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RIVAP ADVISORY FAQs


Advisory FAQs offer guidance about the program to payers and providers. Final FAQs will be published at the end of the implementation process and be updated, as needed, from time to time thereafter. These FAQ’s guide the administration of RIVAP. At all times, however, they are subordinate to any Rhode Island Statute or Regulation.

The Rhode Island Vaccine Assessment Program (RIVAP) seeks to ensure that all Rhode Islanders have access to federally recommended, life-saving vaccines. In 2015, the Rhode Island State Legislature established RIVAP to improve vaccine funding for Rhode Island residents, so that all citizens can share in the public health benefits of vaccines.

The advisory FAQs are divided into five broad categories:
1. “A” means questions related to Assessments.
2. “C” means questions related to Contribution Enrollees.
3. “G” means questions related to Government Programs.
4. “P” means questions related to Providers.
5. “V” means questions related to Vaccines.

Assessments

Hide details for A1. Why did the Rhode Island Legislature form the Vaccine Assessment Program (RIVAP)?A1. Why did the Rhode Island Legislature form the Vaccine Assessment Program (RIVAP)?
RIVAP was formed to improve funding to support universal access to state-distributed vaccine for children and adults. RIVAP enables Rhode Island to purchase vaccines for the state’s entire population and distribute them to health care providers at no cost.
Hide details for A3. How does the program save money?A3. How does the program save money?
By purchasing vaccines in bulk at federal contract rates, Rhode Island qualifies for one of the most significant discounts from the pharmaceutical industry. RIVAP generates its funds for vaccine purchases from assessments collected from insurers and other payers.
Hide details for A4. How will the RIVAP work for payers and providers during the first year?A4. How will the RIVAP work for payers and providers during the first year?
The Rhode Island State-supplied Vaccine (SSV) program will be funded through vaccine assessments fof assessable entities called “payers,” which include health care insurers, health benefit plans, and third-party administrators, and are assessed their proportionate share of the state's overall vaccine costs. RIVAP will use the funds to purchase vaccines at a discounted bulk rate and distribute them statewide at no cost to health care providers (e.g., doctors, hospitals, clinics, etc.). Health care providers will vaccinate patients and will only bill payers for the administration of the vaccine.
Hide details for A5. Who will oversee the new program?A5. Who will oversee the new program?
RIVAP will be overseen by the Rhode Island Department of Health (RIDOH).
Hide details for A6. Are insurance carriers the only entities paying the assessment?A6. Are insurance carriers the only entities paying the assessment?
No. Self-insured employers, Third-party administrators (TPAs), health maintenance organizations (HMOs), employers with health benefits plans, and certain other payers are also subject to assessment. These payers fund the purchase of vaccines for privately insured children and adults.

The Centers for Disease Control and Prevention (CDC)’s Vaccines for Children (VFC), program pays for vaccines for eligible children under 19 years of age, including Medicaid-insured, uninsured, American Indian or Alaska Native children and under-insured children served at federally qualified health centers. Other federal funding cover the cost of vaccines for uninsured adults.
Hide details for A7. What does “assessed entity” mean?A7. What does “assessed entity” mean?
“Assessed entity” means any health care insurers or other entity that contracts or offers to provide, deliver, arrange, pay for, or reimburse any of the costs of health services.

A health care insurer as defined in RI Statute §42-7.4-2:

(a) "Insurer" means all persons offering, administering, and/or insuring healthcare services, including, but not limited to:
    (A) Policies of accident and sickness insurance, as defined by chapter 18 of title 27:
    (B) Nonprofit hospital or medical service plans, as defined by chapters 19 and 20 of title 27;
    (C) Any person whose primary function is to provide diagnostic, therapeutic, or preventive services to a defined population on the basis of a periodic premium;
    (D) All domestic, foreign, or alien insurance companies, mutual associations and organizations;
    (E) Health maintenance organizations, as defined by chapter 41 of title 27;
    (F) All persons providing health benefits coverage on a self-insurance basis;
    (G) All third-party administrators described in chapter 20.7 of title 27; and
    (H) All persons providing health benefit coverage under Title XIX of the Social Security Act (Medicaid) as a Medicaid managed care organization offering managed Medicaid.
(b) "Insurer" shall not include any nonprofit dental service corporation as defined in § 27-20.1-2, nor any insurer offering only those coverages described in § 42-7.4-13.
    (A) an entity that provides the state health care plan described in RI Gen Law
    27-18-1.1-7
    (B) a public or private entity that offers a publicly funded plan in the state, to the extent participation in the program is authorized by law, and
    (C) a third-party administrator as defined in RI Gen Law 27-20.7-2.1
Hide details for A8. Must both the employer and the insurer or Third-party administrators (TPA) administering the plan pay the assessment for a given contribution enrollee?A8. Must both the employer and the insurer or Third-party administrators (TPA) administering the plan pay the assessment for a given contribution enrollee?
No. RIVAP avoids counting any contribution enrollee twice by assuring that the entity that pays for the vaccine administration cost is the same entity that is responsible for paying the assessment.
Hide details for A9. Must Employee Retirement Income Security Act (ERISA) plans pay the assessment?A9. Must Employee Retirement Income Security Act (ERISA) plans pay the assessment?
Yes. ERISA plans are not exempt from the assessment. To the extent allowed by federal law, ERISA plans will be required to participate along with all other payers. Third-party administrators (TPAs), who are often contracted to perform claims processing activities for ERISA plan trustees, will also be included in the required assessment.
Hide details for A10. Will publicly funded health care benefit plans be mandated to participate in the program?A10. Will publicly funded health care benefit plans be mandated to participate in the program?
The majority of publicly funded health care benefit plans are not included in the bill’s definition of “health care insurer.” According to RI Statute §42-7.4-2, this includes Medicare Part A or Part B, the military’s TRICARE, Medicare Supplement Policy, CHAMPUS, the federal employees’ health benefit program, the Veterans’ healthcare program, the Indian health service program, or any local governmental corporation. As stated in §23-1-46: Annual assessments shall…not include any Medicare Supplement Policy (as defined in §27-18.2-1(g)) or Medicare premiums.” However, the municipal employees for the state of Rhode Island will be included in the funding methodology §42-7.4-15, which references the applicability and potential benefits of this program for that population.
Hide details for A11. How are an entity’s assessments determined?A11. How are an entity’s assessments determined?
RIVAP will set separate assessment rates per adult and child contribution enrollee. For more information on what is a “contribution enrollee,” See: C2 and C3

