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?
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.
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?
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?
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.
A10. Where can I find more details about the VVPP assessment rate calculation?
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.
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?
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.
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?
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?
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.
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?
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”?
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?
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?
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?
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?
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.
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).