Texas Providers Webinar August 24, 2021 DISCLAIMER

The information presented today is based on CDC’s recent guidance and MAY change.

August 24, 2021 Today’s Webinar Cadence

🤫🤫 👋👋 You will be automatically Need to go? Click Leave muted during this Meeting to exit the Audience Polls webinar. webinar.

Watch for our polls throughout today’s The “chat” feature will be Have a question? Type a presentation. turned off for attendees in question to the host and this Webinar, but make panelists using the Q&A sure you monitor the box box! for helpful web links! Agenda: DSHS Texas Providers Webinar

Section Presented by Opening Remarks Jennifer Moore COVID-19 Update Saroj Rai, PhD, MPH COVID-19 Vaccine Ordering Update Oscar Paz Texas for Children (TVFC) Jennifer Moore Required vs Recommended Vaccines for Carolyn Smith Children and Adolescents Strategies to Increase Levels Carolyn Smith for Children and Adolescents Moderator: Sarah Gant Live Q&A DSHS Subject Matter Experts Opening Remarks National Immunization Awareness Month National Immunization Awareness Month (NIAM) is an annual observance held in August to highlight the importance of for people of all ages.

Today: How to increase access to vaccination for children (0- 18 years-old) by sharing the benefits of the Texas Vaccines for Children (TVFC) program. Providers are Required to Report To Immtrac2 House Bill 1921

Per House Bill 1921, all health care providers and payors are required to report to ImmTrac2 all vaccines given to children under 18 years old. It is critical that vaccines are reported within 30 days of administration. Register online if your organization has never accessed ImmTrac2 before. If you have questions about ImmTrac2 reporting, please email [email protected].

History of ImmTrac2: https://dshs.texas.gov/immunize/immtrac/History-of-ImmTrac2.doc House Bill 1921: https://capitol.texas.gov/tlodocs/78R/billtext/html/HB01921S.htm COVID-19 Vaccine Updates COVID-19 Vaccine Boosters

• August 18, 2021, the U.S. Department of Health and Human Services released a joint statement on COVID-19 vaccine booster shots. • The announcement states “we have developed a plan to begin offering these booster shots this fall subject to FDA conducting an independent evaluation and determination of the safety and effectiveness of a third dose of the Pfizer and Moderna mRNA vaccines and CDC’s Advisory Committee on Immunization Practices (ACIP) issuing booster dose recommendations based on a thorough review of the evidence. • We are prepared to offer booster shots for all Americans beginning the week of September 20 and starting 8 months after an individual’s second dose.” • An ACIP meeting to discuss booster doses is scheduled for August 30-31.

A COVID-19 vaccine booster is currently NOT authorized for anyone in the U.S. COVID-19 Vaccine Boosters Review Inventory

• In anticipation of a booster dose being authorized and recommended in the coming weeks, DSHS is requesting all Texas COVID-19 vaccine providers to review their COVID-19 vaccine inventory and ensure you have both Pfizer and Moderna COVID-19 vaccines. • With COVID-19 cases continuing to rise, there is ongoing urgency to vaccinate the unvaccinated. • When reviewing inventory, before discarding vaccines, contact the specific COVID- 19 manufacturer to confirm vaccine expiration dates. • Only immunocompromised individuals are eligible for an additional dose of the COVID-19 vaccine at this time. Details of this recommendation can be found here: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html.

A COVID-19 vaccine booster is currently NOT authorized for anyone in the U.S. Pfizer COVID-19 Vaccine (COMIRNATY) FDA Grants Full Approval

• On August 23, 2021, the FDA has granted full licensure approval to Pfizer COVID-19 vaccine making it the first FDA approved COVID-19 vaccine in the U.S. • The vaccine will be marketed as COMIRNATY. • COMIRNATY as a vaccine is indicated for to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) in individuals 16 years of age and older. • Prescribing Information can be found here: https://www.fda.gov/coronavirus-disease- 2019-covid-19/comirnaty-and-pfizer-biontech-covid-19-vaccine

• The vaccine also continues to be available under emergency use authorization (EUA), for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals. Pfizer COVID-19 Vaccine (COMIRTANY) Expiration Date Extended

• The FDA has now approved the extension of the expiration date of the Pfizer COVID-19 Vaccine (COMIRTANY) from 6 months to 9 months under ultra-low frozen temperature conditions.

