (including those with N.C. Health Choice), he or she must keep a private supply of vaccine on hand.  Providers will not be able to use federally-funded, state-supplied vaccine for those patients.  Vaccines that are part of the transition plan (those that are state-funded, state-supplied) may be used for non-VFC-eligible children.  Please refer to the definitions section of this document for clarification on types of state-supplied vaccine.

5. Does this change impact the vaccines the NCIP provides for adults?
Funds for the purchase of certain vaccines provided by the NCIP for adults come from federal funding. Availability of these vaccines is not affected by the change in the program at this time.

The following vaccines are available from the NCIP for certain adults seen in certain facilities (generally local health departments): 

• Hep A/Hep B Combination Vaccine (for adults in LHDs)
• Hepatitis B for adults  (in LHDs)
• Influenza  (for certain adults in LHDs)
• MMR
• Td
• Tdap

Refer to the NCIP Coverage Criteria for complete details on these vaccines and their availability. 

6.  Will the N.C. Immunization Branch communicate additional details of this change?
Yes.  The Branch is working on additional materials to help providers understand this change.  Providers received a memo on this topic explaining whether they are part of the transition plan. 

SECTION II.                            THE TRANSITION PLAN (updated 8/20/10)

1. Is there a transition plan?
Yes.  To help ensure all children are appropriately vaccinated prior to the start of the 2010-2011 school year, $3 million in one-time funding will be used to purchase required vaccines for insured children entering kindergarten through 8th grade.  After this vaccine supply is depleted, patients with insurance will need to use their insurance plan to receive vaccine services.  In some cases this will require a co-pay or deductible.  Providers may not charge a patient or third party for the cost of state-supplied vaccines provided through the NCIP.

2. Which vaccines are included in the transition plan?
The N.C. Immunization Branch has estimated how many non-VFC-eligible children in North Carolina are not up to date on their vaccinations for kindergarten through 8th grade school entry.  The Branch will provide the following required vaccines to a limited number of providers:  DTaP, Polio, MMR and Tdap, as long as supplies last.

3. How will this vaccine be distributed?
Local health departments determined how the transitional vaccine would be distributed in their counties, so distribution varies from county to county.

4. Will all private providers in a county receive vaccine from the transition plan?
No.  The limited amount of vaccine that can be purchased with the transition appropriation precludes shipping to all 1,400 providers in the NCIP.

5. What about VFC-eligible children?
Children who are VFC-eligible are not included in the transition plan because they are not affected by the change.  These children may receive VFC vaccine as they always have. 

6. What about infants or children who need vaccines to be fully up to date?
The General Assembly’s transition funding is intended for vaccines required for school entry only. 

Providers may continue to use the state-funded, state-supplied vaccines they had on hand as of June 30, 2010 according to the June 14, 2010 NCIP Coverage Criteria.  Once these supplies are exhausted, providers will need to purchase vaccines privately for the non-VFC-eligible patients they serve.

7. What about college/university entry?
Vaccines needed for college and university entry are not included in the transition plan.

8. How will non-VFC-eligible patients receive vaccine after the transition period is over?
Patients should contact their health insurance company to find out which vaccines, and vaccine services, are covered under their plan.  They should ask whether they are responsible for paying for any amount of the cost of the vaccines covered.

9. How will providers receive transition vaccine?
All providers received a memo from the Immunization Branch explaining the transition plan and confirming whether they are included.

Providers should label this vaccine as transition vaccine and administer it according to the transition coverage criteria.  They must continue to report doses administered via the NCIR or the Vaccines Administered Log (VAL).

SECTION III.                           THE VFC PROGRAM

1.  What is the Vaccines for Children (VFC) program?
The Vaccines for Children (VFC) program is a federally funded vaccine program for eligible children birth through age 18.  VFC is administered at the national level by the Centers for Disease Control and Prevention (CDC) which contracts with vaccine manufacturers to buy vaccines at reduced rates.  The North Carolina Immunization Branch, within the North Carolina Division of Public Health, administers this program (which is called the NCIP) on a state level.  The Branch enrolls physicians into the VFC program as part of the NCIP program.  To qualify for enrollment, physicians must serve eligible patients birth through 18 years of age and provide routine immunizations.

The VFC program allows VFC-eligible children to be vaccinated in their medical homes, thereby reducing the burden on the patient and the local health departments.  The program has contributed to high immunization rates, reduced delays in immunizations and, subsequently, the risk of serious illness or death from vaccine-preventable diseases has dropped proportionally.  The NCIP ensures vaccines are available for all providers serving VFC-eligible children as soon as the vaccines become available, thus strengthening immunity levels in our communities.

2.  Who is eligible to receive vaccine through the VFC program?
Children birth through 18 years of age who meet at least one of the following criteria are eligible for VFC vaccine:

• Medicaid eligible,
• American Indian or Alaskan Native,
• Uninsured,
• Underinsured children: children who have commercial (private) health insurance but the coverage does not include the vaccines, children whose insurance covers only selected vaccines (VFC-eligible for non-covered vaccines only), or children whose insurance caps coverage at a certain amount- once that coverage amount is reached, these children are categorized as underinsured*; or
• Unaccompanied minors without proof of insurance presenting to local health department Title X clinics.

