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Advisory FAQs


The Vermont Vaccine Purchasing Program (VVPP) operates to ensure that all Vermonters have access to immunizations recommended for children and adults. Authorized by 18 V.S.A. § 1130 and launched on April 1, 2011, the program establishes an insurer-funded vaccine purchasing pool that enables the Vermont Department of Health (VDH) to purchase pediatric and adult vaccines at the lowest possible price and to distribute them to providers free of charge. The program serves two main goals: to lower health care costs and to improve Vermonters’ health by raising immunization rates.

These advisory FAQs offer guidance about the program to payers and providers. The Vermont Department of Health invites anyone having suggestions or additional questions about these advisory FAQs to direct inquiries to info@VTvaccine.org.

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.

Assessments

Hide details for A1. Why did the Vermont legislature form the Vermont Vaccine Purchasing Program (VVPP)?A1. Why did the Vermont legislature form the Vermont Vaccine Purchasing Program (VVPP)?
VVPP was formed to fund and manage Vermont’s universal vaccine purchasing program. This program enables Vermont to purchase vaccines for the state’s entire population and distribute them to health care providers free of charge. In states without such universal programs, providers must purchase vaccines with money out of their own pockets, then await reimbursement from insurance companies

The program also saves money. By purchasing vaccines in bulk at federal contract rates, Vermont qualifies for the largest discount available from the pharmaceutical industry. VVPP funds vaccine purchases with assessments collected from assessed entities.
Hide details for A2. Are insurance carriers the only ones paying for vaccines administered in Vermont?A2. Are insurance carriers the only ones paying for vaccines administered in Vermont?
No. Self-insured employers, TPAs, HMOs, and other payers are also subject to assessment. These payers fund the purchase of vaccines for all privately insured children and adults. The federal Vaccines for Children (VFC) program pays for vaccines for all VFC eligible children less than 19 years of age, including Alaska Natives, American Indians, and Medicaid-insured, uninsured, and underinsured children served at FQHCs and RHCs. Federal 317 funding is used to pay for the cost of vaccines for uninsured adults.
Hide details for A3. What does “Assessed Entity” mean?A3. What does “Assessed Entity” mean?
“Assessed Entity” means any health insurance company, nonprofit hospital and medical service corporation, managed care organizations, and, to the extent permitted under federal law, any administrator of an insured, self-insured, or publicly funded health care benefit plan offered by public and private entities. But, it does not apply to insurers providing coverage only for a specific disease or other limited benefit coverage.
Hide details for A4. Must both the employer and the insurer or TPA administering the plan pay the assessment for a given covered life? A4. Must both the employer and the insurer or TPA administering the plan pay the assessment for a given covered life?
No. VVPP’s plan of operation seeks to avoid double counting any covered life. Generally speaking, the entity responsible for paying for the vaccine administration is also the entity responsible for paying the assessment. However, to avoid double counting, and to accommodate the needs of specialty plans and private contractual arrangements, VVPP will allow another entity to pay the assessment if the agreement between entities is in writing and the existence of the agreement is stated in the “Additional Questions” section of the assessment system. It is recommended that agreements specifically include an indemnification of the entity not paying. The agreement must be made available for review if there is an audit in the future. VVPP does not need to see the agreement and does not have any advance approval role as to the agreement or its content.
Hide details for A5. Must ERISA plans pay the assessment?A5. Must ERISA plans pay the assessment?
Yes. Any health benefit plan that covers child or adult residents of Vermont is required to participate. The VVPP legislation encompasses plans that offer Administrative Services Only (ASO) for ERISA employers. It also includes traditional Third-Party Administrators (TPAs).
Hide details for A6. Are any plans excused from paying assessments? A6. Are any plans excused from paying assessments?
Yes. The following plans are excused from paying assessments: Medicare supplement plans, college plans, pharmacy benefit plans, ASOs and TPAs for behavioral and dental health plans, and plans that do not include immunization services. If you are unsure whether your plan is required to pay assessments, please email VVPP at info@VTvaccine.org or call 1-855-543-7829.
Please note that plans excused from the assessment must self-certify that they have no business to which a vaccine assessment properly should be applied. If a plan’s status changes, it must notify VVPP and begin paying assessments.
Hide details for A7. How are an entity’s assessments determined?A7. How are an entity’s assessments determined?
Each entity’s assessment is based on the entity’s total number of child covered lives and adult covered lives in the months during the previous quarter, multiplied by the respective VVPP assessment rates for children and adults. Payers are required to accurately report child and adult covered lives each quarter. VVPP’s automated web-based assessment system then calculates the assessment amounts owed.
Hide details for A8. What are the VVPP assessment rates for child and adult covered lives?A8. What are the VVPP assessment rates for child and adult covered lives?
Information on the assessment rates for child and adult covered lives is posted under the “FOR PAYERS” tab. Assessments are calculated based on estimated vaccine costs, program expenses, and the total number of covered lives reported to VVPP. The assessments are intended to cover the costs of the program for the calendar year, with some modest reserves. The rates are also programmed into VVPP’s self-reporting assessment system so that the system will apply the correct rate each quarter and calculate the amount owed by each payer. The rate is set each year by the Commissioner of Health, after considering the recommendations of the Immunization Funding Advisory Committee.
Hide details for A9. What method will be used to: a) determine the number of children and adults with private insurance and b) determine the VVPP program costs that will be factored into the assessment?A9. What method will be used to: a) determine the number of children and adults with private insurance and b) determine the VVPP program costs that will be factored into the assessment?
a) The total number of children and adults with private insurance will be determined based on the most recent data available through the assessment system when the rate is set.

