Increasing Capacity to Provide Immunization Services within the Jurisdiction Karen Turner Sr Field Representative, Central Valley Cindy Klaisle, NP Sr Field Representative, Northern CDPH, Immunization Branch May 10, 2012

Background Sections 120325-120380, Chapter 435 of the Health and Safety Code states: HO required to organize & maintain a program to make IZs required for school entry available throughout the jurisdiction IAP Contract Assists in defraying costs of the program to control VPD LHDs must provide all ACIP recommended vaccines to the general public Required to identify unmet need for IS and take action to correct

LHD Immunization Service Requirements As the safety net provider for IS within the jurisdiction: Maintain inventory of vaccines required for school entry Immunize children in need of vaccines required for school entry Make available all ACIP recommended vaccines in accordance with the LHD Vaccine Eligibility Guidelines Be ready and able to respond to a VPD outbreak situation and to immunize at risk patients

LHD Immunization Services (IS) Under IAP contract: Due diligence required to directly provide IS Support for IS should come from local funds and resources Not all counties are equal Diverse levels of funding Diminishing funding Challenging populations Geographic barriers

Options for Expanding Capacity to Provide Immunization Services Use of local clinics or agencies as Health Department Authorized Sites (HDAS) to: Supplement IS provided by the LHD Rural and remote areas Special populations with unmet need Provide IS on behalf of the LHD LHD no longer has funds to provide Cannot reach populations with unmet need Co-location of LHD and public sites Unvaccinated Residents

Definition: Health Department Authorized Site (HDAS) A clinic or agency that agrees to partner with the LHD to provide IS in accordance with VFC guidelines and HDAS Vaccine Eligibility Guidelines. The site will receive vaccine from two sources, the VFC Program and the State, allowing the HDAS to assist the LHD in meeting the safety net provider requirements within the jurisdiction. HDAS are intended to ensure the continuation of immunization service delivery AND are not intended to permanently supplant the direct delivery of immunization services by the LHD.

What is a HDAS? Partnership between the LHD and the site to: Expand access to IS Improve immunization coverage rates Expand LHD capacity to areas with unmet need: Special populations Adults Vaccine hesitancy Rural or remote locations Improve efficiency and cost effectiveness

HDAS Requirements: Public, non-profit entity Willing to or is enrolled in the VFC Program (if sees patients <19YOA) Compliant with VFC Program requirements Located in an area with unmet need Provides all ACIP recommended vaccines Has the capacity to see additional patients Willing to partner with the LHD Willing to abide by LHD policy and HDAS guidelines

Applying for HDAS Status Complete the application Facility name PIN (if enrolled in VFC) Type of provider (FQHC/RHC/CHC) Description of population to be served Estimate of annual vaccine usage Reason for request Impact if request is not granted

Submission and Review Process Completed application discussed with and submitted to your Senior Field Representative (SFR) SFR will submit the application to the CDPH, Immunization Branch for review CDPH, Immunization Branch will advise SFR of decision SFR notifies IZ Coordinator about decision

Memorandum of Understanding (MOU) MOU between LHD and HDAS must be developed and should include: Purpose of partnership & intended results Effective date General terms and conditions of the partnership Respective responsibilities of each party and integrated responsibilities of both parties Terms and methods of information exchange Contact information for both parties How and when the MOU can be terminated VERSUS

Final Approval: Signed MOU submitted to the SFR within 30 days of initial approval notification from the SFR SFR notifies IZ Coordinator when the authorization status can begin Site orders 317 vaccine for use under the MOU

HDAS Responsibilities Immunization Service Delivery: Accurately screens for eligibility and provides appropriate vaccine Provides ACIP vaccines in accordance with HDAS Vaccine Eligibility Guidelines Sees patients referred by LHD or requesting services Has drop in hours or readily available appointments Physical exam is not required to get vaccines Immunizations entered into CAIR at least biweekly Abides by LHD administration fee and waiver policy

HDAS Responsibilities Administrative If able to bill, uses private purchase vaccine for insured patients and bills their insurance Maintains an active reminder/recall system Participates in a Quality Assurance Review (QAR) and CoCASA Assessment every other year Actively communicates and partners with the LHD Vaccine Management: Orders vaccines electronically using myvfcvaccines Maintains separate inventories of VFC, private and 317 vaccine Reports use of VFC and 317 vaccine separately Complies with VFC Program guidelines

LHD Responsibilities Guidance and Oversight Compliance with: VFC Program policy VFC and LHD eligibility screening policy LHD and HDAS Vaccine Eligibility Guidelines LHD Administration Fee and Fee Waiver policy CAIR entry requirements MOU

LHD Responsibilities Partnering and Education: Establish and implement a process patient referrals Publicize the availability of services Conduct a QAR/CoCASA every other year with SFR Provide education and updates on: Changes in the LHD and HDAS Vaccine Eligibility Guidelines 317 vaccine availability Changes in ACIP recommendations Ensure continued compliance with Health & Safety Code Ongoing communication with SFR and site regarding service delivery and barriers to meeting IS requirements

Continuation of HDAS Status Annual renewal application Impact of the services on the community Continued need for services Compliance with policies Vaccine wastage Entry of CAIR data Compliance with vaccine tracking Updated MOU

Revocation of Status Status may revoked at any time by HDAS LHD CDPH, Immunization Branch Must be communicated in writing Potential reasons for revocation Lack of impact from services Failure to comply with terms of MOU Decrease in funding for 317 vaccines LHD resumption of IS

CDPH, Immunization Branch LHD/HDAS Eligibility Guidelines & Guidance Communication LHD CDPH, Immunization Branch HDAS LHD/HDAS Eligibility Guidelines & Guidance VFC and 317 Vaccines Increased IZ Coverage Rates Guidance, Education & Oversight IZ Services

Vaccinated Residents