Programs & Tools:

VFC: Frequently Asked Questions

Note: Consult the Standards Guide for questions not answered on this page.

General Questions

Incorporation of new vaccines into the VFC Program

What is the process for including a new vaccine in the VFC program and how are immunization programs informed about the changes?

The Advisory Committee on Immunization Practices (ACIP) has the advisory role to determine what vaccines should be recommended for administration to children, adolescents, and adults in the U.S. and the operational role to approve which vaccines should be available through the VFC program. The ACIP meets three times a year, and during these meetings newly licensed vaccines may be discussed and recommended for use. Once a vaccine is recommended by ACIP, a vote is taken about whether or not to include the new vaccine in the VFC program through consideration of a VFC resolution. VFC resolutions are specific to each vaccine and include who is eligible to receive the vaccine, the vaccination schedule, and precautions or contraindications to the vaccine. Once the VFC resolution is approved, CDC must negotiate a contract for the vaccine to make it available under the VFC program. VFC resolutions are posted on CDC’s website.

Do CDC and grantees have any federal requirement to implement ACIP-recommended vaccines?

CDC and immunization programs that receive VFC funds are required to implement ACIP-recommended vaccines for which there are VFC resolutions and for which federal contracts have been established to purchase these vaccines. When using 317, [PDF -52KB] (compliant) state and local funds for immunizations, implementation of all ACIP recommendations is not required.

VFC and Medicaid

Note: Included are several general questions related to VFC and Medicaid. Additional questions relevant to Medicaid are included in other sections of the document as well

What is the 90-day VFC Medicaid rule?

Section 13631(g) of the Omnibus Budget Reconciliation Act of 1993 (OBRA ’93) provided that vaccination services covered under the Early and Periodic Screening Diagnostic and Treatment (EPSDT) benefit for Medicaid-eligible children will follow the ACIP-established VFC schedule beginning 90 days after establishment of the schedule. CMS considers the 90-day clock to begin on the publication date in the MMWR of ACIP general recommendations for use of a VFC vaccine. Check with the state Medicaid program or CMS for more information regarding the effective date of a new VFC vaccine requirement for EPSDT children and payment of administration fees for such Medicaid children.

Please Note: The 90-day rule does not apply to other categories of federally vaccine-eligible VFC children (i.e., uninsured, underinsured and American Indian/Alaska Natives). The VFC requirement for non-Medicaid federally vaccine-eligible children is effective on the effective date noted in the ACIP VFC resolution for a particular VFC vaccine or the date vaccine is first available through a CDC VFC contract, whichever is later.

Is Medicaid federally mandated to cover ACIP’s VFC-recommended vaccines for the Medicaid population?

Yes, all of ACIP’s VFC-recommended vaccines are part of the EPSDT benefit package for Medicaid children under age 21. Immunizations through age 18 years are covered by the VFC program. Children 19 years through 20 years are covered by Medicaid program funds.

Can a state require Medicaid providers to become VFC-program registered providers in order to ensure that Medicaid-eligible children receive vaccine under the VFC program?

Yes, the state Medicaid agency does have the option to require participation in the VFC Program.

Is it acceptable for a VFC-enrolled provider to turn away a VFC-eligible child because his/her parent didn't want all the vaccines that a child was eligible to receive administered at one clinical encounter?

This question is outside the scope of the VFC program.

Is it acceptable for a VFC-enrolled provider to ask that parents who do not wish to have their child vaccinated to find a new medical home?

This question is outside the scope of the VFC program.

Vaccine Administration Fees

What are the statutory requirements for the VFC program regarding the vaccine administration fee?

Section 1928(c) (2) (C) (ii) of the Social Security Act (42 U.S.C. 1396s(c) (2) (C) (ii)) states: "The provider may impose a fee for the administration of a qualified pediatric vaccine so long as the fee in the case of a federally vaccine-eligible child does not exceed the costs of such administration (as determined by the Secretary based on actual regional costs for such administration)."