*Note: Children whose health insurance covers vaccinations (except as indicated above) are not eligible for VFC vaccines, even when 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 or because the insurance did not cover the total cost of the vaccine.  Coverage for immunization services by insurance plans may fall into a category known as “wellness” or “prevention” services, which is sometimes capped, or limited, to a dollar amount annually, or over the life of the policy.  If this limit has been reached, the child is then eligible for VFC vaccines.

*Note:  Providers are required by their NCIP Vaccine Agreements to screen patients at every visit (at the time of administration) for VFC eligibility.  The eligibility at the time of administration is used to determine VFC eligibility.

3.  What is the definition of underinsured?
The following children are considered underinsured if:

• they have commercial (private) health insurance but the coverage does not include vaccines*,
• their insurance covers only selected vaccines (in this scenario, only non-covered vaccines may be provided through VFC),
• or their insurance caps vaccine coverage at a certain amount – once that coverage amount is reached, these children are categorized as underinsured.

* Note: Children whose health insurance covers vaccinations (except as indicated above) are not eligible for VFC vaccines, even when 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 or because the insurance did not cover the total cost of the vaccine.  Coverage for immunization services by insurance plans may fall into a category known as “wellness” or “prevention” services, which is sometimes capped, or limited, to a dollar amount annually, or over the life of the policy.  If this limit has been reached, the child is then eligible for VFC vaccines.

4.  Has the definition of underinsured changed?
According to the CDC, the definition has been clarified rather than changed.  The consequences of this clarification will impact providers in the following way:  Providers will no longer be allowed to consider patients underinsured when their private insurance plan does not reimburse the provider at 100% of the vaccine cost.  Therefore, children who have health insurance but whose insurance covers only a percent of the cost of one or more vaccines are not eligible for the VFC program; for example, the insurance covers 80% of the cost of HPV.  This child would be considered insured for the purposes of the VFC program (and the NCIP), and therefore, not eligible to receive vaccine supplied only for VFC eligible patients. If a family’s insurance does not cover a specific vaccine at all, the child is eligible to receive the non-covered vaccine at no cost to the family through the VFC program.

SECTION IV.                          HEALTH INSURANCE

1.  How does a provider know if a patient’s insurance covers vaccines?
Providers are required by their NCIP Vaccine Agreements to screen patients at every visit for VFC eligibility.  This includes determining if the insured patients are underinsured (i.e. underinsured by VFC program criteria).  Underinsured patients may receive state-supplied vaccines.  Providers may accept the parent or guardian’s declaration of VFC eligibility status.  The provider is not required to verify VFC eligibility status.

2.  What if a patient doesn’t know whether their insurance covers vaccines?
Providers should administer privately-purchased vaccine to patients with insurance who are unsure whether their plan covers vaccines. 

3.  If a patient has to pay a co-pay or meet a deductible for vaccine services, is this patient considered underinsured, and therefore eligible for VFC vaccine?
No. This patient would be considered insured and not eligible to receive VFC vaccine.

4.  If a patient has insurance that covers only a portion of the cost of vaccine (regardless of whether a co-pay or deductible is required) is this patient considered underinsured, and therefore eligible for VFC vaccine?
No. This patient would be considered insured and not eligible to receive VFC vaccine.

5.  Are children with the N.C. Health Choice plan considered VFC-eligible?
No.  N.C. Health Choice is North Carolina’s State Children’s Health Insurance Program (SCHIP) program.  Children enrolled in this program are considered insured and are not eligible to receive VFC vaccines.

6.  Are all children who have Medicaid considered VFC-eligible?
Yes.  All children who are Medicaid eligible, even if their Medicaid policy is used as secondary insurance, are considered VFC-eligible. 

7.  If an American Indian and Alaska Native has insurance that covers vaccines (in full or partially) are they considered VFC-eligible?
Yes.  American Indian and Alaska natives are VFC eligible and should participate in the VFC program regardless of their insurance coverage.

V.                                 NCIP PROGRAM PARTICIPATION

1.  Now that state funding has been eliminated, will providers still be able to get vaccine from the state? 
The NCIP will continue to provide vaccines for VFC-eligible patients.  VFC-eligible patients are children birth through age 18 who are:

• Medicaid-eligible,
• American Indian or Alaskan Native,
• uninsured, or
• underinsured.

These are the same people who currently get state-supplied Hepatitis A, HPV, meningococcal, pneumococcal conjugate, rotavirus, and combination vaccines that include DTaP (Kinrix, Pediarix and Pentacel). 

2.  Can a provider stay in the NCIP if they do not see Medicaid patients?
Yes, because Medicaid patients are not the only ones who are VFC-eligible.  Providers should assess the population they serve before withdrawing from the NCIP.

