Medicaid Contract Purchasing Specifications

Part 11 Vaccines for Children (VFC) Program

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on the VFC program is for your consideration. Purchasers may also find it useful to review Negotiating the New Health System (3^rd Ed.) which provides other options relating to immunizations used by state agency purchasers in contracting with Medicaid MCOs at Table 2.4, Vol. 2, Part 2, pages 2-698 through 2-805 (www.gwu.edu/~chsrp).

Table of Contents

§1101. Participation in the Vaccines for Children (VFC) Program
§1102. Prohibition on Use of Capitation Payment for Vaccines Available through VFC Program
§1103. Reimbursement for Other Vaccines not Available through VFC Program
§1104. Reporting by VFC Program Providers

If, as a purchaser, you are interested in purchasing pediatric care for Medicaid-eligible children from managed care organizations on a risk basis, the following language on VFC participation, reimbursement, and reporting is for your consideration.

^K§1101. Participation in the Vaccines for Children (VFC) Program

(a) Providers — As required under §501(e) of Part 5, Contractor shall ensure that each provider participating in Contractor's provider network who furnishes appropriate immunizations covered under §102(b)(1)(C) of Part 1 to enrolled children enter into and comply with the provider agreement with [drafter insert name of state Department of Health] under the Vaccines for Children Program (VFC), §1928(b)(2) of the Social Security Act, 42 U.S.C. §1396s(b)(2).

(b) Contractor — Contractor shall comply with the requirement of §702(e) of Part 7 to enter into a memorandum of understanding with the [drafter insert name of public health agency with responsibility for VFC program] relating to the responsibilities of Contractor, the Agency, and the providers participating in Contractor's provider network with respect to the VFC program.

^K§1102. Prohibition on Use of Capitation Payment for Vaccines Available through VFC Program

Contractor shall ensure that no portion of the capitation payment paid to Contractor under [drafter insert name of purchasing document] is used to pay for any vaccine recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) that is available to providers participating in Contractor's provider network under the VFC program or [drafter insert name of other publicly-purchased vaccine distribution program operating in Contractor's service area].

^K§1103. Reimbursement for Other Vaccines not Available through VFC Program

(a) In General — If a vaccine is covered as an appropriate immunization under §102(b)(1)(C) of Part 1 but it is not available through the VFC program or [drafter insert name of other publicly-purchased vaccine distribution program operating in Contractor's service area], Contractor shall:

(1) obtain and distribute such vaccine to providers participating in Contractor's provider network that furnish appropriate immunizations to enrolled children; or

(2) reimburse such providers for the full cost incurred in obtaining such vaccine.

^K§1104. Reporting by VFC Program Providers

(a) Requirement — Contractor shall ensure that each provider identified by Contractor under §1101(a) and participating in the VFC program shall accurately complete and timely submit to the [drafter insert name of public health agency with responsibility for VFC program] the following:

(1) the Patient Eligibility Screening Record (DHHS 8523 (9/94)) for each enrolled child receiving a vaccine from the provider;

(2) the Quarterly Vaccine Request Form (DHHS 7064 (1/95));¹ and

(3) [drafter insert reference to any additional state health department reporting requirements].

Endnotes

The Patient Eligibility Screening Record DHHS 8523 (9/94) and Quarterly Vaccine Request Form DHHS 7064 (1/95) are available at www.cdc.gov/nip/vfc.