Section 1928(c) (2) (C) (iii) of the Social Security Act (42 U.S.C. 1396s(c) (2) (C) (iii)) further provides that: "The provider will not deny administration of a qualified pediatric vaccine to a vaccine-eligible child due to the inability of the child's parent to pay an administration fee."

The Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services (CMS), published a notice of the federal regional administration fee caps in the Federal Register on October 3, 1994 (59 FR 50235). The notice also indicated that state Medicaid programs could establish lower administration fees for VFC vaccination of Medicaid children. Except in the case of an inability to pay, the notice further stated that VFC providers can charge non-Medicaid federally vaccine-eligible children (i.e., uninsured, American Indian/Alaska Natives, and when administered by an FQHC or RHC, underinsured children) up to but not more than the maximum regional administration charge (if that charge reflects the provider's cost of administration) regardless of whether the state has established a lower administration fee under the Medicaid program.

The administration fee caps do not apply to vaccination of state vaccine-eligible children. The VFC program does not have any authority over administration fees charged to state vaccine-eligible children or privately insured children.

For example:
State A’s Medicaid Agency has set the state Medicaid vaccine administration reimbursement at $10.00. The state’s regional administration fee cap is $15.00. A VFC-enrolled provider can expect to receive $10.00 for the administration of a vaccine to a VFC-eligible child enrolled in Medicaid. The VFC-enrolled provider can charge a maximum of $15.00 to a VFC-eligible child NOT enrolled in Medicaid. The VFC program does not regulate administration fees charged to private pay or privately insured patients.

Who should pay the vaccine administration fee for Medicaid-eligible children? 

The state Medicaid agency should be billed for the administration fee for Medicaid-eligible VFC children immunized by a Medicaid-enrolled VFC provider. State Medicaid agencies establish their own policies and administration fees that may be lower than the regional maximum charges established in 1994. For Medicaid VFC-eligible children, the state Medicaid agency determines and CMS approves the reimbursable amount for their fee-for-service and managed care enrolled recipients. If the provider bills Medicaid the regional maximum charge instead of the Medicaid agency’s allowable rate the provider will be reimbursed only the allowable rate and not the amount billed. The difference between the allowable rate and the amount billed cannot be collected from the parents of the child.

What are the administration fee requirements for insured children who have private health insurance benefits that include immunization coverage?

The VFC administration fee caps only apply to VFC eligible children and do not apply to privately insured children.

What is involved in raising the reimbursement rate for VFC vaccine administration by Medicaid at the state level?  

State Medicaid agencies, through processes that vary from state to state, may raise the VFC administration fees payable to Medicaid providers for vaccinating Medicaid eligible children up to the regional fee cap that was established for each state in 1994. Should a state consider its CMS-imposed cap to be too low, CMS and CDC should be contacted to discuss potential revision of the fee cap. Because so few state Medicaid agencies are reimbursing at the maximum regional charge, the current fee structure will remain in effect until further notice.

How does the CMS maximum regional charge for vaccine administration relate to universal-purchase states?

The October 1994 Federal Register notice gives universal purchase states (states in which the vaccines are purchased by the state for all children in the state) the right to develop administration fees that differ from those established by CMS, provided they are reasonable. Therefore, universal purchase states are provided the flexibility to accept the maximum charges established by the Secretary or develop their own maximum charges. The maximum charges must be developed utilizing a reasonable methodology based on VFC section 1928(c)(2)(C)(ii) of the Social Security Act. The amount of the cap (maximum fee) is not required to be set in state law. However, the authority to set an amount must be based in state law. In either case, CMS gives state Medicaid agencies the option to establish and apply vaccine administration fees that are lower than the specified maximum regional charges if they provide assurances that Medicaid children have access to immunizations to the same extent as the general population.

How does a VFC-enrolled provider who is not already a Medicaid provider file for Medicaid reimbursement for vaccine administration?

It is necessary to be a Medicaid provider in order to receive payment from Medicaid for vaccine administration services provided to Medicaid-eligible children. Providers should consult the state Medicaid agency about the procedures necessary to become a Medicaid provider.

