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CoCASA Questions and Answers on VFC

Questions and Answers

Q: We like to sort our providers by specialty (Pediatrician, Family Practice, etc). Should we just select ‘Other’ in the Provider Type variable and enter the specialty there?

A: It is important to first understand how the Provider Type variable functions in the database before selecting 'other'. 'Provider type' is an important variable for the summary reports that you need to produce for the annual VFC Management Survey. Currently, the report reviews the 'Provider Type’ field and classifies the provider as ‘Public’ or ‘Private’. For example, the options ‘public health dept clinic’ and ‘FQHC’ are classified as ‘Public’ in the report and the option ‘private practice’ and ‘hospital based - private’ are classified as ‘Private’ in the report. So, if you select ‘other’ for your pediatricians who are private physicians, these visits cannot be incorporated into the report summary of your activities as they cannot be included with either public or private visits. We are considering adding a variable for ‘Provider Specialty’ to a future version of the software.

Q: Is there a limit on how long a Custom Question can be?

A: Yes. The limit is currently set at 255 characters (for the multiple choice question option this includes both the question and the answers). However, if you exceed 150 characters, you will not be able to see the entire text of the question.

Q: How do I print a blank 2013 VFC Compliance Site Visit Questionnaire?

A: To print a blank 2013 VFC Questionnaire, navigate to the Reports tab and then the ‘VFC Reports’ tab. Next, expand the ‘VFC Compliance Visit Questionnaire’ reports and click on the ‘VFC Compliance Visit Blank Questionnaire.’ Please note, you cannot print the 2013 VFC questionnaire from the VFC-AFIX Reports tab.

Q: I’m trying to record current temperatures for question #20 on the VFC Compliance Site Visit Questionnaire, but I can’t enter data into the Reviewer’s Thermometer field. What can’t I enter data?

A: The ability to enter data into the Reviewer’s Thermometer field for question #20 is linked to a question in the VFC Questionnaire Set-up.

To access the VFC Questionnaire Set-up, navigate to the Utilities menu, then select ‘Set up New VFC Questionnaire.’ When setting up the 2013 VFC Questionnaire, mark “yes” for the question, “do your reviewers take their own thermometer to provider offices?”

screen shot of VFC questionnaire as described in this question answer

Selecting “yes,” will enable the Reviewer’s Thermometer field in question #20. Please note the Reviewer’s Thermometer field will only be enabled for visits created after the new questionnaire was set-up.   Marking “yes,” will not enable the Reviewer’s Thermometer field for data that was previously entered.

Q: How do I complete question 14a (What type of thermometer is used by the clinic/practice)?

A: This question is asking users to provide information on the thermometer type and whether the probe is placed in glycol.

  • Users should select “yes,” if the thermometer type is used and the probe is placed in glycol
    • Ex. Standard Biosafe Fluid Filled Liquid thermometer (see picture below)
  • Users should select “no,” if the thermometer type is used and the probe is not placed in glycol
    • Ex. Min-Max thermometer (see picture below)
  • Thermometer types not used should be left blank

screen shot of VFC questionnaire as described in this question answer

Q: Is question 13 asking about calibrated thermometers or thermometer placement or both?

A: Although question 13 asks if calibrated thermometers are placed in a central area, reviewers should focus on thermometer placement rather than calibration for this question.   Question 14b addresses thermometer calibration.

Q: Why can’t I print completed 2013 VFC Compliance Site Visit Questionnaires and corrective action plans?

A: Users were unable to run reports and print completed 2013 Compliance Site Visit Questionnaires and corrective action plans in CoCASA Version 8.1. Users can print completed questionnaires and corrective action plans in CoCASA Version 8.2 (released March, 2013).

To view and print completed 2013 Compliance Site Visit Questionnaires, navigate to the Report Tab, then click on the ‘VFC Reports’ tab.  Next, expand the VFC Compliance Visit Questionnaire reports and click on the ‘VFC Compliance Visit Questionnaire Results for Individual Provider Site’ report. This report contains completed questionnaires and any associated corrective action plans for individual providers.