b) The program costs include costs incurred by the Vermont Department of Health in administering the program, as well as the cost of KidsVax® services such as the VVPP website creation and assessment administration.
Hide details for A10. Where can I find more details about the VVPP assessment rate calculation?A10. Where can I find more details about the VVPP assessment rate calculation?
The spreadsheets used to compute the VVPP assessment rate are posted under the “FOR PAYERS” tab.
Hide details for A11. When are assessment payments due?A11. When are assessment payments due?
Quarterly assessments are due forty-five days after the close of each quarter. VVPP operates on a calendar year running from January 1 to December 31. Typically, this means that reports and payments will 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 respective quarter.
Hide details for A12. What if VVPP collects too little?A12. What if VVPP collects too little?
If VVPP’s estimates produce funds which are too low to meet the needed vaccine costs, VVPP may issue a supplemental assessment. VVPP’s reserve methodology has been designed so that no supplemental assessment should be needed, but that cannot be guaranteed in advance.
Hide details for A13. What if VVPP collects too much?A13. What if VVPP collects too much?
All excess funds collected in one year will be used to reduce the overall assessment for the following year
Hide details for A14. What if a beneficiary gets a vaccine in a neighboring state—can the payer get a discountA14. What if a beneficiary gets a vaccine in a neighboring state—can the payer get a discount
No. VVPP will work with neighboring states to establish equitable child covered lives policies, but we do not provide a discount for vaccines that may have been administered in other states.
Hide details for A15. Are payments made by assessment payers accountable as medical expenses? A15. Are payments made by assessment payers accountable as medical expenses?
Yes, VDH believes that assessment payments are properly accountable as medical expenses because they fund the cost of vaccines administered to beneficiaries.
Hide details for A16. Does the Patient Protection and Affordable Care Act (ACA) preempt any provisions of the VVPP?A16. Does the Patient Protection and Affordable Care Act (ACA) preempt any provisions of the VVPP?
No. The ACA does not preempt any provision of state law unless a state law prevents the application of an ACA requirement. VVPP supports the ACA requirement that immunization coverage be provided without cost-sharing. In fact, with ACA requirements that all plans have full first-dollar immunization coverage, the cost savings VVPP captures for payers will be even more beneficial to them.
Hide details for A17. Where do I go to complete the online assessment?A17. Where do I go to complete the online assessment?
http://www.VTvaccine.org/assessment. First-time users must register before they can log in to the assessment system. Please note that because of the system’s security features, there may be a delay of up to 30 minutes before a new account can be accessed for data entry.
Hide details for A18. Are there any tutorials on the use of this system?A18. Are there any tutorials on the use of this system?
Yes. Webinar videos and filing guides are available under the “Web Training” and “Filing Guides” links on the “FOR PAYERS” page.
Hide details for A19. What if I have registered in the assessment system, but I need to change some of my information?A19. What if I have registered in the assessment system, but I need to change some of my information?