Does the VFC program require that a sign be posted in all vaccine providers’ offices that states "No VFC eligible child may be denied federally-supplied vaccine due to the inability to pay the administration fee"? May we use some other communication tools, such as a flyer that allows for a few paragraphs of explanation?

There is nothing in the VFC legislation that mandates a posted sign in provider offices. Other means of communication may be used.

Can a private provider refuse to administer VFC vaccine to VFC-eligible child?
Q&A updated Feb 2011

Section 1928 (c)(2)(C)(iii) of the Social Security Act states, "The provider will not deny administration of a qualified pediatric vaccine to a vaccine-eligible child due to the inability of the child’s parents to pay an administration fee." The statute further notes at Section 1928(c)(2)(C)(i) that "A program-registered provider is not required under this section to administer such a vaccine to each child for whom an immunization with the vaccine is sought from the provider." CDC interprets this to mean that private VFC providers, unless otherwise required by another statute, do not have to honor vaccine requests by VFC-eligible children who "walk in" for immunizations only and are not established patients in the practice. For established VFC-eligible patients and other VFC-eligible patients that the provider chooses to immunize, VFC immunization cannot be denied due to the inability to pay an administration fee.

How will the change in CPT codes affect vaccine administration fees under the Vaccines for Children (VFC) program? Q&A added Dec 2010

The two new CPT codes are:
90460 – Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component, 90461 – Each additional vaccine/toxoid component.

These codes replace 90465, 90466, 90467, and 90468.

Every vaccine administered has exactly one first component, and many vaccines have second and subsequent components (e.g., MMR, DTaP, and DTaP/IPV).

In the VFC program, the regional vaccine administration fee cap rates were established on a per-vaccine basis, not a per-antigen or per-component basis. Under current interpretation of CMS policy, the administration fee for the VFC program will continue to be based on a per-vaccine basis and not on a per-antigen or per-component basis. CMS is looking closely at the VFC administration fee cap to ensure that it keeps up to date with changes in underlying costs of providing vaccines and with medical practice. CMS anticipates updating the fee cap in the near future and is also examining the larger reimbursement structure of the VFC program. In the meantime, State Medicaid agencies can increase the amount they pay providers up to their regional cap by submitting a State Plan Amendment, as most States are currently paying providers rates that are below their State caps. In addition, States can choose to establish different rates, up to their regional caps, for vaccines with multiple antigens and for those that have only a single component.

VFC-enrolled providers may not charge a vaccine administration fee to VFC-entitled children that exceed the regional administration fee cap per dose of vaccine.

Given the VFC policy on the new CPT codes, what codes should providers use?
Q&A added Dec 2010

Providers are encouraged to use the new code 90460 for the administration of a vaccine under the VFC program. If code 90461 is used for a vaccine with multiple antigens or components, it should be given a $0 value for a child covered under the VFC program. This applies to both Medicaid-enrolled VFC-entitled children as well as non-Medicaid-enrolled VFC-entitled children (i.e., uninsured, underinsured, and American Indian or Alaska Native children not enrolled in Medicaid).

Please define the term “waive” in the context of this section of Module 3 (pages 8-9) of the VFC Operations Guide (February 2011):

6. Not deny administration of a federally purchased vaccine to an established patient because the child's parent/guardian/individual of record is unable to pay the administration fee.

Provider Education Goals for this requirement:
By the end of the enrollment or education session the provider and staff will understand

• This requirement applies to VFC vaccines as well as any other vaccines purchased through the CDC federal contracts when the eligible child's family/guardian is unable to pay the administration fee;
  
• The only fee that must be waived is the administration fee. Other visit or office fees may be charged as applicable.
  Q&A added July 2011

The term “waive” in this context is based on the first entry of "waive" as defined in the online version of Merriam-Webster dictionary #1). 1 give up, forsake.

