1. 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

2. Background
Sections , Chapter 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

3. 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

4. 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

5. 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

6. 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.

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Vaccinated Residents