
 | |  | FAQs
The Alaska Vaccine Assessment Program (AVAP) operates to ensure that all Alaskans have access to Advisory Committee on Immunization Practices (ACIP) recommended vaccines. In 2014, the Alaska State Legislature established AVAP, a new statewide funding partnership. The funding partnership was authorized in Alaska statute 18.09.200 and established a vaccine assessment account that will enable the Department of Health and Social Services (DHSS) to purchase all pediatric and select adult vaccines at costs below those of private purchase alternatives.
The advisory FAQs are divided into five broad categories:
1. “A” means questions related to Assessments.
2. “C” means questions related to Covered Lives.
3. “G” means questions related to Government Programs.
4. “P” means questions related to Providers.
5. “V” means questions related to Vaccines.
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Assessments
A2. How does the program save money?
By purchasing vaccines at a bulk contract rate, Alaska qualifies for significant discounts. AVAP funds vaccine purchases with assessments collected from insurers and other payers.
A3. How does AVAP work for payers and providers?
A vaccine assessment account (Vaccine Account) has been established, and funds are used for purchasing pediatric and adult vaccines. The Vaccine Account is funded through vaccine assessments from assessable entities called “payers,” which include health care insurers, health benefit plans, and third-party administrators, based on their proportionate share of the overall vaccine costs. The Immunization Program uses the funds to order vaccine at a discounted bulk rate and distribute it statewide at no cost to health care providers (e.g., doctors, hospitals, clinics, etc.). Health care providers vaccinate their patients, only billing payers for the administrative fee.
A4. Who oversees the program?
AVAP is overseen by an independent Vaccine Assessment Council (Council) appointed by the Department of Health and Social Services (DHSS) Commissioner.
A6. What does "assessable entity" mean?
“Assessable entity” means any health carrier or other entity that contracts or offers to provide, deliver, arrange, pay for, or reimburse any of the costs of health services.
A8. Must Employee Retirement Income Security Act (ERISA) plans pay the assessment?
Yes. ERISA does not prevent the state from assessing payers. To the extent allowed by federal law, ERISA plans are required to participate along with all other payers. Third-party administrators (TPAs), who are often contracted to perform claims processing activities for ERISA plan trustees, will also be included in the mandatory assessment.
A9. Are publicly funded health care benefit plans mandated to participate in AVAP?
Yes. Publicly funded health care benefit plans (e.g., Medicare, the Veterans Administration, and TRICARE) are included in the bill’s definition of “health care insurer.” In 2016, they are not participating in AVAP. Medicare is exempt from mandatory participation until federal approval is obtained. DHSS is working with federal officials and others to obtain the necessary approvals.
Medicaid (adults ≤ 19 years) is not participating in AVAP during 2016; however DHSS is covering the participation cost for Medicaid.
A10. How are an entity's assessments determined?
The assessment is based on an online quarterly survey of assessable entities' covered lives. Each year, AVAP via the Council sets separate assessment rates per adult and child covered life. The Council will evaluate whether the "covered lives" approach will be continued in subsequent years. For more information on reporting and assessment payments, see www.akvaccine.org.
A16. When are assessment payments due?
AVAP operates on a calendar year running from January 1 to December 31. Quarterly assessments are due 45 days after the close of each quarter, meaning reports and payments will typically be due on February 15, May 15, August 15, and November 15. Quarterly payments are based on the number of covered lives an entity reports for the three months in each preceding quarter.
A17. What if AVAP collects too little?
If AVAP’s estimates produce funds that are too low to meet the needed vaccine costs, AVAP may issue a supplemental assessment. AVAP’s reserve methodology has been designed so that no supplemental assessment should be needed, but that cannot be guaranteed in advance.
A24. How do I submit my payment?
Your payment should be submitted via mail through USPS to the address provided on www.AKvaccine.org and include a reference number. The reference number can be found on the “AVAP Remittance Form,” which will appear after you submit your report, and can be printed and saved.
A29. Is the assessment voluntary?
No. Alaska law mandates that all assessable entities (essentially any entity which pays for any health benefits for any Alaska resident), must pay assessments set by the program.
A30. Will participating payers save money starting in 2016?
Yes. 2016 rates are favorable even when viewed against similar programs in other states that are more mature and, therefore, already had paid all of their startup costs. For most payers, savings for 2016 are anticipated to run in the 20% range and to get even better in subsequent years. DHSS is committed to financial transparency in this program and so anticipates publishing a retrospective financial analysis after each program year to evaluate actual cost savings of AVAP when measured against CDC’s annual survey of private purchase vaccine costs. Other states with universal vaccine purchase programs similar to AVAP typically have produced vaccine cost savings, on average, between 22% and 30%. Savings have been consistent year after year in those states.
Covered Lives
C2. What are “adult covered lives”?
“Adult covered lives” are Alaska residents who are 19 years and older who are:
(a) Covered under an individual health insurance policy;
(b) Covered under a group health insurance policy;
(c) Protected, in part, by a group excess loss insurance policy; or
(d) Protected, in part, by an employee benefit plan of a self-insured entity or any government plan for any employer or government entity.
C3. What are “child covered lives”?
“Child covered lives” are Alaska residents who are 0 through 18 years of age who are:
(a) Covered under an individual health insurance policy;
(b) Covered under a group health insurance policy;
(c) Protected, in part, by a group excess loss insurance policy; or
(d) Protected, in part, by an employee benefit plan of a self-insured entity or any government plan for any employer or government entity.
