Assessments
A1. Why did the Alaska legislature form the Alaska Vaccine Assessment Program (AVAP)?
A2. How does the program save money?
A3. How does AVAP work for payers and providers?
A4. Who oversees the program?
A5. Are insurance carriers the only entities paying the assessment?
A6. What does "assessable entity" mean?
A7. Must both the employer and the insurer, or third-party administrator (TPA) administering the plan, pay the assessment for a given covered life?
A8. Must Employee Retirement Income Security Act (ERISA) plans pay the assessment?
A9. Are publicly funded health care benefit plans mandated to particfipate in the program?
A10. How are an entity's assessments determined?
A11. What is the 2017 assessment rate?
A12. Are the childhood and adult vaccine-eligible populations combined to form a single assessment cost per payer?
A13. Are payments made by assessment payers accountable as medical expenses?
A14. Does the Patient Protection and Affordable Care Act (ACA) preempt any provisions of the AVAP?
A15. Where can I find more details about the AVAP assessment rate calculation?
A16. What is the three-year phase-in period?
A17. When are assessment payments due?
A18. What if AVAP collects too little?
A19. What if AVAP collects too much?
A20. If I am a Payer, where do I go to complete the online assessment?
A21. Are there any tutorials on the use of this system?
A22. What if I have registered in the assessment system, but I need to change some of my information?
A23. If I make a mistake in my report, how can I correct it?
A24. I accidentally overpaid. Can I be reimbursed?
A25. How do I submit my payment?
A26. What if I submit a late report or payment?
A27. How do I create a password for the assessment system on www.akvaccine.org?
A28. What should I do if my company has created a password for the assessment system on www.akvaccine.org, but I no longer have it?
You can have your password reset by sending an email to Help@AKvaccine.org. In the email, please state that you have registered on the website, but you have forgotten your password. Kindly include your Federal EIN. We will then reset your password for you.
A29. Can payers opt out of the Alaska Vaccine Assessment Program?
Yes. As part of the transition to Alaska’s improved universal-select vaccine purchasing, the Legislature allowed payers to opt out for periods prior to January 1, 2018 according to procedures set by DHSS.
A30. Is opt out advisable?
No. Vaccines recommended by medical experts have long been recognized as the second most effective public health initiative next to clean drinking water. Overall, studies have shown that direct savings in health care costs from proper vaccination exceed $10 for every $1 spent. Perhaps even more substantial are the indirect costs for caregivers and those who die, become disabled, or experience other effects of vaccine-preventable illnesses.
AVAP is an important initiative by the State of Alaska to capture more of the benefits of recommended vaccines by making it easier for providers to participate in vaccination programs for their patients while also lowering the costs for payers. AVAP builds upon the proven track record of programs in other states, which have resulted in consistently lower vaccine costs, generally saving between 20-25% on vaccine costs for health benefit plans.
Plans that undermine this initiative for their own beneficiaries also diminish “herd effect” of protecting the small number of individuals for whom vaccinations are not medically advisable. Hence they expose themselves to liability risks on multiple fronts.
A31. Can individual health plans or clients opt out on their own?
A32. Have the opt out procedures been established as contemplated by statute [AS.18.09.220(e)]?
A33. Is the assessment voluntary?
No. Alaska law mandates that all assessable entities (essentially any entity which pays for any health benefits for any Alaska resident), must pay assessments set by the program. There is however a special phase in period that allows entities to opt out annually during the first three years of the program. For the reasons set forth in other FAQs, DHSS strongly recommends against payer opt out. Wholly apart from the DHSS recommendation, the vast majority of Alaska payers have confirmed that they will be participating in the program from its inception.
A34. Will participating payers save money starting in 2016?
Covered Lives
C1. Must entities report only child covered lives, or should adult covered lives be included as well?
C2. What are “adult covered lives”?
C3. What are “child covered lives”?
C4. Must an entity file reports even if it does not provide medical benefits and therefore has zero covered lives?
Yes. However, the entity may be eligible to file an Annual or Permanent Zero Covered Lives Report instead of the typical quarterly reports. Please note that if an entity has zero covered lives for one quarter only, then it should file a normal quarterly report with “0” values.
If, however, an entity does not administer medical benefits and therefore has zero covered lives, it should file one of two types of Zero Covered Lives Reports. For example, this type of report would be appropriate for entities such as those administering eye care or dental benefit only plans. If the entity has zero covered lives and will continue to have zero covered lives for the balance of the year, then it should file an Annual Zero Covered Lives Report during the first quarter of the calendar year. No other report will be due until the first quarter of the following calendar year. If the entity has zero covered lives and expects to never have covered lives, it should file a Permanent Zero Covered Lives Report to eliminate the need for further compliance follow up. A guide to Zero Covered Lives Reports is available here.
C5. If an entity files a Permanent Zero Covered Lives Report, but it later has covered lives, what should it do?
C6. If my company has filed an Annual Zero Covered Lives Report, when should we file our next report?
C7. Must Payers who opt out still report their covered lives using the AVAP online self-reporting assessment system?
Government Programs
G1. Has AVAP changed anything for the federally funded Vaccines for Children Program (VFC) or state-sponsored medical plans?
G2. Do providers still need to screen for VFC eligibility?
Providers
P1. Does this program affect how providers receive vaccine?
P2. What are the benefits for my practice in receiving state-supplied vaccine through AVAP?
P3. Can providers still purchase vaccines privately?
P4. Do providers need to pay for state-supplied vaccines for children and covered adults?
P5. How does this program affect patients?
P6. Are health care providers who care for uninsured adults required to participate in the assessment?
P7. Could providers get vaccine for uninsured adults, funded by surplus funds, even if they don't opt in?
No. State funds are not sufficient to cover adults who are uninsured or not covered by an assessed payer. Providers who don’t opt in for uninsured can receive state-supplied vaccine only for covered adults with participating payers or Medicaid, but will need to use privately purchased vaccine for uninsured adults and adults with non-participating payers (e.g., TRICARE, Medicare). A list of non-participating payers is posted here.
P8. Will providers incur a higher assessment cost for adult vaccines than they are currently paying?
P9. How will providers be compensated for the administration of vaccines?
P10. Are pharmacists able to participate in the program?
P11. Should providers bill $0.00 or $0.01 for state-supplied vaccines?
P12. How do providers enroll to receive state-supplied vaccine?
P13. How can I get updated information on AVAP?
P14. What patient eligibility (VFC) Codes should be used?
P15. Will providers have a choice of which vaccine brands to use?
P16. Why is PCV13 not on the adult state-supplied formulary?
Vaccines
V1. Who sets vaccine policy?
V2. What vaccines are covered by the Alaska Immunization Program?
V3. Is the cost of seasonal flu vaccine included in the assessment rates?
V4. Does AVAP establish a vaccine mandate?
V5. What is VacTrAK?
V6. Does AVAP impact my taxes?
No. AVAP does not impact taxes as it is not funded by taxpayers. AVAP collects the costs of vaccines and program expenses from insurers, third-party administrators, and other payers who are already obligated to pay health care costs for their beneficiaries.
V7. How does AVAP know the amount of vaccine it needs to purchase?
V8. Does DHSS expect vaccine uptake rates to increase once AVAP goes into effect?