New York State Vaccines for Children Program
The New York State Vaccines for Children (VFC) Program is a federally-funded program that provides vaccines at no cost to eligible children. The vaccines are distributed to private physicians' offices and public health clinics enrolled as VFC providers. VFC providers administer the vaccines to VFC-eligible children. VFC providers may also obtain other publicly-funded vaccines to serve children eligible under other criteria.
Publicly-funded childhood vaccines include
- Federal VFC vaccine,
- New York State-funded vaccine, and
- The New York State Child Health Plus (CHP) children's health insurance plan-funded vaccine.
Who is eligible to receive VFC and other publicly-funded vaccine?
A child is eligible for VFC vaccine if he or she is younger than 19 years of age and meets at least one of the following criteria:
- Medicaid-enrolled (includes both fee-for-service and managed care)
- A child who has commercial health insurance but the coverage does not include vaccines, a child whose insurance covers only selected vaccines (VFC-eligible for non-covered vaccines only), or a child whose insurance caps vaccine coverage at a certain amount or number of visits (VFC-eligible once that cap is exceeded). Underinsured children are eligible to receive VFC vaccine only through a Federally Qualified Health Center (FQHC). New York State allows private providers to vaccinate underinsured children using state-funded vaccine.
- American Indian or Alaska Native
A child is eligible for other publicly-funded vaccines if he or she is younger than 19 years of age and meets one of the following criteria:
- Enrolled in the New York State Child Health Plus (CHP) insurance program.
- Underinsured and vaccinated at a provider other than an FQHC.
Participation in the VFC Program:
- Reduces vaccine cost as a barrier to vaccinating VFC-eligible children at the right time with the right vaccine.
- Eliminates the need to refer children to public clinics, thereby allowing them to receive services in their medical homes.
- Increases immunization rates because health care providers are able to offer vaccine to eligible patients who might not be able to afford them.
- How to Enroll
- Vaccine Personnel
- Site Visits
- Vaccine Storage and Handling Requirements
- Provider Education
- Vaccine Ordering and Inventory
- Eligibility Screening and Documentation
How to Enroll
In order to join the NYS VFC Program, providers must:
- Maintain an active Health Commerce System (HCS) account (For information about HCS, contact the Commerce Account Management Unit (CAMU) Help Desk at 1-866-529-1890 or email@example.com); and
- Register with the New York State Immunization Information System (NYSIIS). Call the NYSIIS Help Desk at 1-866-389-0371 or email NYSIISHelpDesk@hp.com; and
- Determine the annual number of VFC, CHP, underinsured and insured patients expected to be served. This information will determine the type of publicly-funded vaccine a provider may order; and
- Download, complete, and submit the following forms
- Participate in an enrollment site visit.
To prepare for participating in the program and the enrollment visit, providers should have the following available:
- Refrigerators and freezers capable of maintaining appropriate temperatures.
- Certified calibrated thermometers or digital data loggers including their calibration certificates.
- The name of a vaccine coordinator and at least one back up who will be responsible for receiving vaccine, monitoring temperatures and ordering vaccine.
- A procedure describing how the provider office will screen for and record patients' vaccine eligibility and record doses administered in NYSIIS.
- Access to the Health Commerce System and NYSIIS.
New providers will be contacted by the New York State Department of Health (NYSDOH) to schedule an enrollment site visit prior to being authorized to order vaccine.
Annual Re-Enrollment Process
Each year providers must re-enroll in the VFC Program by submitting a VFC Provider Agreement and Profile and a Vaccine Storage and Handling Plan. Providers will receive email notices regarding the re-enrollment process and deadlines.
Provider Agreement and Profile
By enrolling or re-enrolling in the program, providers agree to the VFC Program requirements listed in the Provider Agreement and Profile Form and the Vaccine Storage and Handling Plan. The physician who signs the agreement and all other immunization providers at each VFC-enrolled practice are accountable for compliance with the requirements.
All VFC provider sites must designate a physician-in-charge, a primary vaccine coordinator and at least one back-up vaccine coordinator who is able to perform the same responsibilities as the primary vaccine coordinator in the event that the primary person is unavailable.
The vaccine coordinator and back-up must personally complete the following vaccine management activities or ensure the tasks are completed by other designated staff members:
Training and Communication
- Read and be familiar with the information in the VFC Provider Agreement, the Vaccine Storage and Handling Plan, resource materials posted on the NYSDOH VFC website, and any other communications sent from the NYSDOH Bureau of Immunization via mail or email.
- Serve as the provider's contact for the NYSDOH, including during site visits.
- Participate in training on VFC Program requirements.
- Train all staff at the practice on proper vaccine handling and storage.
- Obtain and maintain a New York State Immunization Information System (NYSIIS) account and complete required reporting in NYSIIS.
