ANNEX 2

SFY 2014 PUBLIC HEALTH MASTER AGREEMENT ANNEX

Program Descriptions and Reporting Requirements

PROGRAM NAME: Immunization

PROGRAM CODE: 066 - Immunization Action Plan

FUNDING SOURCE: 100% Federal-Immunization VFC Grant

PURPOSE:

Immunization Programs provide vaccines to Georgians of all ages, and work to reduce the incidence of vaccine preventable diseases throughout the state through education, training, and vaccinating at-risk populations.

FUNDING REQUIREMENTS:

Restrictions:

  1. Indirect costs may not be charged to this program unless a cost allocation plan has been approved by the Division of Financial Services.
  2. Motor Vehicle, building improvements, and capital improvement purchases are not allowed.
  3. Funds must be used for the Immunization Program only.
  4. Vaccine purchases are not allowed.
  5. Equipment purchases greater than $1,000 must be submitted in writing to the Immunization Program Director via email for consideration of approval.
  6. Travel for the District Immunization Coordinator and district perinatal hepatitis B manager for quarterly and annual meetingsmust be included in the grant-in-aid budget.
  7. Ensure funding will be made available for hepatitis B post-vaccination serologic testing (HBsAg & anti-HBS) through the Georgia Public Health Laboratory for infants and children currently being tracked by the Perinatal Hepatitis B Prevention Program (PHBPP) that are underinsured or uninsured.

Deliverables:

Primary:

  1. Designate a District Immunization Coordinator to work with the Georgia Immunization Program (GIP) to perform immunization programmatic activities and ensure all information and communications from GIP are disseminated to all public health clinics in the district’s service area.
  2. Actively promote the importance of immunizations, including special promotional activities for CDC-recognized national campaigns (See references).
  3. Provide integrated immunization services with other programmatic visits, including but not limited to, Child Health, WIC, STD, HIV, Perinatal Health, on a walk-in basis during normal business hours of operation and provide interpreter services and language-specific materials as needed.
  4. Will not withhold vaccine, 3187, or 3231 forms due to inability to collect vaccine administration fee. Upon request, will provide a personal immunization record to each parent or guardian of a child and records should be shared with other providers.
  5. Comply with all GA Immunization Program guidelines that are located in the GIP Manual.(GIP Manual)
  6. Ensure that 100 percent of all vaccine administration data be entered into GRITS within 30 calendar days from the date of administration (either manually or via data transfer/exchange).
  7. Ensure that immunization assessments are conducted at all childcare, kindergarten, and sixth grade programs in the public and private sectors in the district’s service area. (All compliance data must be collected and entered into the SendSS database no later than December 31 annually). Assessments must be performed according to the most current programmatic guidelines.(GIP Manual – Chapter 5)
  8. In the event of a vaccine-preventable disease (VPD) outbreak, the District’s Immunization Coordinator must communicate with the District Epidemiologist and Georgia Department of Public Health.
  9. Screen and document eligibility status for each patient during each immunization encounter and maintain Eligibility Screening Records for a period of three years. If requested, will make such records available to the Georgia Department of Public Health (DPH), the United States Department of Health and Human Services (DHHS) or as requested.
  10. The District’sImmunization Coordinator will develop an Immunization Education Plan with assistance from the State Immunization Program Consultant assigned to the district. The plan will include immunization trainings as outlined in the Quality Assurance Standards (GIP Manual – Chapter 13)that will orient and update nurses and other personnel performing immunization services. CDC/NCIRD webcasts may also be included. The plan will target education of public and private health care providers and community stakeholders. It is strongly encouraged that regional trainings for representatives from all sectors in the district’s service area be offered annually. The Immunization Education Plan (provided by the GA Immunization Program) is to be submitted to the Immunization Program by March 1 annually.
  11. Administer vaccine supplied by Georgia Immunization Program (GIP) as listed in the VFC Provider Agreement (GIP Manual – Chapter 9).
  12. Designate a district perinatal hepatitis B case manager to work with the Georgia Perinatal Hepatitis B Prevention Program (PHBPP) to perform case management activities. The district PHBPP case manager must have access to the State Electronic Notifiable Disease Surveillance System (SendSS) Perinatal Hepatitis tracking module.