To view and print corrective action plans, navigate to the Report Tab, then click on the ‘VFC Reports’ tab. Next, expand the VFC Non-Compliance reports and click on ‘Corrective Action Plans for Individual Provider Site.’ This report contains corrective action plans for individual providers.

Q: I noticed there are no longer red exclamation marks (!) for the high risk questions on the VFC Provider Compliance Site Visit Questionnaire, but there are still red exclamation marks next to some of the questions in CoCASA. What do the red exclamation marks mean?

A: The red exclamation marks have been removed from the VFC Compliance Site Visit Questionnaire. All questions in section 1 of the VFC Compliance Site Visit Questionnaire require an answer.  If an inappropriate answer is given, then education and/or corrective action must be performed.  A greater weight is not placed on one question over another.

There are some questions that are for data collection purposes and serve as opportunities to educate providers. Non-compliance reporting to CDC will include all questions except for questions 2, 9a, 14a, 20, and 31-34. In CoCASA  Version 8.2, red exclamation marks have been removed from questions 2, 9a, 14a, 20, and 31-34 to signify they are not included in the non-compliance reporting to CDC. Please see the VFC Compliance Site Visit Answer Key for additional information.

Q: Where should I enter 2013 follow-up visits that correspond to visits conducted prior to 2013?

A: To document 2013 follow-up that is related to visits conducted prior to 2013 in CoCASA, users should navigate to the “2013 AFIX/pre-2013 VFC-AFIX Evaluation Tab” on the main CoCASA tool bar and select “VFC Site Visit Follow-up.”
Follow-up related to 2013 Compliance Site Visits or unannounced Storage and Handling Visits should be documented within the corrective action tab.

Q: Where should I enter educational visits?

A: To meet the annual provider educational requirement, educational opportunities performed for those providers not receiving a VFC compliance visit during the year should be entered as “VFC Vaccine Management Education” in CoCASA.  These educational opportunities must include the training elements outlined in Module 9, Page 4 of the VFC Operations Guide.  An awardee developed system for tracking and reporting provider education may be used instead.
Educational visits performed in addition to VFC compliance visits and formal education captured on the VFC Vaccine Education Management tab should be documented as a VFC contact.

Q: What is the definition of a VFC contact?

A: A VFC contact is any contact with a provider that occurs between VFC site visits (but not related to the most recent VFC site visit or corrective action plan) which is directly related to communicating VFC program requirements.

Q: Since secondary and tertiary educational visits have been removed from CoCASA should we still use the Failure to Comply with VFC Requirements Algorithm (Non-Compliance with VFC Provider Requirements Protocol)?

A: Secondary and tertiary educational visits can still be performed and documented as follow-up to compliance site visits conducted prior to 2013 by accessing the “2013 AFIX/pre-2013 VFC-AFIX Evaluation” tab on the main CoCASA tool bar. Beginning in 2013, follow-up performed to correct issues identified during VFC compliance site visits or unannounced storage and handling visits should be documented on the corrective action tab.

CDC’s Non-compliance with VFC Provider Requirements Protocol must be used to determine what actions should be performed to correct identified issues and the appropriate timelines for performing follow-up.  CDC is in the process of reviewing this tool and developing new guidance on the minimum actions necessary to address specific non-compliance issues.

Q: Associated with question 1 of the VFC compliance site visit questionnaire: Can a provider billing private insurance for the vaccine administration fee for a child who is eligible for the VFC Program due to their AI/AN status bill the insurance company above the regional administration fee?

A: CDC does not set billing thresholds for private insurers. The provider has the relationship with the insurance company and the acceptable billing amount for the administration fee.  The goal of question 1 is to determine if a provider charges eligible non-Medicaid patients above the set regional administration fee cap.

In the case of VFC eligible children (such as AI/AN) with private insurance, if private insurance is billed for the administration fee, the administration fee is not capped by the CMS administration fees set for non-Medicaid patients.  Providers must not bill the insurance company AND Medicaid for the administration fee.

Q:  What expiration date should I use in 14b of the Compliance Site Visit Questionnaire?