- Ensure that all necessary documentation and reporting is properly completed, including, but not limited to, eligibility screening and doses administered reporting. Doses administered must be reported in NYSIIS within two weeks of administration.
- Keep the physician informed of VFC Program requirements and all compliance issues.
- Notify the NYSDOH immediately if there are changes at the practice (such as a change in the primary or back-up vaccine coordinator, practice name change, practice is moving to a new location, practice is being sold, physician is retiring, practice is merging with another practice or becoming part of a larger organization, patient profile changes).
Monitoring Vaccine Temperatures
- Record temperatures for each storage unit (refrigerators and freezers) on a temperature log twice a day when practice is open, and enter this information into NYSIIS within 14 days of the date the temperature is read.
- Review vaccine temperature logs daily.
- Take action if temperatures are outside of acceptable ranges.
- Implement the vaccine emergency plan, if necessary.
- Be present when vaccine shipments are delivered and process vaccines into inventory.
- Ensure that the cold chain for safe storage and handling of vaccines has been maintained.
- Ensure the proper organizing and labeling of vaccine within the storage units, including the rotation of inventory to ensure that vaccine is used prior to expiration date and the clear separation of publicly-funded and privately-purchased vaccine.
- Perform routine cleaning of vaccine storage units.
- Conduct periodic physical inventory of all vaccines.
- Place vaccine orders using the NYSIIS Vaccine Ordering module.
VFC providers must participate in site visits conducted by NYSDOH Bureau of Immunization staff and local health department staff. Site visits are conducted to evaluate and promote compliance with the laws, policies and recommendations of: the VFC Program, the Advisory Committee on Immunization Practices (ACIP) and the Childhood and Adolescent Immunization Schedules, as published by the Centers for Disease Control and Prevention (CDC).
The practice's vaccine coordinator must attend the site visit. The physician-in-charge and all staff who have access to vaccine should also be available to provide or receive feedback.
These visits include:
- VFC Enrollment Site Visit. The visit includes an initial assessment to certify that the provider has the capacity to adequately store and administer vaccine to eligible children.
- VFC Compliance Site Visit. Providers are visited at least once every two years to assure that they maintain compliance with program requirements such as screening and maintaining records for eligibility, and adhering to storage and handling requirements.
- VFC Unannounced Storage and Handling Site Visit. These visits are conducted, as needed, to follow-up on storage, handling or accountability issues noted during a previous visit or based on other concerns related to the provider's ability to meet program requirements. Providers are not notified about these visits before the visits are conducted.
- Assessment, Feedback, Incentive and Exchange Visits (AFIX). Local health department staff visit providers to assess childhood and adolescent vaccination rates, identify missed opportunities to vaccinate and identify quality improvement strategies to increase providers' vaccination rates. Most VFC providers will receive an AFIX visit once every three to four years.
- Vaccine Storage Units
- Vaccine Placement
- Temperature Monitoring
- Responding to Temperature Excursions
- Expired and Spoiled Vaccine
- Vaccine Transfers
- Vaccine Borrowing
VFC providers must comply with the requirements and activities listed in the Vaccine Storage and Handling Plan. Storage and handling errors result in the loss of millions of dollars' worth of vaccine each year in the United States. Appropriate vaccine storage and handling depends on choosing the right equipment, conforming to policies implemented across the state, and keeping vigilant about vaccine temperatures. Vaccines should be properly stored and administered to ensure maximum efficacy and safety. Specific recommendations for proper handling and storage should be posted on, or near, each refrigerator and freezer used for vaccine storage. For guidance refer to the CDC Vaccine Storage and Handling Toolkit. In addition, brief webinars on storage and handling requirements, recommendations, and best practices can be found online in the Immunization Update Webinar Series – Vaccines for Children (VFC) Program Topics.
Vaccine Storage Units
As of January 1st, 2015 providers purchasing new refrigerators or freezers to store VFC vaccine are required to purchase stand-alone storage units (units that are only a refrigerator or only a freezer). Providers who currently use household combination units may continue to do so as long as those units continue to function properly. The freezer must be able to maintain temperatures at or below 5° Fahrenheit (-15° Celsius) and the refrigerator must be able to maintain temperatures consistently between 35° and 46° Fahrenheit (2° to 8° Celsius).
In all storage unit types, vaccines should be placed in the middle shelf of the unit and away from any cold air vents. Vaccine should not be placed in doors of storage units.
VFC providers are required to have certified, calibrated thermometers in each storage unit containing publicly-purchased vaccine. Beginning January 1st, 2015 CDC requires all providers to have one certified, calibrated back-up thermometer available. For more information on thermometer and calibration requirements, please see the NYS VFC Temperature Monitoring Device Guide (PDF, 301KB) and the California VFC Program's Checklist for Thermometer Certificate of Traceability and Calibration.