So, if the parent cannot pay the administration fee for a VFC vaccine, the provider must give up or forsake the VFC administration fee.

Can providers send a bill in order to collect the vaccine administration fee after the date of service (for vaccines provided to non-Medicaid VFC-eligible children)? Q&A added July 2011

There are no restrictions against sending a bill for the vaccine administration fee after the point of service. However, the provider cannot send the bill for the vaccine administration fee to collections if the parent cannot afford to pay (i.e., if the parent does not pay the bill). The provider can send the office visit fee or any other visit fee (e.g., labs) to collections if unpaid, but not the vaccine administration fee. The federal requirement restricts the provider from seeking payment if the parent cannot afford it. But this is not a restriction from sending a statement or bill after the point of service. If the parent cannot pay the administration fee for a VFC vaccine, the provider must waive it.

VFC Eligibility

How can you determine if a health benefits organization is a health insurance company when determining a child’s VFC eligibility?

Health insurance is subject to the Employee Retirement Income Security Act of 1974 (ERISA) or is regulated by a state’s Insurance Commissioner as insurance. ERISA is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. Contact the state Insurance Commissioner to determine if an organization is a health insurance company.

 

For providers who offer a medical concierge service (i.e., provision of special medical services at a set member fee), is the service considered health insurance? Q&A added July 2011

Health insurance is defined as a plan subject to ERISA or regulated by the state’s Insurance Commissioner as insurance (see Q&A above). If the service does not fall in either of these two categories, the service is not considered a form of insurance for the purposes of the VFC program.

If a family has a medical savings account or health savings account does that account affect a child’s VFC eligibility?

Individuals covered by medical savings accounts or health savings accounts must also have high deductible health plan coverage. Therefore, such individuals are insured.

If a child presents for vaccines and does not have health insurance but the parent plans to insure the child, would this child be eligible for VFC vaccine?

If the child has no health insurance on the day he/she presents at the office for immunizations, the child would be VFC eligible because he/she is uninsured. VFC eligibility screening must take place with each visit even though the patient screening form needs to be updated only when the eligibility status of the child changes.

If a child is eligible for insurance and the parents choose not to insure the child, would the child be eligible for VFC vaccine?

If the child has no health insurance on the day he/she presents at the office for immunizations, regardless of the reason, the child would be VFC eligible because he/she is uninsured.

Can VFC vaccines be administered to the underserved population?

VFC does not have a category specifically for the underserved. The term "underserved" refers to a geographic location such as a county or a census tract or a population living in a specific geographic location that has been designated by HRSA as medically underserved. For further information on medically underserved areas or population, please visit the Health Resources and Services Administration (HRSA) website at http://www.hrsa.gov/index.html.

It is common for VFC- eligible children to live in medically underserved areas or to be members of medically underserved populations.

If a child is eligible for a Title V program that pays for medical care for that child, is the child VFC eligible?

Title V is not a type of health insurance so it has no effect on VFC eligibility of a child. To be eligible for VFC a child has to meet the age and eligibility criteria of the VFC program. To learn more about the Title V program see the HRSA website: https://perfdata.hrsa.gov/mchb/TVISReports/Default.aspx

If a VFC-eligible child starts a vaccine series (such as hepatitis B) at age 18, can the series be completed using VFC vaccine after the child turns 19?

No. Children are eligible to participate in the VFC program only through age 18 years regardless of the child’s immunization status (series completed or series not completed) when they age out of VFC.

Are all children enrolled in Medicaid programs automatically VFC eligible?

Yes, all children from birth through 18 years of age who are covered by Medicaid are considered VFC eligible because of their Medicaid status.

Are all children who have Medicaid as a secondary insurance covered by VFC?Q&A added Feb 2011

Yes, all children who have Medicaid as a secondary insurance are covered by VFC. The state Medicaid agency will pay the claim for the administration fee and seek reimbursement from the primary insurance.

How should providers bill administration fees for VFC vaccines administered to children who are covered by Medicaid and have another form of health coverage?