VFC-eligible patients are children birth through age 18 who are:

• Medicaid-eligible,
• American Indian or Alaskan Native,
• uninsured, or
• underinsured.

These are the same people who currently get state-supplied Hepatitis A, HPV, meningococcal, pneumococcal conjugate, rotavirus, and combination vaccines that include DTaP (Kinrix, Pediarix and Pentacel). 

It is up to individual providers to determine whether the NCIP will continue to be of benefit for their clients. The N.C. Immunization Branch will work with providers to review data and determine how many VFC-eligible children a provider serves.

If a provider chooses to leave the NCIP, they should submit the request in writing.  They can contact the Help Desk for additional information.  The provider must ensure any unused state-supplied vaccine is transferred to the local health department or another NCIP provider in their county.  Providers should contact the local health department or the NCIP provider to confirm they have available storage space for the transferred vaccine. 

3. Has the North Carolina Immunization Registry (NCIR) been eliminated?
No.

4.  Can a provider continue to use the NCIR if they leave the NCIP?
Yes, in fact the N.C. Immunization Branch strongly recommends providers continue to document ALL doses administered in one system (either the NCIR if they are an NCIR user or on VAL forms if they are not an NCIR user) to insure a complete and accurate immunization record exists for every child.  Doing so will allow a practice to accurately track the immunization status of its patients and ensure they are appropriately vaccinated.

Providers who wish to leave the NCIP but continue using the NCIR will need to complete a revised NCIR contract.  This contract is currently under development.  In the meantime, providers who wish to leave the program should contact the Help Desk at 1-877-873-6247 or ncirhelp@dhhs.nc.gov.   Practices may not continue using the NCIR if they do not use it to document vaccines administered.

5.  Can providers who are not currently enrolled in the NCIP become NCIR users?
Not at this time.  The N.C. Immunization Branch remains committed to offering NCIR access to NCIP providers who administer the most childhood vaccines.  Over 88 percent of NCIR-eligible providers are current or soon-to-be current NCIR users.  Within the next several months, the N.C. Immunization Branch will begin adding select non-NCIP participants as users of the NCIR.

6.  Will there be a change in the way providers report doses administered data?
Providers are required to continue reporting doses administered of federally-funded and state-funded, state-supplied vaccine in the same way they always have, either via the NCIR or VALs (if the provider is not an NCIR user).  Providers are not required to report doses administered of privately-purchased vaccine.  However the N.C. Immunization Branch strongly recommends providers continue to document ALL doses administered to insure a complete and accurate immunization record exists for every child.  Doing so will allow a practice to accurately track the immunization status of its patients and ensure they are aware of all vaccine administered and are appropriately vaccinated at each encounter. The N.C. Immunization Branch recommends providers add privately-purchased vaccine into the NCIR and/or indicate privately-purchased vaccine in the note section of VAL forms.

7.  If a provider sees pop-ups on the NCIR regarding the use of state-supplied vaccine for non-VFC-eligible children - is this an error?
Not for all providers at this time.  NCIP providers may administer the state-supplied vaccine they have on hand as of June 30, 2010 to non-VFC-eligible patients (following the June 14, 2010 NCIP Coverage Criteria).  The NCIR will show a pop-up when this occurs.  It is not an error to administer the vaccine at this time (as long as the provider received the vaccine prior to July 1, 2010). However it will become an error when your practice depletes its June 30, 2010 inventory of state-supplied vaccine.  This point in time will vary for among individual practices.  This NCIR pop-up functions as an alert of vaccine administered outside the current NCIP Coverage Criteria and is not tied to individual practices’ inventories.      

VI.                                PURCHASING VACCINE

1.  How does a provider purchase private vaccine?
Providers will need to contact vaccine manufacturers and/or vaccine distributors to purchase vaccine.  Providers also may join a vaccine purchasing group.  The North Carolina Pediatric Society (NCPS) and the North Carolina Academy of Family Physicians (NCAFP) will help identify vaccine purchasing groups that offer favorable pricing for vaccines. Both organizations also will provide assistance with billing and coding practices to help ensure appropriate reimbursement. Information will be posted on the associations’ websites. 

The NCPS’s website is www.ncpeds.org
The NCAFP’s website is www.ncafp.com 

2.  What if a provider can’t get privately-purchased vaccine fast enough?
Providers may borrow vaccine from their state-supplied stock for use in non-VFC eligible patients in very limited circumstances.  In addition, providers may use privately purchased vaccine for VFC eligible patients in certain circumstances.   Only one occurrence of borrowing is acceptable in a 12-month period, according to the CDC. Please refer to the December 22, 2009 memo detailing this policy on our website at www.immunizenc.com/memos.htm.   

4. How can a provider determine how much vaccine to purchase privately?
Contact the Immunization Branch for assistance in assessing how much vaccine to purchase privately.

Section VI.                    Definitions

Providers may want to label vaccine in their refrigerators according to this chart.  The labels could read: VFC, state funded, and privately funded.