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Doneen Hollingsworth, Secretary of Health

December 17, 2012 Meeting Minutes

The Immunization Workgroup met Monday, December 17, 2012 in Pierre, to continue discussion of the goals of the South Dakota Immunization Program, which include creating a simplified system, no missed opportunities and improved immunization rates for South Dakota’s children. Secretary of Health Doneen Hollingsworth opened the meeting with a summary and overview from the initial meeting held last August. She stated South Dakota is well positioned as a state, and that Governor Daugaard is supportive of creating a safety net for children on grandfathered insurance plans.  He has proposed one-time funding of $1,000,000 for this purpose; however, this is pending approval by the Legislature.

 

Dr. Lon Kightlinger, State Epidemiologist, presented a PowerPoint on current vaccination coverage rates in South Dakota, with emphasis on children missing their fourth DTaP dose.  This dose would be routinely recommended at 15-18 months of age. He said there has been a downward trend in the past five years, and children getting this fourth dose would greatly improve our rates, although generally children are current by the time they start kindergarten.

 

Since the last meeting, Randy Moses from the Department of Labor’s Division of Insurance surveyed private health insurers to see who was grandfathered in for insurance coverage. Based on his findings, he estimates there are about 3062 children 18 years and under that are without preventative services, including immunizations.

 

In October and November, 2012, Tim Heath from DOH’s Office of Disease Prevention conducted a survey of 280 clinics regarding immunization barriers. To summarize, the top five barriers are:

  • Determining what a patient’s insurance will cover
  • Reminding or recalling patients

  • Missed opportunity to vaccinate due to unknown insurance coverage

  • Dual entry of immunization data into the state’s immunization registry and the clinic’s electronic medical record

  • Referring underinsured children elsewhere for vaccination

The full results of the survey are available on the PowerPoint on the DOH website.

 

In an effort to eliminate barriers and improve immunization rates, the Department of Health announced beginning January 1, 2013, federal 317 dollars would be used to support underinsured children in their medical home. Bonnie Jameson from DOH’s Office of Disease Prevention stated the process should be seamless for the health care providers.  

 

Discussion followed regarding development of a safety net.  The safety net would provide one time funding for vaccines for children who would not have “first dollar coverage” for immunizations because they are insured under grandfathered insurance plans which may not cover childhood vaccines.  The vaccines purchased for the Safety Net cannot be purchased from the federal contract.  DOH will utilize other contracts for the vaccines needed to replace doses administered by providers for children who are covered by the “safety-net”.

 

Discussion included:

  • Questions regarding reimbursement for administration fee for vaccines provided through the safety net.  Funding is currently not available to support administration fee. 

  • Sanford staff shared Minnesota and a few other states have already gone to a plan where providers are paid a quarterly fee from insurance companies for vaccinations.  Providers do not bill the insurance company for the shots. 

  • For further information regarding states entering into agreements with insurance companies, go to www.kidsvac.com 

  • Pharmaceutical representative indicated that ND also tried a similar approach.  The pharmaceutical representatives present stated they liked the Safety Net concept but do not want to see private market shut out.

  • Provider choice:  Although the recent DOH survey did not indicate provider choice was an issue, there was discussion among the workgroup members that in their respective practices, provider choice is a concern.

  • The Department of Health indicated in FY15 when our current stock-pile of vaccine has been administered, providers will have provider choice for vaccine received through the VFC Program.

  • The Immunization Program staff shared the Federal VFC administration fee is going to go from $13.56 to $20.73 in 2013.

The Department of Health will establish a subcommittee to further define the process for use of the safety net concept in providing vaccines for children who do not have first dollar coverage for immunizations.   The workgroup is challenged with defining a system and process for assuring there is no missed opportunity for children to receive their vaccinations, the provider receives reimbursement/replacement for the vaccine, and there is appropriate documentation to assure accountability for the safety-net funds. 

 

The workgroup discussed opportunities and recommendations to improve South Dakota’s immunization rates.  Providers expressed concern regarding overall rates.  Suggestions included:

  • Work with South Dakota High School Activity Association to encourage inclusion of immunization status as a portion of the sports physical.

  • Provide additional information to parents regarding their child’s immunization status.  Although the requirement for kindergarten entry results in excellent rates for South Dakota kindergarten children, many parents of children in middle school are unaware their children are in need of additional vaccines.  Many middle school children are inadequately immunized to be protected from vaccine-preventable diseases.

  • Consider middle school immunization requirements.  Distribution of immunization information to parents of middle school children upon entry to middle school.  Workgroup was reminded the current school entry immunization requirements are merely the minimum.  School districts have the option to expand and enforce the requirements for their own district. 

  • Ongoing parent education.  Encourage parents to review their child’s immunization records.  Question arose regarding whether there is a website parents could go visit to see their child’s immunization records.  This is not currently available.  SDIIS is available for schools and providers.

  • Dr. Paul Amundson proposed clearly defining our immunization goals to all providers.  

    • Department of Health 2020 goal

      •  Increase percent of 2-year olds who are age appropriately immunized from 81% in 2010 to 90% in 2020.

      • Increase percent of adolescents ages 13-17 years who have received at least 1 dose of Tdap from 54.4% in 2011 to 80% in 2020.

    • Increase percent of 15-18 month old children receiving their 4th dose of DTaP.

    • Increase the percentage of middle school children receiving Tdap, meningococcal and HPV vaccinations.

  • Colleen Winter indicated the Department of Health will continue communicating with providers and clinics to assist them in looking at their specific coverage rates, sharing the statewide goals, and discussing options to improve rates.  Support and assistance from the membership of the workgroup will be particularly beneficial. 

  • The issues of bi-directional exchange of immunization data between the state’s immunization registry (SDIIS) and the electronic health records were discussed.  This functionality would eliminate dual entry.  The state is working on several pilot projects with vendors.  Bi-directional exchange is critical to assure complete immunization records. 

Members interested in participating on the sub-group to define the safety net process should contact Bonnie Jameson by January 11, 2013.  Her contact information is:  Phone 605-773-3917. Email bonnie.jameson@state.sd.us.

 

Tentative date for next meeting – April 2013

 

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