• Contact the manufacturer to reconfirm the expiration date, as appropriate.

https://www.fda.gov/vaccines-blood-biologics/comirnaty?utm_medium=email&utm_source=govdelivery COVID-19 Vaccine Ordering Updates Moderna and Pfizer COVID-19 Vaccine Product Availability Update COVID-19 Providers can once again order Moderna COVID-19 10-dose vials.

Moderna COVID-19 orders can be placed in multiples of 10-dose/100 dose or 14-dose/140 dose. COVID-19 Providers can now order Pfizer 1,170 and Pfizer 450 is NO LONGER available Reminder! Improved COVID-19 Vaccine Order Process Texas Vaccines for Children (TVFC) Program Did you know… Texas Vaccines For Texas leads the nation in the number of uninsured and under-insured children. Many of these children are not receiving the complete series of Children (TVFC) required to protect them from About the TVFC Program vaccine-preventable diseases. Your participation in TVFC can help change this.

The passage of the Omnibus Today there are more Budget Reconciliation Act (OBRA) than 3,000 Texas created the VFC program, providers enrolled in TVFC guaranteeing no cost vaccines to serving an estimated 4.5 providers to immunize eligible million eligible children children through age 18. across Texas. 1993 2021

1994 VFC began operations and Texas became a VFC awardee. The Immunization Unit began administering the TVFC program for eligible children in Texas. Texas Vaccines For Children (TVFC) The patients who benefit from TVFC

TVFC removes the burden of the financial cost of vaccines, thereby eliminating the need to refer clients. Children are then kept in their "medical home," which is beneficial to the provider and client. Families who are currently paying for may be TVFC eligible. The following children (18 years old and younger) are eligible for TVFC: • Uninsured • Underinsured • Children who are covered by CHIP or Medicaid • Native American or Native Alaskan heritage children

Information for Providers - Texas Vaccines for Children: https://www.dshs.texas.gov/immunize/tvfc/info-for-providers.aspx Texas Vaccines For Children (TVFC) Vision, Mission & Goals

Vision Mission Goals A Texas free of vaccine- To remove barriers to complete Eliminate vaccine cost as a barrier to preventable diseases. and timely vaccination, increase immunizations; reduce the need for vaccine coverage levels, and referrals by private providers to public reduce the burden of vaccine- clinics through keeping children in their “medical home” for preventable diseases for all Texas comprehensive health care; and infants, children, adolescents, and provide a vaccine delivery system that adults. is both efficient and effective for public and private providers

Texas Vaccines for Children and Adult Safety Net Provider Manual: https://www.dshs.texas.gov/immunize/tvfc/docs/2018-TVFC-and-ASN-Provider-Manual.pdf Texas Vaccines For Children (TVFC) Which vaccines are included?

• There are more than 20 pediatric vaccines available through TVFC. Refer to the complete list of available TVFC vaccines for more information on vaccines, brand names, pack sizes, and more.

Available TVFC Vaccines: https://www.dshs.texas.gov/immunize/tvfc/docs/Available-TVFC-Vaccines.pdf Texas Vaccines For Children (TVFC) The requirements to on-board

 TVFC/ASN Provider Policy Training  Ensure you are registered in ImmTrac2 (annually): www.vaccineeducationonline.org  You Call the Shots Module 10:  Complete required provider online training www.cdc.gov/vaccines/ed/youcallth eshots.html  You Call the Shots Module  Gather Necessary Information based on your 16: www.cdc.gov/vaccines/ed/youcal ltheshots.html clinic: • Key personnel information • Population data • Equipment inventory data  Sign the Program Agreement (update annually)

Visit the Texas Vaccines for Children Provider Manual for detailed information. Gather Necessary Information Key personnel information

Clinician: The signing clinician's name, title, email address, phone number, fax number, license number (MD/DO, PA, APN, etc.), and NPI.