Any over-payments in a one-year period will be applied to the next year's assessment calculation to reduce the assessment rate for that year.
Hide details for A12. What will the RIVAP's state fiscal year 2016-17 assessment be?A12. What will the RIVAP's state fiscal year 2016-17 assessment be?
The current assessment rates are $15.84 per month per child contribution enrollees and $1.66 per month per adult contribution enrollees. Assessments will be due on July 30, 2016, October 30, 2016, January 30, 2017, and April 30, 2017.
Hide details for A13. Will the childhood and adult vaccine-eligible populations be combined to form a single assessment cost per payer?A13. Will the childhood and adult vaccine-eligible populations be combined to form a single assessment cost per payer?
No, Childhood and Adult vaccines will have separate assessments because the cost for each adult is much less than the cost for each child. However, a single payment may be submitted for both assessments.
Hide details for A14. Are payments made by assessment payers accountable as medical expenses?A14. Are payments made by assessment payers accountable as medical expenses?
Yes. Assessment payments are properly accountable as medical expenses because they fund the cost of vaccines administered to beneficiaries.
Hide details for A15. Does the Patient Protection and Affordable Care Act (ACA) preempt any provisions of the RIVAP?A15. Does the Patient Protection and Affordable Care Act (ACA) preempt any provisions of the RIVAP?
No. The ACA does not preempt any provision of state law unless a state law prevents the application of an ACA requirement. The Vaccine Assessment Account supports the ACA requirement that coverage be provided without the imposition of cost- sharing for immunizations for routine use in children and adults.
Hide details for A16. Where can I find more details about the RIVAP assessment rate calculation?A16. Where can I find more details about the RIVAP assessment rate calculation?
Draft spreadsheets used to compute the RIVAP assessment rate will be posted under the “REFERENCE” tab under the heading “How is the assessment rate determined?"
Hide details for A17. When are assessment payments due?A17. When are assessment payments due?
Quarterly assessments are due 30 days after the close of each quarter, meaning reports and payments will typically be due on or before January 30, April 30, July 30, and October 30 each year. Quarterly payments are based on the number of contribution enrollees an entity reports for the three months in each preceding quarter.
Hide details for A18. What if RIVAP collects too little?A18. What if RIVAP collects too little?
If RIVAP’s estimates produce funds that are too low to meet the needed immunization program costs, RIVAP may adjust the remaining quarterly assessment rates. RIVAP’s reserve methodology has been designed so that no supplemental assessment should be needed, but that cannot be guaranteed in advance.
Hide details for A19. What if RIVAP collects too much?A19. What if RIVAP collects too much?
Any excess funds collected in one year will be applied to the overall assessment for the following year.
Hide details for A20. Where do I go to complete the online assessment?A20. Where do I go to complete the online assessment?
Click here First-time users must register before they can log in to the assessment system. Please note that because of the system’s security features, there may be a delay of up to 30 minutes before a new account can be accessed for data entry.
Hide details for A21. Are there any tutorials on the use of this system?A21. Are there any tutorials on the use of this system?
Yes. Webinar videos and filing guides are available under the “Web Training” and “Filing Videos” links on the “FOR PAYERS” page. They walk through the entire filing system in detail and explain how to complete each type of filing.
Hide details for A22. What if I have registered in the assessment system, but I need to change some of my information?A22. What if I have registered in the assessment system, but I need to change some of my information?
Kindly contact KidsVax® by using the e-mail address Help@RIvaccine.org, explain what adjustments you need, and provide your contact information. A trained KidsVax® representative will follow-up on your request.
Hide details for A23. If I make a mistake in my report, how can I correct it?A23. If I make a mistake in my report, how can I correct it?
Please email Help@RIvaccine.org with an explanation of the mistake. RIVAP will provide assistance so that you can print a corrected remittance form.
Hide details for A24. I accidentally overpaid. Can I be reimbursed?A24. I accidentally overpaid. Can I be reimbursed?
Yes. Please email Help@RIvaccine.org explaining the mistake and the amount you need for reimbursement. RIVAP will then determine the best way to correct the mistake. Usually, overpayments will be applied to subsequent quarterly reports.
Hide details for A25. How do I submit my payment?A25. How do I submit my payment?
Your payment will be submitted via mail to the PO Box on the remittance form or via Automated Clearing House (ACH) transaction. The reference number can be found on the “RIVAP Remittance Form,” which will appear after you submit your report, and this form can be printed and saved.
Hide details for A26. What if I submit a late report or payment?A26. What if I submit a late report or payment?
Please prepare your report as soon as possible. KidsVax® will report your late payment to RIDOH. RIDOH will take enforcement action, should that become necessary. Interest will be due on any late payments at 18% per year. See §42-7.4-6 and §44-1-7. As stated in statute §42-7.4-5: “If an insurer required to make the contribution pursuant to this chapter shall fail to pay a contribution within thirty (30) days of its due date, the secretary may request any agency of state government making payments to the insurer to set-off the amount of the delinquency against any payment or amount due the insurer from the agency of state government and remit the sum to the secretary.” Additionally, by statute §42-7.4-6: “If the failure [to pay] is due, in whole or part, to negligence or intentional disregard of the provisions of this section, a penalty of ten percent (10%) of the amount of the determination shall be added to the contribution. The secretary shall collect the contribution with interest.”
Hide details for A27. How do I create a password for the assessment system on this site?A27. How do I create a password for the assessment system on this site?
You may create your own password by entering your Federal Employer Identification Number, your e-mail address, and a private password of your choice at this link: http://www.rivaccine.org/assessment.
Hide details for A28. What should I do if my company has created a password for the assessment system on this website, but I no longer have it?A28. What should I do if my company has created a password for the assessment system on this website, but I no longer have it?
You can have your password reset by sending an e-mail to Help@RIvaccine.org. In the e-mail, please state that you have registered on the website, but you have forgotten your password. Kindly include your FEIN. We will then reset your password for you.
Hide details for A29. Are insurance carrier members subject to the assessment when Medicare A or B is the members' primary or secondary coverage?A29. Are insurance carrier members subject to the assessment when Medicare A or B is the members' primary or secondary coverage?
Yes, even though Medicare A or B coverage is excluded for the purposes of covering the vaccine assessment, the other insurance carrier is not excluded from covering the assessment unless it is listed under RIGL 42-7.4-2(3)(ii).


