Legal Aspects of Children s Health Services A Guide to Public Health Services for Children. Part 4: Immunizations

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1 Legal Aspects of Children s Health Services A Guide to Public Health Services for Children Part 4: Immunizations

2 Developed in 2014 by in partnership with Updated June 24, 2014 Authors: Jane Perkins, JD, MPH; Sarah Somers, JD, MPH; and Corey Davis, JD, MSPH The Network for Public Health Law, Southeastern Region Office at The National Health Law Program This guide was funded by the Robert Wood Johnson Foundation to support the development of trainings in public health law.

3 Immunizations This part of the Legal Aspects of Children s Health Services Resource Guide will focus on programs that cover immunizations: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) and Vaccines for Children (VFC). I. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Immunizations In this section, we will explain how the screening services of EPSDT include free administration of most scheduled vaccines recommended for children. II. Vaccines for Children (VFC) In this section, we will look at the federally funded Vaccines for Children program, which provides free or low cost vaccines for children who might not otherwise be able to afford them. III. Vaccine Recommendations In this section, we will describe the vaccine schedule recommended by the Advisory Committee on Immunization Practices, and list the 16 diseases that the recommended vaccines for children cover. Legal Aspects of Children s Health Services 3

4 Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Immunizations A child who is eligible for Medicaid and therefore Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), can receive most vaccines at no cost. Under the EPSDT program, medical screening must include appropriate immunizations for the child s age and health history. Program-registered providers, who won t be charged for the cost of vaccine or its delivery, can administer vaccines. Providers can be any health care worker licensed or authorized to administer pediatric vaccines under state law; they don t have to participate in Medicaid. Providers may charge an administration fee for vaccines for people who have the means to pay. They can t deny vaccines to an eligible child because the parent can t pay an administration fee. However, this doesn t mean that providers are required to administer a vaccine to every child who seeks one. The extent of participation is left to the provider. States must make sure that there are adequate numbers of EPSDT-participating providers of vaccines. Each state s vaccine program must include a wide range of providers to participate in vaccinating children. This includes private health care providers. Additionally, Health and Human Services (HHS) must purchase and deliver enough vaccines, without charge, to each state or tribe. If states need more vaccines for state-eligible children, they should notify HHS as soon as possible, since HHS negotiates a discount based on the number of vaccines needed. Legal Aspects of Children s Health Services 4

5 Vaccines for Children (VFC) The federally funded Vaccines for Children (VFC) program provides vaccines at no cost to children who might not otherwise be able to afford them. The Centers for Disease Control and Prevention (CDC) purchases vaccines and distributes them to state, local, and tribal health departments, which then distribute them at no charge to registered VFC providers. More information on the Vaccines for Children program is available from the CDC. Children qualify for the program if they are 18 or younger and are Medicaid-eligible, uninsured, underinsured, or an American Indian or Alaska Native. Children also qualify if they are insured but their insurance doesn t cover the cost of the vaccine, but only if they receive the vaccine from a Federally Qualified Health Center or Rural Health Center. States may also choose to purchase additional vaccines directly from the manufacturer at a reduced price and provide them to children who do not meet one or more of these criteria. There is no charge for any vaccine given in the program. However, there may be other fees. For example, providers are permitted to charge a small fee to administer the vaccine, but only if the family can afford to pay it. There can also be a fee for the office visit to receive the vaccine, and providers are permitted to charge for other services that might be given at the same time (such as a blood test). The covered vaccines are those recommended by an expert group, the Advisory Committee on Immunization Practices (ACIP). Vaccine Recommendations The EPSDT and VFC programs cover all vaccines recommended by the Advisory Committee on Legal Aspects of Children s Health Services 5

6 Immunization Practices (ACIP). ACIP consists of fifteen experts selected by HHS after an application, selection, and nomination process. Fourteen are required to be medical experts, and one is a consumer representative. Currently, immunizations for 16 diseases are recommended. The CDC provides more information about Immunization Schedules recommended by ACIP. List of Covered Immunizations Diphtheria Haemophilus influenzae type b(hib) Hepatitis A Hepatitis B Human Papillomavirus (HPV) Influenza (flu) Measles Meningococcal disease Mumps Pertussis (whooping cough) Pneumococcal disease Polio Rotavirus Rubella (German measles) Tetanus (lockjaw) Varicella (chickenpox) Immunizations must be administered in accordance with the schedule developed by the ACIP. Legal Aspects of Children s Health Services 6