Form and submit via email to DPH

Dear Colleague,

We are pleased to invite you to participate in the Vaccines for Children (VFC) program. This program was authorized because of concern regarding the high cost of vaccinating children. In 1993, federal legislation was implemented to create VFC Program intended to help raise childhood immunization levels in the United States, especially infants and young children. This federally funded program supplies vaccine free of charge to participating providers. The vaccine may be made available to children through 18 years of age who are:

? Medicaid Enrolled ? Uninsured (child has no health insurance coverage) ? Underinsured (child has health insurance but immunizations are not a covered benefit

and seen in a Federally Qualified Health Center [FQHC] or Rural Health Center [RHC]) ? American Indian or Alaska Native as defined by the Indian Health Care Improvement Act

(25 U.S.C. 1603)

Children whose health insurance covers the cost of vaccinations are not eligible for VFC or state supplied vaccines, even when a claim for the cost of the vaccine and its administration would be denied for payment by the insurance carrier because the plan's deductible had not been met.

Your practice may also administer vaccine to children enrolled in the PeachCare for Kids? Program which is administered by the Department of Community Health (DCH). While a child enrolled in the PeachCare for Kids Program is considered fully insured, your office will use statesupplied vaccine for these children. All claims for vaccines administered to PeachCare for Kids participants will be filed and reimbursed through either DCH or its contracted Care Management Organizations (CMOs). In addition to PeachCare for Kids coverage, VFC utilizes state funds to ensure that underinsured patients seen in a non-FQCH or RHC can receive state supplied vaccines as well.

The VFC Program allows providers to immunize eligible children for a nominal administration fee. The maximum administration fee a provider may charge is $21.93 per injection (Medicaid patients are exempt from the administration fee).

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You may enroll by completing the Provider Profile, Provider Agreement and the Vaccine Order Form. The Vaccine Loss Policy, Accountability Policy, and the Fraud and Abuse Policy should be reviewed for specific terms and conditions of enrollment. Although the Medical Director will sign the Provider Agreement for the entire group, each group member must read and sign the Provider Agreement and a copy of the medical licenses must be submitted for each physician, physician assistant, and nurse practitioner signed to the provider list.

The enrollment period lasts approximately 3-4 weeks and will include a scheduled site visit for program requirement review and for approval of your storage equipment. Your vaccine order will arrive within 5 business days from your approved site visit.

To begin the process:

? Complete and submit the Enrollment Form, Provider Agreement, and First Vaccine order form and submit via email to DPH-gavfc@dph. or fax to (800) 372-3627

? Purchase storage equipment: Refrigerator and stand-alone freezer sized large enough space to accommadte your maximum inventory without crowding

? Purchase digital data loggers per guidelines outlined in your enrollment materials ? Once digital data loggers are in place, begin recording current, minimum, and maximum

temperature at the beginning of each work day.

You may contact the VFC Program at (404) 657-5013 with any additional questions you may have at. We look forward to partnering with you!

Sincerely,

Vaccines for Children Program Georgia Immunization Program Georgia Department of Public Health

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