Generally, providers are required to bill third parties before Medicaid will make payment (we refer to this as cost avoidance). However, there are a few exceptions to the cost avoidance rules. In the case of preventive pediatric services including EPSDT, if the Medicaid agency is billed, it is required to make payment and then seek reimbursement from the third party (CMS refers to this as pay & chase) - see 1902(a)(25)(E) of the Social Security Act. The Medicaid agency is to seek recovery as long as it is cost effective to do so, i.e., where the amount of reimbursement the State can reasonably expect to recover exceeds the cost of recovery (see 1902(a)(25)(B)). Since child immunizations fall under this exception, the provider has several options for billing the administration fee:

The provider could administer VFC vaccine, and then bill the maximum regional charge for the vaccine administration to the Medicaid agency and Medicaid would be responsible for seeking reimbursement from the primary insurance.

The provider could administer private stock vaccine and bill the primary insurance the usual and customary charge for both the vaccine and the vaccine administration fee.

If the primary insurance is billed first and the insurance denies the claim, the provider could replace the private stock vaccine used with VFC vaccine then bill the maximum regional charge for the vaccine administration fee to Medicaid. The Medicaid agency should bypass their cost avoidance edit allowing the claim to be considered for payment.

Also, if the third party payer pays less than the Medicaid amount for the vaccine administration fee, the provider can bill Medicaid for the balance of the vaccine administration fee up to the amount Medicaid pays for the administration fee.

Vaccine Storage and Handling

Where can I get more information on vaccine storage and handling?
Q&A added Feb 2011

CDC’s Vaccine Storage and Handling Toolkit is available on-line. The link to download the toolkit is http://www2a.cdc.gov/nip/isd/shtoolkit/splash.htm.

What is the impact of a power outage on vaccine and what should be done with vaccine? Q&A Updated Feb 2011

General procedures for power outages are described in the Vaccine Storage and Handling Toolkit. (http://www2a.cdc.gov/nip/isd/shtoolkit/splash.html)

All providers should have an Emergency Vaccine Retrieval and Storage Plan Worksheet prepared in advance to guide them in the event of a power outage or other emergency. This should include plans for alternative storage and transport of vaccines

Please Note: The following key messages for immunization providers:

In any type of power outage:

• Do not open freezers and refrigerators until power is restored, except to transport vaccine to an alternative storage location.
• Monitor temperatures and duration of power outage; don’t discard vaccine; don’t administer affected vaccines until you have discussed with public health authorities.

Are "Dorm Style" refrigerators acceptable storage units for VFC vaccines?

Dormitory-style refrigerators should only be used to store a clinic's single-day supply of refrigerated vaccines and these vaccines should be returned to the main refrigerator storage unit at the end of each clinic day.  Dormitory-style refrigerators are not adequate for long-term or permanent storage of biological products because they do not maintain appropriate temperatures.

Storage of VFC vaccine in refrigerators that are designed for use in small household spaces such as dorm rooms are never acceptable for  permanent storage of VFC vaccines.  Permanent storage is defined as the vaccine supply is maintained in the unit 24 hours a day/7 days a week.

"Dorm Style" refrigerators are acceptable for short-term storage of select VFC vaccines under very limited conditions which are listed below:

1. The purpose of using these units is for temporary storage when it is not reasonable for the staff administering the vaccine to go to the main storage unit to obtain vaccine for each and every patient.  
2. The unit is never used for storing Varicella-containing vaccines
3. Only small amounts of inactivated vaccines can be maintained in these units. The amount of inactivated vaccines stored in the unit must never exceed the amount used in the clinic in one day. 
4. The vaccine is returned to the main storage unit at the end of  each clinic business day and vaccine is never stored in these units overnight or during periods of time when the practice is not open for business.
5. Each unit has a dedicated certified thermometer in place.
6. Temperatures are monitored and documented twice a day on temperature log specifically for that unit.  Appropriate action is immediately taken when the temperatures are outside the appropriate range.
7. These units must be included and examined during the VFC compliance visit and corrective actions taken and documented by the grantee if any of the above conditions are not met.