All staff members working with vaccines must be familiar with proper temperature monitoring. The vaccine coordinator and back-up should have primary responsibility for maintaining and reviewing temperature logs and taking action when temperatures are outside the appropriate range.
- Temperatures need to be recorded manually twice daily regardless of the type of temperature monitoring device being used.
- Information recorded on paper temperature logs must be entered in NYSIIS within 14 days following the date the temperature was observed.
- Acceptable unit temperature ranges are 35° to 46°F (2° to 8°C) for refrigerators, and 5°F (-15°C) or colder for freezers. Providers should strive for 40°F and 0°F for refrigerators and freezers, respectively.
- NYSDOH recommends using a digital data logger for continuous temperature monitoring and recording in all vaccine storage units.
- For more information on temperature monitoring requirements and recommended data logger functionality, please see the NYS VFC Temperature Monitoring Device Guide (PDF, 301KB)
Responding to Temperature Excursions
Any instance of an out-of-range temperature should be reported to the NYS VFC Program within one business day by calling 1-800-KID-SHOT (1-800-543-7468). When contacting the program please have ready: the amount of time that temperatures were out of range, the minimum and maximum temperatures if known, the type of storage unit and the amount of vaccines affected. Depending on the out- of-range temperatures, providers may need to contact the vaccine manufacturers to assess vaccine viability, and complete a NYS VFC Vaccine Manufacturer Follow-up Information Sheet. (PDF, 286KB)
Expired and Spoiled Vaccine
All publicly-funded expired and spoiled vaccines must be reported by completing and faxing the Vaccine Expired/Loss Report (PDF) to the NYS VFC Program at 518-449-6912. Once the report is received, the NYS VFC Program will fax the provider a return authorization sheet, and McKesson Specialty (the vaccine distributor) will send the provider a postage-paid mailing label to be used to return only publicly-funded vaccine received through the NYS VFC Program. This includes vaccines for VFC, Child Health Plus, and underinsured patients.
The following publicly-funded vaccine items must be reported as wastage, but not returned: Syringes filled but not used, any used syringes with or without needles attached, broken vials, and any multi-dose vial from which some vaccine has already been withdrawn. Properly dispose of these items as medical waste.
VFC providers needing to transfer vaccines must contact and receive approval from the program before attempting to transfer any VFC vaccines. Vaccine transfer requests are approved on a case by case basis and, generally, are only allowed when a practice relocates or in the event of an emergency or the need to transfer vaccine that will soon expire. Such emergencies consist of:
- refrigerator/freezer malfunctions
- power failures, natural disasters or other emergencies that might compromise appropriate vaccine storage conditions
If requests are approved, the designated provider, vaccine coordinator, or the back-up vaccine coordinator at each site must designate a point person responsible for packing, relocating, receiving, and unpacking vaccine transfers. Each site's designated point person must be available during the entire vaccine transfer. The provider will need to complete a Vaccine Transport Tracking Document.
VFC providers are expected to maintain adequate inventories of vaccine to administer to all privately-insured patients and patients receiving publicly-funded (VFC, CHP or State-funded) vaccine. Publicly-funded vaccine cannot be used as a replacement system for a provider's privately purchased inventory. Borrowing vaccine must not prevent a VFC, CHP or underinsured child from receiving needed vaccination because the publicly-funded vaccine was administered to a non-eligible child.
VFC providers must request prior approval from the NYS VFC Program to borrow any publicly-funded vaccine, in the rare event that the need to borrow arises. Borrowing can occur only when there is a lack of private-stock vaccine due to unexpected circumstances such as a delayed vaccine shipment or the vaccine spoiled in-transit to the provider. To request approval, VFC providers should contact their regional VFC representative to discuss the specific circumstances of each request. All instances of borrowing must be properly documented, reported and replaced. A Vaccine Borrowing Report (PDF, 245KB) must be completed when either privately-purchased vaccine is administered to a child eligible for publicly-purchased vaccine or publicly-purchased vaccine (VFC, CHP, state-funded) is administered to a privately-insured child.
All VFC providers are required to participate in recurring educational activities about the Vaccines for Children Program. The physician-in-charge, vaccine coordinator and back-up coordinator at each site are required to complete the following trainings:
- CDC's Webinar: You Call the Shots, Module 16, Vaccines for Children
- CDC's Webinar: You Call the Shots, Module 10, Vaccine Storage and Handling
An additional optional training is also recommended:
- CDC's Video: Keys to Storing and Handling Your Vaccine Supply
Newly enrolling VFC providers must complete these trainings within 60 days of their initial enrollment. Renewal providers must complete these trainings within 60 days of the renewal deadline date or anytime there is a change to the site's vaccine coordinator, back up, or physician-in-charge.
