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Vaccine Services Update. Karen Hess Vaccine Services Manager February 19, 2009. Topics. Providers NIS Vaccine Update Electronic Vaccine Accounting Non-Compliance Policy. 2007 Co-CASA Rates. Public vs. Private Recruitment Doses Administered Percentage. 2007 NIS Texas vs. National.

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vaccine services update

Vaccine Services Update

Karen Hess

Vaccine Services Manager

February 19, 2009

topics

Topics

Providers

NIS

Vaccine Update

Electronic Vaccine Accounting

Non-Compliance Policy

number of vaccines in the routine childhood and adolescent immunization schedule
Number of Vaccines in the Routine Childhood and Adolescent Immunization Schedule

1985

1995

2008

Measles

Rubella

Mumps

Diphtheria

Tetanus

Pertussis

Polio

Hib (infant)

HepB

Varicella

Measles

Rubella

Mumps

Diphtheria

Tetanus

Pertussis

Polio

Hib (infant)

HepB

Varicella

Pneumococcal disease

Influenza

Meningococcal disease

HepA

Rotavirus

HPV

Measles

Rubella

Mumps

Diphtheria

Tetanus

Pertussis

Polio

7

10

16

vaccines currently available through the tvfc program
DTaP

Hepatitis B

Hepatitis A

Hib

Human Papillomavirus

Influenza

Polio

Varicella

MMR

Meningococcal

Pneumococcal Conjugate

Combination Vaccines

DTaP/Hepatitis B/Polio

DTaP/Polio/Hib

Hepatitis B/Hib

MMR/Varicella

Vaccines Currently Availablethrough the TVFC Program
  • Rotavirus
  • Td
  • Tdap
last three years in vaccine releases
Last Three Years In Vaccine Releases
  • 3 Newly Licensed Vaccines in 2006
    • Gardasil®,Zostavax®, RotaTeq®
  • 2 Newly Licensed Vaccines in 2007
    • Menactra™ (2-10 years)
    • FluMist® (5-49 years)
  • 4 Newly Licensed Vaccines in 2008
    • Kinrix®, Pentacel®, Rotarix®, BOOSTRIX® (for 19-65 year olds), FluMist® (2-49 years)

As of 1/20/2009

pedvaxhib shortage
PedvaxHib® Shortage
  • Improvement in the supply is not expected until summer 2009
  • The booster dose of Hib vaccine usually administered at 12-15 months of age should be deferred except for children at increased risk of Hib disease
    • asplenia
    • sickle cell disease
    • immunodeficiency (including HIV infection and cancer)
    • American Indian children
    • Alaska Native children

Note: DSHS distributes the 3 dose ActHib® product only.

hib tvfc maximum stock levels and pentacel
Hib TVFC Maximum Stock Levels and Pentacel®
  • Currently providers are limited to a 60-Day supply of Hib based on previous usage
  • Pentacel® (DTaP-IPV/Hib) counts as part of that 60-day allocation

A dose of Pentacel = A dose of Hib

recombivax hb shortage
Hib Shortage

Hib

Hepatitis B/Hib

DTaP/Polio/Hib

Hep B Shortage

Hepatitis B/Hib

DTaP/Hepatitis B/Polio

January 2009, Merck experienced a supply interruption in the U.S. for the adult formulation of their hepatitis B vaccine, Recombivax HB®.

Pediatric Shortage possible

Recombivax HB® Shortage
electronic vaccine accounting eva
Electronic Vaccine Accounting (EVA)
  • CDC New Vaccine Ordering System
    • New reporting elements
    • On-line ordering and reporting for all TVFC providers.
  • Vaccine Choice Legislation
    • Increase Brand Options
    • Add presentation (syringes, vials)
  • Simplify ordering
    • Create “recommended order”
    • Auto mathematical calculation features
    • Pre-population of previously entered inventory information (lot number, NDC, expiration date)
    • Automated reminder
slide20

EC-33 Monthly Biological Report

Legend: Yellow – provider completes

Green – pre-populated on the form

Blue – mathematical summation

slide21

EC-33 Monthly Biological Report Legend: Yellow – provider completes

Green – pre-populated on the form

Blue – mathematical summation

eva next steps
EVA - Next Steps
  • Request capital authority
  • Contract out for bid
  • Workgroup formed
  • Focus group and pilot testing
  • Goal by September 2010
provider compliance policy
Provider Compliance Policy
  • CDC Focus on Quality
    • Certified Thermometers
    • Refrigeration/Freezer Units
    • Fraud and Abuse
    • Inventory control
slide25

Hierarchy of VFC Provider Education

Primary-Routine, orientation, updates

Secondary- Moderate compliance issues-

Tertiary- Serious compliance issues immediate & Significant actions must occur to correct situation

3

Research must occur through out all steps of algorithm and is defined as contacting other internal or external agencies that may include but not limited to legal counsel, Medicaid, licensing board or excluded provider list

provider compliance policy26
Provider Compliance Policy

Purpose

  • Consistent process when handling TVFC compliance issues
  • Identify high risk non-compliance issues
  • Protect TVFC from potential fraud and abuse
  • Prevents re-occurrence with sufficient training, education, and documentation
  • Identifies need to refer providers to the Texas State Office of Inspector General (OIG), or terminate from the TVFC program
slide27

Non-Compliance Flow Chart

Initial Problem Identification

SECONDARY

EDUCATION

Problem

Resolved

Extenuating

Circumstances

FORMAL

INTERVENTION

TERTIARY

EDUCATION

REFERRAL TO OIG

TERMINATION

FROM TVFC

provider compliance policy28
Provider Compliance Policy

Format

  • Policy
  • Definitions
  • Procedures
    • Non-Compliance Identified During a On-Site Visit
    • Non-Compliance Identified by Other Means
10 high risk questions
10 High Risk Questions
  • 12. Vaccines provided regardless of inability to pay
  • 14. Administration fee is less than or equal to the maximum fee
  • 48a. Appropriate refrigerators/freezers are used to store vaccine
  • 50a. Refrigerator/freezer temperature log is available for the last three months
  • 50d.From the logs provided, all recorded refrigerator temperatures are within the recommended range.
  • 51c. From the logs provided, all recorded freezer temperatures are within the recommended range.
  • 55. A physical inventory of vaccine is done monthly
  • 57. The loss/gain is less than 5%
  • 59. TVFC vaccines can be distinguished from private stock
  • 61a. All clients are screened for eligibility
compliance policy feedback
Compliance Policy Feedback
  • Operations Manual Appendix
  • Gauge Success
  • CDC and HSR/LHD feedback