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Vaccines for Children Program

1. What is the Vaccines for Children (VFC) program?
The Vaccines for Children (VFC) program, established in 1994, provides free vaccines to enrolled physicians for administration to VFC-eligible children. A child is eligible for free VFC vaccines if he or she is under age 19 and meets one or more of the following criteria:

• Medicaid recipient (fee-for-service or managed care)
• Child Health Plus enrollee
• Uninsured
• Underinsured (has insurance that does not cover immunizations)
• Native-American

For additional information, visit the Centers for Disease Control and Prevention Web site at www.cdc.gov/vaccines/programs/vfc.

2. How does the VFC program work?
The VFC program is administered at the national level by the Centers for Disease Control and Prevention (CDC) through the National Immunization Program. The CDC contracts with vaccine manufacturers to buy vaccines at reduced rates. States and eligible US programs enroll physicians who then provide routine immunization services to eligible patients at no cost. Physicians do not have to be New York State–approved Medicaid providers to participate in the VFC program.

3. Why should physicians enroll in the VFC program?
In accordance with our contracts with the New York State Department of Health (NYSDOH) and the City of New York, EmblemHealth does not reimburse physicians for the cost of vaccines administered to Medicaid or Child Health Plus members. Note: We do reimburse the administration fee for these vaccines at the rates indicated in your physician fee schedule.

To obtain vaccines free of charge for VFC-eligible children, physicians should consider enrolling in the VFC program. Other benefits of enrollment include:

• Increased opportunities for children to be vaccinated while saving out-of-pocket costs
• Coverage of all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP)

4. How can physicians enroll in the program?
To enroll in the VFC program:

• New York City physicians should call the New York City VFC Immunization Program at 1-347-396-2405.
• Nassau, Suffolk, Westchester, Orange or Rockland County physicians should call 1-800-543-7468.

5. Is enrollment in the VFC program mandatory?
Enrollment in the VFC program is not mandatory. However, if you choose not to enroll, EmblemHealth does not reimburse physicians for the cost of vaccines administered to Medicaid or Child Health Plus members. In addition, you may not bill the member for the cost of the vaccine. Note: EmblemHealth does reimburse the administration fee for these vaccines at the rates indicated in your physician fee schedule.

6. Can physicians who do not participate in Medicaid Fee-for-Service (FFS) enroll in the VFC program?
Yes. Physicians in managed care plan networks that serve VFC-eligible Medicaid and Child Health Plus patients can — and are encouraged — to enroll. Although they may not see Medicaid patients, they can enroll in the program to provide immunizations for other eligible children. The VFC program also includes coverage for underinsured children when vaccinated at participating federally-qualified health centers or rural health clinics.

7. Can Medicaid FFS physicians who do not enroll in the VFC program bill the Medicaid Program for the administration of vaccines?
Yes, but the reimbursement rate for the administration fee will be only $4.62. If physicians enroll in the VFC program, the Medicaid Program reimburses up to a maximum of $17.85.

8. How do I bill EmblemHealth for the administration fee?
You should bill EmblemHealth with the same CPT codes used for the administration of a vaccine.

9. Do I still have to report immunized children to the Citywide Immunization Registry or the State?
Yes. New York City physicians must report all required immunizations to the New York Citywide Immunization Registry at 1-212-676-2323 or www.nyc.gov/health/cir, regardless of the source of the vaccine. For physicians outside of New York City, report all immunizations to the New York State Immunization Information System at 1-518-473-4437 or www.health.state.ny.us/prevention/immunization/information_system.

In the event of an adverse reaction from the administration of a vaccine, all physicians must file a report using the Vaccine Adverse Event Reporting System (VAERS) form. The form may also be obtained by calling 1-800-822-7967.

For vaccines purchased with public funds, physicians must report adverse reactions to the county, city or district health office where the patient resides. For vaccines purchased with private funds, the physician must report to:

Vaccine Adverse Event Reporting System
PO Box 1100
Rockville, MD 20849-1100