After completing the training(s):
- Report completion by clicking on the following link to submit the name of your office, the names of those who participated in the training and feedback on your training needs. https://www.surveymonkey.com/s/NYS-VFC-Training-attest
- Maintain documentation at your site that includes the name of each training completed, the name of each staff person who completed the training, and the date the training was completed.
Vaccine Ordering and Inventory
VFC providers must use NYSIIS to order publicly-funded vaccine and report and maintain vaccine inventory information. Providers may place an order as often as every 30 days. However, very small provider offices may prefer to order vaccine only two or three times per year. Provider orders are evaluated based on the number of vaccine doses reported in NYSIIS, the amount of vaccine a provider has in inventory, the amount of vaccine ordered and the amount of vaccine wasted over the past 12 months. Providers are encouraged to keep vaccine orders at a reasonable interval and level to reduce the risk of vaccine expiration and loss due to storage and handling issues. NYS VFC staff may reduce orders in order to address over-ordering or based on availability of vaccine. For more information on how vaccines are evaluated please see the NYS VFC Order Review Process. (PDF 201KB)
Eligibility Screening and Documentation
At each immunization encounter, VFC providers are required to screen patients and document eligibility status for patients eligible for publicly-funded vaccine. Providers may use their practice's paper or electronic system to document eligibility, but must also enter eligibility status for each dose administered into NYSIIS for patients eligible for publicly-funded vaccine.
Vaccine Information Statements
Providers are required to give patients the most current Vaccine Information Statement (VIS) just prior to the administration of each dose of vaccine. The most current VIS available can be found on the Immunization Action Coalition website www.immunize.org/vis and the CDC website. Providers must document the following information in the patient's medical record: which specific VIS was given (e.g., MMR), the date of publication of the VIS, and the date the VIS was provided to the patient.
NYSDOH is required by the Centers for Disease Control and Prevention to implement a vaccine restitution policy (see NYS VFC Restitution Policy). Vaccine wastage is calculated for a 12-month period as: the number of vaccine doses wasted, expired or lost divided by the number of vaccine doses ordered.
Vaccine wastage includes all vaccine lost due to temperature excursion or expiration that results from actions under the control of providers. Providers who meet the minimum storage and handling requirements and who lose vaccine due to equipment failure or power outage will not have those losses counted against their wastage allowance. Please use the following link to report vaccines that are expected to expire: https://www.surveymonkey.com/s/FBTH26G. Providers who notify NYSDOH between 90 and 60 days in advance of expiration dates with a reasonable explanation of why they have vaccine that will go unused, will not have those doses counted against their wastage allowance.
VFC providers must immunize children eligible for publicly-funded vaccine (VFC, CHP, State) at no charge to the patient for the cost of the vaccine. VFC providers may be able to receive an office visit fee and a vaccine administration fee, depending on the eligibility category through which children qualify for the program. VFC providers must not deny administration of publicly-funded vaccines to any eligible child due to the inability of the child's parent or guardian to pay the vaccine administration fee. If the parent or guardian cannot pay the administration fee for a VFC vaccine, the provider must waive the administration fee. Health care providers must not refer Medicaid and CHP members to other sites, such as public health clinics, for their vaccines. Health care providers who inappropriately refer patients or attempt to force collection of administration fees from patients will be prohibited from participating in the Medicaid and CHIP programs.
Maximum Reimbursement by Eligibility Category: Vaccine Administration Fees
- Medicaid Fee-For-Service $17.85
- Medicaid Managed Care per contractual agreement with managed care company
- CHP (Child Health Plus) per contractual agreement with managed care company
- Uninsured $25.10
- Underinsured $25.10
- American Indian/Alaskan Native $25.10
Fraud and Abuse
The NYS VFC Program has policies in place to prevent, identify and investigate suspected cases of fraud and abuse of publicly-funded vaccine (VFC, CHP, State). To report suspected cases of fraud or abuse, complete the NYS VFC Fraud and Abuse Referral Sheet (PDF).
Resources for Providers
- Vaccine Storage and Handling Toolkit, Centers for Disease Control and Prevention
- Immunization Update Webinar Series – Vaccines for Children (VFC) Program Topics, NYSDOH
- Immunization Information for Providers, NYSDOH
- Storage and Handling Handouts: Clinic Resources, Immunization Action Coalition
- Vaccines For Children: For Parents - U.S. Department Of Health & Human Services, Centers for Disease Control and Prevention, and National Immunization Program
- Frequently Asked Questions: Immunizing Your Child, Paying for Immunizations - American Academy of Pediatrics
Questions? Contact the New York State Vaccines for Children Program at firstname.lastname@example.org or 1-800-543-7568