Spend Plan: Setting up for FY 2015

Spend Plan: Setting up for FY 2015 Vaccine Supply and Assurance Branch Vaccine Advice, Consultation, Contracts Team Program Managers Meeting July 10, 2014 National Center for Immunization & Respiratory Diseases Immunization Services Division

Agenda Inputs to Spend Plan Set Up FY 2015 Spend Plan Set Up Timeline Spend Plan Uses 317 Tracking Open Q&A

INPUTS TO FY 2015 SPEND PLAN SET UP

Vaccine Funding for Spend Plan Set up Sources of vaccine funding VFC 317 CHIP State For each fund type, there are different tools/inputs for calculating how much an awardee receives VFC -> PES, NIS, ACIP 317 -> CAT CHIP -> CAT, VPET State -> CAT

Tools/Inputs for FY 2015 Spend Plan Set up Population Estimate Survey (PES) National Immunization Survey (NIS) Cost & Affordabilty Tool (CAT)

Population Estimate Survey (PES) What is PES and how is it used for spend plan set up? Provides the basis for determining awardee VFC eligible population The VFC eligible population is loaded into FY 2015 VTrckS spend plans One input into determining awardee total # VFC vaccine doses FY 2015 PES to be finalized this week Multi-step process Key priciple pre-populate as much as possible to minimize awardee effort

PES Inputs Step 1 - awardees sent spreadsheet for collecting most recent Medicaid and CHIP data from local CMS Awardees are not required to provide more recent Medicaid data and may opt to accept CDC data Note: S-CHIP data is not included in PES but is in CAT; S-CHIP spreadsheet provided since both Medicaid and CHIP data are requested from the same source

PES Inputs Step 2 - PAPA PES application pre-loaded with awardee data Total population for each age group, the higher of either 2012 census estimate or 2015 census projection Medicaid population apply Medicaid percentage from FY 2014 PES to 2015 total population Uninsured population for each age group, apply most current uninsured rate (from census) to total population American Indian/Alaska Native (AIAN) population for each age group, apply AI/AN percentage to total population Underinsured population 2011 NIS Delgated Authority (DA) not pre-populated; awardee enters into PAPA

PES Inputs Step 3 awardees submit Medicaid data; complete DA entry Step 4 CDC validation and awardee follow up is total population birth cohort > medicaid population cohort; is AIAN de-duplicated in Medicaid data; are there unusual patterns or significant magnitude changes; is DA consistent with VFC management survey Step 5 CDC determines percentage of VFC eligible population and applies to 2015 census population projection to arrive at FY2015 VFC eligible population

PES Completion/Validation Underway FY 2015 PES to be finalized this week Data is finalized and uploaded Awardees acknowledge by submitting as final FY 2015 eligible VFC population are loaded into VTrckS FY 2015 spend plans

National Immunization Survey (NIS) What is NIS and how is it used for spend plan set up? NIS provides awardee specific pediatric vaccine coverage rates by age group and vaccine type CDC translates coverage rates into pediatric dose tables for each awardee; dose tables are used in VTrckS spend plan, CAT, VPET Another input for determining awardee total # VFC vaccine doses for FY 2015 spend plan Dose tables are loaded into FY 2015 VTrckS spend plan Used to determine total recommended pediatric doses by vaccine type for VFC; other funds that include pediatric vaccines VFC recommended doses cascade to other fund types with pediatric vaccines

Sample VTrckS Population and Dose Table Funding Type Component Population Percen t Age Doses Total Doses Total With Waste VFC DTAP 39803 2.01 0 2.7490 109,418 114,889 VFC DTAP 32631 1.93 1 0.8280 27,018 28,369 VFC DTAP 33179 2.16 4 0.7390 24,519 25,745 VFC DTAP 33179 2.16 6 0.0350 1,161 1,219

Cost & Accountability Tool (CAT) What is CAT and how is it used for spend plan set up? Defines an awardee s vaccine finance policy - what populations to be served and vaccines to be provided for non-vfc fund types Populations defined in CAT are loaded into FY 2015 VTrckS spend plans CAT submissions were due June 27 th and currently under review

CAT Inputs 317 targets Level funding for FY 2015 of $80M Awardee equity was determined as a proportion of the total adult uninsured from census - 2012 estimate or 2015 projection, whichever is higher Awardee equity amount was compared with 2014 target Awardees with equity above or below 2014 target received a 5% decrease or 7% increase, respectively

CAT Inputs CAT projects costs of awardee finance policy Pediatric vaccine dose tables developed from NIS (same as loaded into VTrckS) Awardee specific market share and cost by vaccine type is determined by age group and vaccine type, the proportion of each brand used is along Current vaccine prices Populations served are entered by awardee

CAT Completion/Validation Underway CDC currently reviewing CAT submissions First review by Vaccine Advisors in conjunction with Proejct Officers Additional review and follow up as necessary by Vaccine Advisors, Project Officers, VSAB, POB Leadership CDC review and validation Attestation included? Populations covered for provider types included? S-CHIP population same magnitude as VPET? Significant pediatric underinsured in 317? Major changes to finance policy?