Secondary:

  1. The District Immunization Coordinator will participate in four quarterly GIP meetings for training.
  2. The district perinatal hepatitis B case manager must participate in one annual meeting with the state Perinatal Hepatitis B Program Coordinator.

ANNUAL PERFORMANCE MEASURES (for clients receiving public health services in the district):

Objective: Maintain ≥ 90% coverage rate, or increase immunization coverage rateby 2% (if less than 90%), of 2-year old population in district’s service area for all ACIP-recommended vaccines.

Objective: Maintain ≥ 90% coverage rate, or increase immunization coverage rate by 2% (if less than 90%), of HIV-positive clients receiving public health HIV care services in district’s service area for all condition-indicated, ACIP-Recommended vaccines.

Objective: Maintain ≥ 90% coverage rate or increase doses administered of seasonal influenza vaccine to the elderly population (ages 65 years and older) indistrict’s service area by 5% (if less than 90% coverage rate).

Objective: Maintain ≥ 90% coverage rate or increase doses administered of pneumococcal vaccine to the elderly population (ages 65 years and older) indistrict’s service area by 10% (if less than 90% coverage rate).

Objective: Maintain 100% compliance rate or increase number of infants/children enrolled in childcare facilities in district’s service area with valid documentation on file by 1% (if less than 100%).

Objective: Maintain 100% compliance rate or increase number of infants/children enrolled in school facilities in district’s service area with valid documentation on file by 1% (if less than 100%).

Objective: Maintain a 90% completion rate or increase the number of completed (3-dose hepatitis B vaccine series and post-vaccination serologic testing) perinatal hepatitis B cases in district’s service area by 2% (if less than 90%).

ALLOCATION METHOD

Funding is allocated to each health district based on an average of the district’s proportion of the state’s 0-19 age population, total population, and the number of new births.

REFERENCES

Georgia Immunization Program Manual -

CDC-Recognized National Campaigns -

REPORTING REQUIREMENTS

a)Report data collected from the population-based survey by September 13, 2013, using methodologies and protocols provided by the GA Immunization Program. A response rate of at least 90% is required.

b)Infants born in 2012 to HBsAg-positive mothers and tracked by the perinatal hepatitis B program should be reported with complete post-vaccination serology (HBsAg & anti-HBs) by December 31 annually,via SendSS.

c)Submit an annual immunization assessment of all district clinic sites to the Immunization Program office within thirty days of the selected common review date (the state office will notify districts of the selected common review date at least two weeks prior to the date). CoCASA is the instrument of choice. The evaluation must include 19-35 month old children and be based on the 4:3:1:3:3:1:4 series.

d)Submit monthly programmatic progress reportsthat detail progress made towards meeting targeted program measurements, requirements and deliverables, promotional activities conducted for nationally recognized immunization campaign weeks/months and in collaboration with the District Epidemiologist include monthly vaccine-preventable diseases (VPD) surveillance data. Reports should also be accompanied by narrative summaries that reference accomplishments and/or areas of concern that affect immunization services, rates, and activities in the district’s service area. Programmatic reports should be received by the 15th day of the month following the end of each month(provided by the Georgia Immunization Program).

e)Submit a Grant-In-Aid line item budget using Form 5410 to the Immunization Program for the use of these funds by August 15 annually.

f)Submit the District Coordinator Education Report form (provided by GA Immunization Program) and the Immunization Education Plan (provided by the GA Immunization Program)by March 1 annually.

For the most recent revision of reporting forms contactSteven Mitchell at .

All reports are to be mailed or emailed to Steven Mitchell () with the Immunization Program.

Mailing address is:PROGRAMMATIC CONTACT:

Georgia Department of Public HealthGeorgia Department of Public Health

Immunization ProgramImmunization Program

Attention: Steven MitchellAttention: Steven Mitchell

Immunization Program DirectorImmunization Program Director

2 Peachtree Street, Suite 13-3012 Peachtree Street, Suite 13-301

Atlanta, GA 30303Atlanta, Georgia 30303

EMAIL:

Phone: 404-657-3071

Perinatal Hepatitis B Prevention Program Contact:

Georgia Department of Public Health

Epidemiology Program

Attention: Tracy Kavanaugh

Perinatal Hepatitis B Program Coordinator

2 Peachtree Street, NW Floor 14-263

Atlanta, GA 30303

Email:

Phone: (404) 651-5196 (Phone)

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