Advisory FAQs

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

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.
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?
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?
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?
The spreadsheets used to compute the VVPP assessment rate are posted under the “FOR PAYERS” tab.
A11. When are assessment payments due?
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.
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?
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?
A24. What if I submit a late report or payment?
A25. When is my remittance considered paid?
A26. How do I create a Password for the Assessment System on this Site?
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?

Covered Lives

C1. Must entities report only child covered lives, or should adult covered lives be included as well?
C2. What are “adult 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.
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?
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?
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.
C8. If my company has filed an Annual Zero Covered Lives Report, when should we file our next report?

Government Programs

G1. Has VVPP changed anything for the federally-funded Vaccines for Children (VFC) program or state-sponsored medical plans?
G2. Do providers still need to screen for VFC eligibility?

Providers

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?
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.
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?
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

V1. Does VVPP set vaccine policy?
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

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?