Primary and backup coordinators: Names, phone numbers, email addresses, and a fax number for each person.

Practitioners: A list of all practitioners at your site with prescribing authority, including full names, titles, license numbers (MD/DO, PA, APN, etc.), and NPI numbers. Gather Necessary Information Population data

Population Estimates Data source options Eligibility categories

Clinics that are new to the TVFC This information can be Data will be populated into the Program should include a collected from: following TVFC eligibility projection of patients you • Filed Medicaid claims categories on the Provider anticipate will be served in the • Vaccine doses administered Agreement Form: upcoming year (including insured • Your billing system • Enrolled in Medicaid or patients). • Encounter data Medicaid-Eligible • Calculate the number of • Uninsured children seen in your facility in the previous 12 months in the • American Indian/Alaskan Native following categories: • Underinsured • Under one year of age • CHIP • One to three • Insured • Four to six • Seven to 18 years of age Gather Necessary Information Equipment inventory data

Federally Qualified Health Number of data loggers, Centers (FQHC) and Rural Number of refrigerators and including a back-up, to Health Centers (RHC) must freezers that will contain monitor the temperatures of also submit a copy of the site TVFC vaccine. the refrigerators and designation from the Centers freezers. for Medicare & Medicaid Services (CMS). Texas Vaccines For Children (TVFC) Review the provider guidelines

Visit the Texas Vaccines for Children Provider Manual for detailed information on requirements and guidelines after signing up for the program that include:

TVFC Enrollment Visit TVFC Site Set Up Vaccine Accountability Provider Identification Number Provider Change of Information Annual Re-Enrollment

https://www.dshs.texas.gov/immunize/tvfc/docs/provider-manual/01-tvfc-provider-eligibility-and-enrollment.pdf Texas Vaccines For Children (TVFC) Texas Immunization Registry – ImmTrac2

To participate in the TVFC Program, sites must enroll in and report to the Texas Immunization Registry (ImmTrac2). Texas Law requires vaccinators to report all immunizations administered to children 17 years of age and younger to ImmTrac2 within 30 days of administration of the vaccine.

Benefits of Utilizing ImmTrac2:  Documents necessary vaccine series are completed for patients.  Reduces chances for unnecessary doses of vaccines or missed opportunities.  Generates reminder and recall options.  Provides a personal immunization record of received vaccines.  Ensures that Texas receives sufficient federal funding for TVFC immunizations.

Standards for Practice: Document: https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/referral.html Texas Vaccines For Children (TVFC) Questions

Contact us at: Email: [email protected] Phone: 888-777-5320 Audience Poll True or False

One of the goals for TVFC is to eliminate vaccine cost as a barrier to immunizations A) True B) False Required vs. Recommended Vaccines for Children and Adolescents When Are Vaccines Required? Children (0-18 years old)

Children may need specific immunizations to participate in certain activities and events. Educate your patients and their families on which vaccines are required for each of the following:

Enrolling in child Attending school Attending care / pre-K (K-12) College/University or Technical Program Required vs. Recommended: Child care and Pre-K

Required: Recommended: • DTaP • Flu (annual) • IPV • Rotavirus • Hep B • Hib • PCV • MMR • Varicella • Hep A

https://dshs.texas.gov/immunize/school/child-care-requirements.aspx Required vs. Recommended: K - 12

Vaccine Minimum for K-6th Minimum for 7th Minimum 8th-12th DTaP/DTP/DT/Td/Tdap 4-5 doses 3 doses + booster within 5 years 3 doses + booster within 10 years MCV4 Not required 1 dose Polio 3-4 doses MMR 2 doses Hepatitis B 3 doses Varicella 2 doses Hepatitis A 2 doses Recommended: Flu (annual) HPV

https://dshs.texas.gov/immunize/school/school-requirements.aspx Required vs Recommended: Colleges, Universities, and Technical Schools

Required: All entering students at an institution of higher education are required to show proof of a meningococcal vaccination or booster within the last five years.

Vaccines must be given at least 10 days before the semester begins.