A: Although the certificates of calibration do not contain an expiration date, they do have a date of issue. CDC recommends using the manufacturer recommending testing schedule. In the event the manufacturer does not provide a recommended calibration testing schedule, then the industry standard of 1 year from issue or date provided on the certificate should be used to determine when the thermometer should be re-tested. If there is no manufacturer recommendation for calibration testing, then the expiration date would be one year (or reflect your policy) from the date of calibration testing listed on the certificate.

VFC Operations Guide - Module 6, page 5: Providers enrolled in the VFC Program are required to have calibrated thermometers in all refrigerator and freezer compartments used for VFC vaccine storage in order to monitor temperatures. Each device is to be covered by a Certificate of Calibration Testing.  Thermometer calibration must be tested annually or according to manufacturer recommendations by a laboratory with accreditation from an ILAC MRA signatory body.

Q:  When reviewing current temperature readings and temperature logs what is the acceptable temperature range for freezer storage units?

A: -58°F and +5°F [- 50°C and -15°C].

Q: Question #20 in the VFC Compliance Site Visit Questionnaire has space to document the temperature of the provider’s thermometer and the reviewer’s thermometer. Do I have to enter both?

A: If the reviewer accepts the provider’s temperature reading, the reviewer’s thermometer section can be left blank. In order to accept a provider’s temperature reading instead of a reviewer’s temperature assessment during a site visit the provider must meet all of the following storage and handling practices for each storage unit:

  1. Vaccine must be stored in one of the following equipment types:
    1. Stand alone refrigerator
    2. Stand alone freezer
    3. Combination refrigerator/freezer- using only the refrigerator compartment for vaccine storage
    4. Pharmaceutical/medical/laboratory grade refrigerator
    5. Pharmaceutical/medical/laboratory grade freezer
    6. Compact (under counter) refrigerator
    7. Compact (under counter) freezer
  2. Temperature monitoring devices and practices must be in place:
    1. Digital data logger displayed on the outside of the unit with the following characteristics:
      1. Reset button
      2. Low battery indicator
      3. Non-overwriting memory storage (does not erase or copy over data)
    2. Temperature data are downloaded and reviewed by provider weekly
    3. Biosafe glycol (other buffer material) encased probe
      1. The probe must be detachable from the data logger
    4. Current Certificate of Traceability and Calibration from a ILAC accredited laboratory (see VFC Operations Guide, Module 6 for more information)
    5. Accuracy of thermometer verified on the certificate -/+ 1 degrees Fahrenheit (0.5 degrees C)
  3. Storage temperatures are manually recorded:
    1. twice a day
    2. 3 months of temperature logs available

Q: When is a provider’s signature required?

A: There is a signature line on the last page of the Compliance Site Visit Questionnaire and the Storage and Handling Questionnaire. This is not a required field. Awardees may choose to collect provider signatures on completed questionnaires.

Providers are required to sign completed corrective action plans. A digital signature function on the corrective action tab is planned for future versions of CoCASA. Until this functionality is available, awardees with the capability to collect signatures electronically are encouraged to do so.

Awardees that do not have this capability should collect paper-based signatures and keep the corrective action plan signature page on file.


Q: Considering question 30 on the VFC compliance site visit questionnaire, how do we capture screening coverage when a provider documents eligibility status (eligibility category) using the IIS or Electronic Medical Records?

A: Question 30 captures whether the eligibility status has been documented for each child at each immunization visit.  If an IIS or EMR is used to document eligibility status, the reviewer would select 100% as the appropriate response if the IIS or EMR meets the following criteria: the eligibility fields are required and a quality assurance method is used to ensure that screening documentation is collected 100% of the time.

Reviewers should follow CDC guidance on assessing a provider’s screening practices (VFC Operations Guide, Module 9).  It is critical to determine if a provider understands the eligibility categories and how to appropriately screen for VFC eligibility.  The provider must demonstrate how the eligibility screening process is conducted for each child birth through age 18 years.

CDC is reviewing this question for the 2014 calendar year.



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