C4. Must an entity file reports even if it does not provide medical benefits and therefore has zero covered lives?
Yes. However, the entity may be eligible to file an Annual or Permanent Zero Covered Lives Report instead of the typical quarterly reports. Please note that if an entity has zero covered lives for one quarter only, then it should file a normal quarterly report with “0” values.
If, however, an entity does not administer medical benefits and therefore has zero covered lives, it should file one of two types of Zero Covered Lives Reports. For example, this type of report would be appropriate for entities such as those administering eye care or dental benefit only plans. If the entity has zero covered lives and will continue to have zero covered lives for the balance of the year, then it should file an Annual Zero Covered Lives Report during the first quarter of the calendar year. No other report will be due until the first quarter of the following calendar year. If the entity has zero covered lives and expects to never have covered lives, it should file a Permanent Zero Covered Lives Report to eliminate the need for further compliance follow up. A guide to Zero Covered Lives Reports is available here.
Government Programs
Providers P1. Does this program affect how providers receive vaccine?
No. Providers must complete the annual Vaccine Distribution Program renewal/enrollment process to receive state-supplied vaccine. Providers will receive all children's vaccine and select adult vaccines from the Alaska Immunization Program directly instead of purchasing them privately. Further details are explained in FAQs below and on the AVAP Provider Summary at www.akvaccine.org on the Providers tab. If you have questions, please contact the Alaska Immunization Program at immune@alaska.gov or 907-269-8000. KidsVax®, the administrator for AVAP, does not collect, store or distribute any vaccines.
P3. Can providers still purchase vaccines privately?
Yes. Nothing in the statute prohibits this. However, regulation 3 AAC 26.110 allows payers to reimburse providers at the state's cost for the vaccine, instead of the provider's private purchased priced. Reimbursement rates will be set by payers, providers will need to negotiate this privately with payers.
P5. How does this program affect patients?
Patients whose payers have opted into AVAP will not be charged for the cost of the vaccine; however, some patients may still be charged an immunization administration fee by their provider.
P8. Will providers incur a higher assessment cost for adult vaccines than they are currently paying?
Not likely. Because vaccines will be purchased in bulk at discounted rates, providers are expected to pay about the same amounts for adult vaccines by opting into the assessment program. Further, the administrative work associated with AVAP should be less when providers opt in because they do not need to separate public and private vaccines in their vaccine storage unit. The provider’s share of the total assessment is based on their number of uninsured adults.
P12. How do providers enroll to receive state-supplied vaccine?
Providers who currently receive state-supplied vaccine will enroll for the statewide program during their annual Vaccine Distribution Program re-enrollment period. New providers will need to initiate enrollment through the Alaska Immunization Program. Providers can order state-supplied vaccine as soon as they complete this enrollment.
Vaccines V1. Who sets vaccine policy?
The Alaska Immunization Program provides vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). KidsVax® takes no position for or against the administration of any particular vaccine to any specified individual.
V2. What vaccines are covered by the Alaska Immunization Program?
The DHSS commissioner will maintain a list of vaccines included in the program based on the department’s review of the ACIP recommendations and the clinical and cost-benefit analysis of potential vaccines. Here is the current vaccine formulary offered by the Alaska Immunization Program.
V4. Does AVAP establish a vaccine mandate?
No, AVAP does not set vaccine policy or create vaccine laws. It facilitates the state’s universal-select purchase of vaccines by collecting assessments from insurers, third-party administrators, and other payers.
V5. What is VacTrAK?
VacTrAK is Alaska’s Immunization Information System (IIS). This web-based system provides a confidential, population-based, computerized system to maintain immunization information for Alaskans of all ages. Effective December 29, 2013, health care providers are required to report all administered immunizations to VacTrAK within 14 days of vaccine administration (7 AAC 27.650). This reporting requirement is applicable for any vaccine administered, including state supplied and privately purchased vaccine.
V6. Does AVAP impact my taxes?
No. AVAP does not impact taxes as it is not funded by taxpayers. AVAP collects the costs of vaccines and program expenses from insurers, third-party administrators, and other payers who are already obligated to pay health care costs for their beneficiaries.
V7. How does AVAP know the amount of vaccine it needs to purchase?
Alaska's Department of Health and Social Services calculated the amount of vaccine needed to be purchased based on an evaluation of vaccine usage in the State Immunization Information System (VacTrAK) and current vaccine inventory. Then, DHSS made adjustments for adult vaccines based on estimates of vaccine not documented in VacTrAK and estimates of increased usage during the first year due to increased vaccine availability. Vaccine purchases are made monthly so that the state will be able to regulate its stock.
V8. Does DHSS expect vaccine uptake rates to increase once AVAP goes into effect?
Yes. DHSS expects vaccination rates for most childhood vaccines required in school to be stable or increase slightly as immunization rates in school-aged children are already over 90-95% for many vaccines. DHSS expects a gradual increase over the next few years in uptake of some childhood vaccines used in infancy, such as rotavirus and PCV13. Additionally, DHSS expects an increase in teen HPV vaccine uptake. Since AVAP will increase vaccine availability, DHSS anticipates a gradual increase in some adult vaccines such as Zoster.
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