Special immunization requirements exist for medical and veterinary students whose coursework may expose them to higher risk of potential exposure to viruses and bacteria.

Recommended: Men B

https://dshs.texas.gov/immunize/school/college-requirements.aspx Audience Poll True or False

There are specific vaccines required for students enrolled in Healthcare or Veterinary coursework.

A) True B) False Strategies to Increase Immunization Levels for Children and Adolescents Creating a Culture of Immunization within a Practice Foster Support for Vaccination in Your Practice

1. Host “lunch and learns” and other team events in your practice to train staff on how to foster support for vaccination 2. Implement procedures and policies that help staff support vaccination by designating a primary and alternative vaccine coordinator to oversee vaccine management in your office 3. Create consistent messaging about the importance of vaccines and about vaccine effectiveness and safety at all levels of the practice 4. Adhere to proper , handling, and administration procedures

Foster Support for Vaccination in Your Practice: https://www.cdc.gov/vaccines/hcp/conversations/your-practice.html Immunization Strategies for Healthcare Practices: https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/strat.pdf No Missed Opportunities

1. Make parents aware of your immunization policy at their first visit. • Share your policy on your practice’s website. Include a copy of your policy in new parent packets. Post your policy in the waiting room. 2. Review each patient’s vaccination status and prepare them to receive vaccines. • Before each visit, determine which vaccines are due by checking the patient’s immunization history using ImmTrac2 and your practice’s EMR system. • At sign in, remind parents which vaccines are due for their child. • Ask patients and parents to complete a form or checklist for contraindications and precautions while they’re waiting. • Make vaccine resources easy to find. Making information readily available saves time by helping patients and parents get their questions answered before they meet with you. 3. Schedule upcoming vaccinations before the patient leaves the office.

Foster Support for Vaccination in Your Practice: https://www.cdc.gov/vaccines/hcp/conversations/your-practice.html Screen for Contraindications and Precautions: https://www.cdc.gov/vaccines/hcp/admin/screening.html Address Physical Barriers within your Clinic Consider these solutions to accommodate your patient population Increase access by:

 Be mindful of your wait times. Take that Barriers to vaccination may include: opportunity to screen patients for the vaccines • Clinic hours may not accommodate patients they may need and offer to vaccinate before their who are available only after 5pm appointment time. • Long wait times at the clinic may discourage  Extend office hours to accommodate working patients from considering extra time to be parent schedules​. vaccinated after the visit.  Offer days and times for walk-in vaccine • Transportation to and from your clinic may be appointments for routine vaccines​. cumbersome for some patients, in addition to time constraints.  If transportation is an issue for patients, consider setting up an off-site clinic in locations convenient to your patients (schools/parks/event centers) or refer them to vaccine providers in their area, such as pharmacies.

Immunization Strategies for Healthcare Practices: https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/strat.pdf Give Strong Recommendations Listen to any questions from patients and parents and answer them clearly and patiently. Review some common questions with answers that patients and parents may have regarding vaccination, along with FAQ resources.

1. Answers to Your Most Common Questions 3. Talking to Pregnant Women About about Childhood Vaccines Vaccines Why do adolescents need vaccines? I thought vaccines Won’t breastfeeding protect my baby from were just for babies and young children? diseases until she gets her own vaccines? Vaccines are recommended throughout our lives to protect in breast milk give your baby some against serious diseases. As protection from childhood protection from flu and whooping cough, but only vaccines wears off, adolescents need vaccines that will if you get vaccinated during pregnancy. Breast milk extend protection. Adolescents need protection from only offers short-term protection, though, so it’s additional as well, before the risk of exposure very important for your baby to start her own increases. vaccines on time.