Simply log back in to your account and made any changes needed. This should not create any problems for you or the system.
Hide details for A20. If I make a mistake in my report, how can I correct it? A20. If I make a mistake in my report, how can I correct it?
Please email help@VTvaccine.org with an explanation of the mistake and the Federal EIN used to file the report. VVPP will provide assistance so that you can print a corrected remittance form.
Hide details for A21. I accidentally overpaid. Can I be reimbursed?A21. I accidentally overpaid. Can I be reimbursed?
Yes. Please email help@VTvaccine.org explaining the mistake and the amount you need for reimbursement. VVPP will then determine the best way to true up to the correct amount. Normally that will be via deductions from subsequent quarterly reports.
Hide details for A22. How do I submit my payment? A22. How do I submit my payment?
When you file your report in the assessment system on this website, the program will generate a “VVPP Remittance Form” that you can print and save. This form will contain a unique reference number. You must include this reference number with your payment. The form will also include detailed instructions for submitting your payment by ACH transfer, which is the preferred payment method.
Hide details for A23. Am I required to pay by ACH transfer? A23. Am I required to pay by ACH transfer?
No. While the Vermont Department of Health prefers that you send your payment by ACH transfer, they also allow you to mail a check. Checks should be made payable to “Vermont Vaccine Purchasing Program” and should be mailed to:
      Vermont Vaccine Purchasing Program
      c/o Immunization Program Ste. 305
      Vermont Department of Health
      PO Box 70
      Burlington, VT 05402
Hide details for A24. What if I submit a late report or payment?A24. What if I submit a late report or payment?
Please prepare your report as soon as possible. KidsVax® will report your late payment to VDH. VDH will take enforcement action should that become necessary.
Hide details for A25. When is my remittance considered paid?A25. When is my remittance considered paid?
The remittance is considered paid on the effective date for any ACH transfer. If you pay by check, it will be considered paid on the date postmarked.
Hide details for A26. How do I create a Password for the Assessment System on this Site?A26. How do I create a Password for the Assessment System on this Site?
You may create your own password by entering your Federal Employer Identification Number, your e-mail address, and a private password of your choice at this link: http://www.vtvaccine.org/vermont/vtnames.nsf/profile.html
Hide details for A27. What should I do if my company has created a password for the assessment system on this website, but I no longer have it?A27. What should I do if my company has created a password for the assessment system on this website, but I no longer have it?
You can have your password reset by sending an e-mail to help@VTvaccine.org. In the e-mail, please state that you have registered on the website, but you have forgotten your password. Please also include your Federal EIN. We will then reset your password for you.
Hide details for A28. Are payers double paying for a vaccine when a private provider administers a vaccine that was not purchased through the state system?A28. Are payers double paying for a vaccine when a private provider administers a vaccine that was not purchased through the state system?
No. VVPP only charges payers for vaccines purchased by the state Immunization Program and supplied to enrolled providers for use in insured children and adults.