Some of our providers have small compact storage units that were designed to hold medical biologicals. Are these storage units acceptable for permanent storage of VFC vaccine?

Yes, these types of vaccine storage units are acceptable if they meet the following conditions:

1. The refrigerator and freezer compartments each have a separate external door, or
2. Units are stand-alone refrigerators and freezers
   
   Refrigerators or freezers used for vaccine storage must comply with the following requirements:
   •  Be able to maintain required vaccine storage temperatures year-round;
   • Be large enough to hold the year's largest inventory;
   • At a minimum, have a working certified thermometer inside each storage compartment.  Grantees may require VFC providers to have a calibrated certified thermometer inside each storage compartment.  Calibration must be traceable to standards provided by the National Institute of Standards and Technology (NIST) (a U.S. Government agency within the Commerce Department) or a laboratory recognized by NIST.  Calibration can be traceable to NIST using American Society for Testing and Materials (ASTM) methods for the calibration process;
   • Be dedicated to the storage of vaccines. (Food and beverages must not be stored in a vaccine storage unit because this practice results in frequent opening of the door and destabilization of the temperature.)

It appears that some manufacturers’ package inserts and CDC’s storage and handling recommendations for refrigerated vaccines differ by one degree on the bottom of the refrigerated range. What range should the field staff use as their guide?

Merck, GSK and Wyeth's package inserts recommend storage temperatures for their products to be 2° - 8°C (36° - 46°F). On the other hand, Sanofi's package inserts state that their products should be stored at 2° - 8°C (35° - 46°F). I have spoken with both the manufacturers and FDA on this matter. This is a non-issue with the manufacturers. In addition, the FDA (CBER's Office of Vaccine Research and Review (OVRR)) does not have any official position on this rounding issue. However, it is the opinion of OVRR that four-tenths of a degree should not cause any problem with the quality of vaccines and 35°F is acceptable. As you know, the vaccines should not be exposed to freezing temperatures, particularly those vaccines containing aluminum adjuvants. The take home message is that the recommended temperature ranges are effective in keeping vaccine storage away from the dreaded 0°C (32°F).

Celsius °C	Fahrenheit °F
0 °C	32.0 °F
1 °C	33.8 °F
2 °C	35.6 °F
3 °C	37.4 °F
4 °C	39.2 °F
5 °C	41.0 °F
6 °C	42.8 °F
7 °C	44.6 °F
8 °C	46.4 °F

Some of our providers have been removing VFC vaccine that comes in manufacturer prefilled syringes from the original packaging to store in plastic containers if storage space is a concern. What is CDC’s position on this?

CDC’s position is to have providers store vaccine in their original containers to help protect the vaccine from damage due to storage errors, as well as, to decrease the possibility of administration errors from inadvertently confusing similarly packaged vaccines.

VFC Provider Enrollment

What should we do if a VFC-enrolled primary care provider does not want to order or offer one specific VFC vaccine based on his or her medical judgment?

The VFC statue, at section 1928(c)(2)(B)(i) of the Social Security Act (42 U.S.C. 1396s(c)(2)(B)(i)), states within the provider agreement section that the provider agrees as follows:

"Subject to clause (ii) the provider will comply with the schedule, regarding the appropriate periodicity, dosage, and contraindications applicable to pediatric vaccines, that is established and periodically reviewed and, as appropriate, revised by the…[ACIP], except in such cases as, in the provider’s medical judgment subject to accepted medical practice, such compliance is medically inappropriate." CDC interprets this provision to mean a medical judgment based on the situation of an individual VFC patient. Except as noted in the next Q and A regarding varicella vaccine, only specialty providers may choose, at the discretion of the grantee, to offer only specific VFC vaccines and their choice is based on the scope of their medical practices. Other VFC providers must offer the full list of VFC vaccines according to the schedule determined by the ACIP in its VFC resolutions, except when in the provider’s medical judgment, subject to accepted medical practice, the circumstances of an individual VFC patient makes such vaccination medically inappropriate.