2. Answering Questions about the HPV Vaccine

1. https://www.cdc.gov/vaccines/parents/FAQs. Why do boys need the HPV vaccine? html 2. https://www.cdc.gov/hpv/hcp/answering- HPV vaccine is important because it prevents infections questions.html that can cause . That’s why we need to start the shot 3. https://www.cdc.gov/vaccines/pregnancy/hcp series today. HPV vaccination can help prevent future -toolkit/downloads/talking-about-vaccines- infections that can lead to of the penis, anus, and 508.pdf back of the throat in men. Best Practices as a TVFC Provider Children Ages 18 and Up

Once a patient is 19 years old, they no longer qualify for TVFC (max age is 18 years old). Your practice can be prepared to guide children who will soon age out of the TVFC program by considering the following when the child turns 18 years old:

1. Patient must sign an ImmTrac2 Adult Consent Form.

2. Students are required to show proof of an initial meningococcal vaccination or a booster dose during the five-year period prior to enrolling. They must get the vaccine at least 10 days before the semester begins. Send reminders to older teen patients that they may need these vaccines to enter college. Ask patients at office visits if they are preparing to enter an institution of higher education. ImmTrac2 Adult Consent Form: https://www.dshs.texas.gov/immunize/docs/F11-13366.pdf Toolkits and Resources for Providers A focus on child patients

#HowIRecommend Vaccination Video Series The #HowIRecommend video series features short, informative videos from clinicians like you. These videos explain the importance of vaccination, how to effectively address questions from parents about vaccine safety and effectiveness, and how clinicians routinely recommend same day vaccination to their patients.

Provider Resources for Vaccine Conversations with Parents CDC, AAP, and AAFP created these materials to help you assess parents’ needs, identify the role they want to play in making decisions for their child’s health, and then communicate in ways that meet their needs. These resources are collectively called Provider Resources for Vaccine Conversations with Parents.

Talking to Parents About Vaccines Many parents have questions about their children’s vaccines, and answering their questions can help parents feel confident in choosing to immunize their child according to the CDC’s recommended immunization schedule. The materials in this webpage are intended to help health care professionals start or continue conversations with parents.

https://www.cdc.gov/vaccines/howirecommend/index.html https://www.cdc.gov/vaccines/hcp/conversations/index.html https://www.cdc.gov/vaccines/hcp/conversations/conv-materials.html Toolkits and Resources for Patients A focus on child patients

Why Vaccinate

Parents can read as to why on-time vaccination throughout childhood is essential because it helps provide immunity before children are exposed to potentially life-threatening diseases by visiting this CDC webpage.

Making the Vaccine Decision: Common Concerns

Most parents choose to vaccinate their children according to the recommended schedule. But some parents may still have questions about vaccines and getting answers they can trust may be hard. The CDC webpage, Making the Vaccine Decision, is intended for parents to become educated in how vaccines work, their ingredients, safety, and associated mild side effects.

Combination Vaccines – Fewer Shots Same Protection

Parents and patients can learn about combination vaccines; how patients can get fewer shots, but the same protection.

https://www.cdc.gov/vaccines/parents/why-vaccinate/index.html https://www.cdc.gov/vaccines/parents/why-vaccinate/vaccine-decision.html https://www.cdc.gov/vaccines/parents/why-vaccinate/combination-vaccines.html Audience Poll Choose one Your clinic is having longer wait times than usual with “back-to-school” season in progress. What is something your practice can do to ensure all patients have up-to- date vaccinations during this busy season? A) Screen patients during the wait time to see what vaccines are needed and what can be administered today B) Offer vaccine walk-in times C) Extend office hours D) All of the above Live Q&A Final Notes What’s Coming?

The goals of the DSHS Immunization Unit are to eliminate the spread of vaccine preventable diseases by increasing vaccine coverage for Texans Join us next week to learn more about increasing access to vaccines to adults through the state vaccination program, Adult Safety Net (ASN). Take Our Survey!

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The follow-up email will come from Monitor your inbox GovDelivery for a follow-up email communication that contains a post- webinar survey, a link to access Make sure to take our 3-minute today’s webinar survey! materials, and links to register for future webinars! The email also This is where you can view today’s (and past) webinars, as well as Highlights and contains helpful the slides we presented. links and resources. Vaccine Manufacturer Medical Information Contacts COVID-19 Vaccine Provider Resources

The Provider Support Resources document is full of great resources that you can browse based on the type of question you may have! It includes these resources… … AND MORE! Thank You!