Covered Lives
Hide details for C1. Must entities report only child covered lives, or should adult covered lives be included as well? C1. Must entities report only child covered lives, or should adult covered lives be included as well?
Entities must report both child and adult covered lives. Individuals less than 19 years of age are considered children. Individuals 19 and older are considered adults.
Hide details for C2. What are “adult covered lives”?C2. What are “adult covered lives”?
“Adult covered lives” are Vermont residents who are age 19 to 64 and are covered under a health benefit plan provided or administered by an Assessed Entity.

For reports filed for reporting periods after January 1, 2016, only individuals up to age 64 are included in the program. This is a change from the prior procedure. This change will apply to the reports that are due on May 15, 2016. For reports filed for time periods prior to January 1, 2016, adult covered lives included all individuals age 19 and older, without any age limit.

Hide details for C3. What are “child covered lives”?C3. What are “child covered lives”?
“Child covered lives” are Vermont residents who are less than 19 years who are covered under a health benefit plan provided or administered by an Assessed Entity.
Hide details for C4. What if I do not know the specific address where a child resides, and am unable, therefore, to determine with certainty whether he or she is a Vermont resident?C4. What if I do not know the specific address where a child resides, and am unable, therefore, to determine with certainty whether he or she is a Vermont resident?
Plans are permitted to use a commercially reasonable methodology to estimate the number of child covered lives. For example, some plans may want to use the address of the primary insured to determine the residence of the child. So long as a methodology is uniformly used in a manner which does not bias the report towards a lower child covered lives number, such a reasonable estimate is acceptable. Whenever an estimate is used, please include a brief description of the methodology in the “Additional Questions” section of the self-reporting system.
Hide details for C5. What if a child of a Vermont primary insured attends school out of state—is that life counted?C5. What if a child of a Vermont primary insured attends school out of state—is that life counted?
Generally, yes. However, if the plan definitively knows (1) the child’s PCP is out of state, (2) the child is out of state year round, AND (3) the plan also adopts a practice of counting students attending schools in Vermont whose parents reside out of state, that covered life should not be counted. Accordingly, the default rule for college-age children, where a specific year-round residence address is unknown, should be to count the child as a resident of the state of the primary insured.
Hide details for C6. Must an entity file reports even if it does not provide medical benefits and therefore has zero covered lives?C6. Must an entity file reports even if it does not provide medical benefits and therefore has zero covered lives?
Yes, but 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 in the “Filing Guides” section under the “FOR PAYERS” tab.
Hide details for C7. If an entity files a Permanant Zero Covered Lives Report, but it later has covered lives, what should it do?C7. If an entity files a Permanant Zero Covered Lives Report, but it later has covered lives, what should it do?
Start reporting regularly beginning with the first quarter in which it has covered lives. You will need to send an e-mail to help@VTvaccine.org to have your account changed to be able to make a quarterly report.
Hide details for C8. If my company has filed an Annual Zero Covered Lives Report, when should we file our next report?C8. If my company has filed an Annual Zero Covered Lives Report, when should we file our next report?
An Annual Zero Covered Lives Report covers one calendar year. You should plan to file your report again by February 15th of each calendar year.


Government Programs
Hide details for G1. Has VVPP changed anything for the federally-funded Vaccines for Children (VFC) program or state-sponsored medical plans?G1. Has VVPP changed anything for the federally-funded Vaccines for Children (VFC) program or state-sponsored medical plans?
No. VVPP is a financing mechanism for a portion of Vermont’s universal vaccine purchasing system for children and adults. Neither the federally-funded Vaccines for Children program, nor the state’s purchase of vaccines for children in state-sponsored medical plans is affected by the Vermont Vaccine Purchasing Program. All providers receiving vaccine through this program must enroll annually in the VFC and/or VFA program and adhere to all program requirements.
Hide details for G2. Do providers still need to screen for VFC eligibility?G2. Do providers still need to screen for VFC eligibility?
Yes. VFC status screening is still a federal requirement for every visit and hasn’t changed. More information for providers can be found here: http://www.healthvermont.gov/hc/imm/provider.aspx.


