Vaccine Replacement Model

This alternate enrollment model streamlines inventory management for large healthcare systems and birthing hospitals. Facilities use their private stock to vaccinate all patients and are subsequently reimbursed monthly with replacement doses for all VFC-eligible patients. A separate application must be completed and approved by CDC.

Available Vaccines

The VFC Program supplies all ACIP-recommended vaccines and other immunizing agents that protect against 18 diseases at no cost to providers who serve VFC-eligible children. Providers must offer all ACIP-recommended vaccines for patient populations served. For example, birthing hospitals only need to stock HepB and monoclonal antibody immunizing products (e.g., nirsevimab).

Patient Eligibility

The VFC Program is an entitlement program. Facilities screen patients and document VFC eligibility status at each patient visit and administer VFC vaccines only to children from birth through 18 years of age who meet at least one of these eligibility criteria: Medi-Cal-eligible (or enrolled), American Indian (AI) or Alaska Native (AN), Uninsured and Underinsured.

Qualifying Providers

Large healthcare systems, birthing hospitals, and pharmacies (by invite only).

Provider Agreements

Participating providers partner with the VFC Program to help meet the program’s goals and ensure that federal and state requirements are met to protect VFC vaccines and program integrity. See Replacement Requirements at a Glance (PDF) for a summary with supporting job aids.

• VFC Provider Agreement (PDF)
• CA Provider Agreement Addendum (PDF)

Documentation Requirements

Facilities must be able to electronically document patient eligibility at the dose level.  Eligibility status (including insurance information) must be documented during registration and verified and updated as necessary to change vaccine doses to VFC vaccine prior to vaccine administration.

Reporting Doses Administered

Facilities must report doses administered (including NDCs, patient eligibility status, and funding source) to a California immunization registry (CAIR or Healthy Futures/RIDE) through a data interface or My Turn’s CAIR Quick Entry. Replacement of doses is based on administration data recorded in a registry, so accuracy must be ensured.

Requesting Replacement Doses

Submit vaccine orders and required administration reporting of eligible patients monthly and at same time (+/- a couple of days). Facilities must report a calculated virtual inventory of public doses on hand on each vaccine order by applying the percentage of location’s VFC-eligible population to current inventory. VFC will assess aggregate and patient level data prior to fulfilling replacement vaccine orders to determine the number of doses to replace and then replace private doses used on VFC-eligible patients.

Billing for Administration

Facilities must update their billing practices to ensure that VFC-eligible children are not billed for the cost of a vaccine. For non-Medi-Cal, VFC-eligible children: Facilities may charge patients a vaccine administration fee but fee must not exceed the vaccine administration fee cap (PDF) established by the Centers for Medicare and Medicaid (CMS). For Medi-Cal patients, facilities must bill Medi-Cal for the administration fee.

Enrollment

Contact the California VFC Program at (877) 243-8832 or see Replacement Requirements at a Glance (PDF) for more details.