Our state has large rural areas and many rural providers do not have the appropriate storage units to stock varicella vaccine and may be the only medical provider for several hundred miles. Are these providers non-compliant with the provider agreement for the VFC program because they are not offering a specific VFC vaccine?

Certain vaccines, such as varicella vaccine, require special storage and it would be accepted medical practice not to order or store those vaccines if the provider did not have the appropriate storage facilities. We encourage grantees to assist providers in finding ways to obtain vaccine storage that will allow provision of all VFC vaccines.

When enrolling inpatient facilities such as birthing hospitals or juvenile inpatient treatment facilities in the VFC program, is it necessary to list all providers (e.g., residents, interns) authorized to administer vaccines under the supervision of the VFC provider who signs the enrollment form?
Q&A added July 2011

No. Due to the potentially large number of individuals that would be listed on the form and the difficulty in maintaining the accuracy of the list, it is not necessary to list these individuals on the enrollment form for birthing hospitals.

Can a pharmacist become a VFC program registered provider?
Q&A added July 2011

Yes, in accordance with state law. If a pharmacist is granted the authority to administer vaccine by state law (whether by prescription, protocol, or prescribing authority), the pharmacist is eligible to become a VFC program registered provider within the state.

In jurisdictions where pharmacists are not authorized to administer vaccines except under the direct supervision of a physician, then the supervising physician must co-sign the provider enrollment agreement along with the pharmacist in order for the pharmacist to be enrolled as a VFC registered provider.

Must specialty providers offer all age-appropriate VFC vaccines to their VFC-eligible patients in order to enroll in the VFC program? Q&A added July 2011

No. Specialty providers enrolled in the VFC program, at the discretion of the grantee, may limit their VFC practice to particular relevant vaccines. Specialty providers would include birthing hospitals, juvenile detention centers or juvenile inpatient treatment facilities, OB/GYN practices, family planning and STD clinics, and pharmacists/ pharmacies.

VFC Accountability

On page 4 of the Accountability Module of the VFC Operations Guide (January 2011), there is a new requirement to monitor and report the volume of publicly purchased vaccine lost/wasted* due to expiration and/or improper storage and handling practices. Should grantees include unaccounted for public vaccine in the calculations? Q&A added Feb 2011

No, the calculations should be based on only the volume of vaccine that can be confirmed as expired or lost/wasted* due to improper storage and handling practices. Unaccounted for public vaccine is defined as vaccine that’s existence/status cannot be determined at this time. *For the purposes of the VFC program, VFC Operations Guide Module 8 and this document, lost/wasted vaccine is defined as the loss of vaccine because of spoilage, waste or expiration due to improper storage and handling practices.

Should grantees include unused influenza doses that are returned at the end of the flu season as expired for CDC reporting purposes? Q&A added Feb 2011

No, influenza vaccine that is returned at the end of the flu season because of lack of demand should not be included in the calculations for reporting of expired or lost due to improper storage or handling. Influenza vaccine lost during the flu season due to improper storage or handling should be included in the calculations.

VFC Associated Web Site Resources

• General VFC Information

  http://www.cdc.gov/vaccines/programs/vfc/default.htm

  http://www.cdc.gov/vaccines/programs/vfc/projects/default.htm#faq

• Excise Tax Credits

  http://www.cdc.gov/vaccines/programs/vfc/forms/excise-tax.htm

• Vaccine Contracts Guidelines  

  http://www.cdc.gov/vaccines/programs/vfc/downloadsguide-vac-contracts-508.pdf (Temporarily pulled from site while it is being updated)

• Early Periodic Screening Diagnosis and Treatment (EPSDT) Services

  http://www.cms.gov/MedicaidEarlyPeriodicScrn/01_Overview.asp

Note: For further information or clarification on VFC programmatic questions please contact: Nancy Fenlon @ ncf1@cdc.gov or 404-639-8810.

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