Providers
Hide details for P1. Does this program affect how providers receive vaccine?P1. Does this program affect how providers receive vaccine?
No. For providers who are enrolled in the VFC and/or VFA program, vaccines are obtained by contacting the Department of Health at AHS.VDHImmunizationProgram@vermont.gov or by calling 802-863-7638. KidsVax®, the administrator for VVPP, does not collect, store or distribute any vaccines. VDH handles the purchase and distribution of vaccines under this program.
Hide details for P2. What are the benefits to my practice if we enroll in the VFC and/or VFA program?P2. What are the benefits to my practice if we enroll in the VFC and/or VFA program?
Vermont is a universal vaccine purchase state, where the state Immunization Program purchases vaccines from the CDC federal contract at no cost to providers, for use by all children and adults. Patients may still be charged an immunization administration fee. This is intended to assist you in providing comprehensive preventive care and to allow for fewer missed opportunities for immunization.
Hide details for P3. Can VDH require all providers to enroll in the VFC and/or VFA program?P3. Can VDH require all providers to enroll in the VFC and/or VFA program?
No. VVPP’s enabling legislation only states that . . . “the department shall solicit, facilitate and supervise the participation of health care professionals, health care facilities . . .” However, VDH encourages all primary health care providers to enroll.
Hide details for P5. How will this program affect patients?P5. How will this program affect patients?
Patients will not be charged for the cost of the vaccine. This program ensures that proper funding is available to continue to distribute vaccines at no charge to the patient. Some patients may still be charged an immunization administration fee.
Hide details for P6. What if my office no longer wants to participate in the VFC and/or VFA program and wants to privately purchase and bill for vaccines? P6. What if my office no longer wants to participate in the VFC and/or VFA program and wants to privately purchase and bill for vaccines?
It is the goal of VVPP to implement this program in a way that allows all Vermont primary healthcare providers to participate fully. This program does not dictate whether health plans or other payers must continue to reimburse providers for any privately purchased vaccines. Each health plan or other payer must make its own policy. Please contact the appropriate health plan directly for further information.
Hide details for P7. Should providers bill $0.00 or $0.01 for state-supplied vaccines?P7. Should providers bill $0.00 or $0.01 for state-supplied vaccines?
VDH has no preference regarding whether state-supplied vaccines are billed with a charge of $0.00 or $0.01, but VDH is committed to working with all interested parties to establish procedures that support the providers and insurers who participate in the program. Please contact your billing servicer for specific instructions about its billing procedures. Generally, servicers require providers to use the Health Care Procedure Coding Systems (HCPCS) National Level II Medicare Code Modifier (SL: State supplied vaccine) when billing for state-supplied vaccine.


Vaccines
Hide details for V1. Does VVPP set vaccine policy?V1. Does VVPP set vaccine policy?
Neither VVPP nor KidsVax® takes a position for or against the administration of any particular vaccine to any specified individual. The VVPP will generally fund the vaccines shown on the Vermont Recommended Immunization Schedule.
Hide details for V2. What vaccines are covered by VVPP? V2. What vaccines are covered by VVPP?
The Vermont Department of Health publishes detailed information on covered vaccines. Information on which vaccines are covered can be found at: http://www.healthvermont.gov/sites/default/files/documents/pdf/ID_IZ_INFOHCP_VFCVFA_VFCandVFAVaccineAvailability.pdf

Hide details for V3. Is the cost of seasonal flu vaccine included in the vaccine cost estimates?V3. Is the cost of seasonal flu vaccine included in the vaccine cost estimates?
The cost of seasonal flu vaccine for children is included in vaccine estimates and in the cost calculations.

The cost of seasonal flu vaccine for adults is not included in either the vaccine estimates or cost calculations at this time.
Hide details for V4. Does this program establish a vaccine mandate?V4. Does this program establish a vaccine mandate?
No. VVPP does not set vaccine policy or create vaccine laws. It facilitates the state’s universal purchase of vaccines by collecting assessments from insurers, third-party administrators, and other payers.
Hide details for V5. What is the Immunization Registry? V5. What is the Immunization Registry?
The Vermont Immunization Registry (IMR) is a confidential, computerized system for maintaining immunization records. It tracks the dates of immunizations given, prints reports for parents/schools, and provides guidance for timing of vaccine administration.
Hide details for V6. How does VVPP impact my taxes? V6. How does VVPP impact my taxes?
VVPP is not funded by taxpayers. VVPP 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. These funds are paid directly to the state so the state can purchase vaccines at federal contract rates. This lowers the cost to insurers of funding immunization services.


These FAQs were last updated on January 2, 2016. (FAQ C2 updated).








VVPP Tax ID: 03-6000264


Copyright 2013 Vermont Vaccine Purchasing Program