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.
A1. Why did the Vermont legislature form the Vermont Vaccine Purchasing Program (VVPP)?
A2. Are insurance carriers the only ones paying for vaccines administered in Vermont?
A3. What does “Assessed Entity” mean?
A4. Must both the employer and the insurer or TPA administering the plan pay the assessment for a given covered life?
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).
A6. Are any plans excused from paying assessments?
A7. How are an entity’s assessments determined?
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.
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?
A10. Where can I find more details about the VVPP assessment rate calculation?
A11. When are assessment payments due?
A12. What if VVPP collects too little?
A13. What if VVPP collects too much?
A14. What if a beneficiary gets a vaccine in a neighboring state—can the payer get a discount
A15. Are payments made by assessment payers accountable as medical expenses?
A16. Does the Patient Protection and Affordable Care Act (ACA) preempt any provisions of the VVPP?
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.
A18. Are there any tutorials on the use of this system?
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.
A20. If I make a mistake in my report, how can I correct it?
A21. I accidentally overpaid. Can I be reimbursed?
A22. How do I submit my payment?
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:
A24. What if I submit a late report or payment?
Vermont Vaccine Purchasing Program
c/o Immunization Program Ste. 305
Vermont Department of Health
PO Box 70
Burlington, VT 05402
A25. When is my remittance considered paid?
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
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.
A28. Are payers double paying for a vaccine when a private provider administers a vaccine that was not purchased through the state system?
C1. Must entities report only child covered lives, or should adult covered lives be included as well?
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.
C3. What are “child covered lives”?
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.
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.
C6. Must an entity file reports even if it does not provide medical benefits and therefore has zero covered lives?
C7. If an entity files a Permanant Zero Covered Lives Report, but it later has covered lives, what should it do?
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.
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.
G2. Do providers still need to screen for VFC eligibility?
P1. Does this program affect how providers receive vaccine?
P2. What are the benefits to my practice if we enroll in the VFC and/or VFA program?
P3. Can VDH require all providers to enroll in the VFC and/or VFA program?
P4. Can VDH provide a list of participating providers in “real time”?
P5. How will this program affect patients?
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.
P7. Should providers bill $0.00 or $0.01 for state-supplied vaccines?
V1. Does VVPP set vaccine policy?
V2. What vaccines are covered by VVPP?
V3. Is the cost of seasonal flu vaccine included in the vaccine cost estimates?
V4. Does this program establish a vaccine mandate?
V5. What is the Immunization Registry?
V6. How does VVPP impact my taxes?
These FAQs were last updated on January 2, 2016. (FAQ C2 updated).