FY 2015 SPEND PLAN SET UP

FY2015 Spend Plan Timeline Dates are estimated and subject to change By July 25 th : finalize data inputs VFC eligible population (PES) Pediatric dose tables ( derived from NIS) Non-VFC pediatric populations (CAT) Adult population (census) Adult doses ( CAT) Between July 28 th and August 8 th : Upload data into test system Create FY 2015 spend plans in test Validate data/test functionality/update as necessary Extract data from test; upload into production Create FY 2015 spend plans

FY2015 Spend Plan Timeline Between August 11 th and August 29 th : awardees create FY 2015 spend plans for VFC ans VFC only Awardees notified 2015 spend plans have been created Awardees complete VFC and 317 spend plans only PO Balance function in VTrckS requires state and S-CHIP funds remain unplanned until new federal FY 2015 Awardees determine VFC ceiling amount brand allocate all VFC doses Between September 1 st and September 19 th : spend plans reviewed/validated/approved Vaccine Advisors review spend plan for VFC and 317 fund types Determine awardee follow up with Project Officers

FY2015 Spend Plan Timeline Between September 22 nd and September 30 th : awardee follow up completed October 1 st : FY 2015 spend plans live VFC, 317 budgets available for processing orders CHIP and State targets loaded Awardees plan CHIP and State funds based on PO Balance availability (PO Balance rolls over automatically from FY 2014) Vaccine advisor office hours Between October 1 st and October 10 th (or later based on awardee requirements): vaccine advisors review/ approve CHIP and state budgets

FY 2015 Spend Plan Set up Considerations CDC will conduct webinar in early August on FY 2015 spend plan set up CHIP and state funds need to be planned after October 1 st ; awardees will need to be prepared to set up spend plan immediately Ensuring enough funds for state and CHIP to plan for sufficient budget to process orders VFC schedule above recommended need justifications Other?

SPEND PLANS HOW ARE THEY USED?

How does CDC use Spend Plans? #1 Determine Awardee quarterly budgets for each fund type Awardee Spend Plan Apr May Jun TOTAL Awardee Quarterly Budgets TOTAL VFC Pediatric Vaccine $11 5 $135 $110 $360 VFC Pediatric Vaccine $360 317 Pediatric Vaccine Adult Vaccine State Pediatric Vaccine Adult Vaccine* $55 $65 $50 $170 $30 $10 CHIP Pediatric Vaccine* $30 $10 $50 $10 $50 $10 $35 $5 $35 $5 $115 $115 317 Pediatric Vaccine Adult Vaccine State Pediatric Vaccine Adult Vaccine* $170 $115 CHIP Pediatric Vaccine* $115 Note: There must be sufficient quarterly budget to process orders

How does CDC use Spend Plans? #2 Contracts are incrementally funded based on bona fide need CDC uses the spend plans to determine the amount of funding to be applied to each contract CDC funds contracts on a quarterly basis An obligation analysis is performed using the awardee spend plans as a gauge for what NDCs are being requested, their volume and cost The analysis ultimately determines the funds that are applied to each contract based their respective NDCs in the spend plans

How does CDC use Spend Plans? #3 What funding is applied to weekly purchases As providers order, central inventory is drawn down CDC calculates bulk purchase order needs on a weekly basis What funding is applied to the weekly orders depends on the relative funding percentages of awardee spend plans

How does CDC use Spend Plans? #4 One of multiple sources of information to assist in planning For new vaccines with no prior history Best estimate is used based on similar product in the spend plan The quantity of doses in the initial seed order is usually sufficient to fill orders for a few weeks until there is enough order history to calculate the bulk replenishment quantities using the standard approach Ongoing and year end funds planning Routinely look at what the spend plans indicate grantees are planning through the end of the fiscal year and compare with where we are with funds obligation

317 FUNDS TRACKING

317 Vaccine Funding and Tracking, I 317 Vaccine funding is an important component of public sector vaccine funding, focusing increasingly on key gaps, such as vaccines for uninsured and underinsured adults vaccine for outbreak response Over the past five years, CDC has worked closely with awardees to minimize the amount of 317 vaccine budget unexpended at fiscal year end: During the second half of each fiscal year, CDC assesses awardee progress and determines how funds may be reallocated Awardees are requested to submit requests for additional vaccine funding using a detailed template

317 Vaccine Funding and Tracking, II A special report was developed to help awardees understand what has been spent to date, what is programmed, what is unprogrammed (Aggregate Monitoring Report, SP 125) This tracking and redistribution activity is an important aspect of stewardship for 317 Vaccine funding; awardee participation in the process is critical for its success

Open Question and Answer For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Immunization & Respiratory Diseases