Contribution Enrollees
Hide details for C1. What are “contribution enrollees”?C1. What are “contribution enrollees”?
“Adult contribution enrollees” are Rhode Island residents ages 19 and older. “Child contribution enrollees” are Rhode Island residents who are younger than 19 years of age.

According to RI Statute 42-7.4-2.3, a contribution enrollee is
(a) “an individual residing in this state, with respect to whom an insurer administers, provides, pays for, insures, or covers health care services, unless excepted by this section.”

A contribution enrollee is not
(a) “an individual whose healthcare services are paid or reimbursed by Part A or Part B of the Medicare program, a Medicare supplemental policy as defined in section 1882(g)(1) of the Social Security Act, 42 U.S.C. 1395ss(g) (1), or Medicare managed care policy, the federal employees' health benefit program, Tricare, CHAMPUS, the Veterans' healthcare program, the Indian health service program, or any local governmental corporation, district, or agency providing health benefits coverage on a self-insured basis”
Hide details for C2. If a group of contribution enrollees switches to a new plan, administrator, or TPA after the end of a quarter, is the new entity then responsible for the previous quarter’s payments for that group of contribution enrollees? C2. If a group of contribution enrollees switches to a new plan, administrator, or TPA after the end of a quarter, is the new entity then responsible for the previous quarter’s payments for that group of contribution enrollees?
No. In this circumstance, the payments are due from the entity responsible for those contribution enrollees in the quarter in which they were counted. Even though payments are due in the new quarter, assessments are based on the counts reported for the previous quarter. Therefore, the outgoing reporting entity will submit payments for that group of contribution enrollees, even though they are moving. In this way, payments can be made based on actual counts of contribution enrollees rather than on predicted numbers, thus rendering a more accurate number.
Hide details for C3. Must entities report only child contribution enrollees, or should adult contribution enrollees be included as well?C3. Must entities report only child contribution enrollees, or should adult contribution enrollees be included as well?
Entities must report both child and adult contribution enrollees. Individuals younger than age 19 are counted as children. Individuals age 19 and older are counted as adults.
Hide details for C4. Must an entity file reports even if it does not provide medical benefits and therefore has zero contribution enrollees?C4. Must an entity file reports even if it does not provide medical benefits and therefore has zero contribution enrollees?
Yes, but the entity may be eligible to file an Annual or Permanent Zero Contribution Enrollees Report instead of the typical quarterly reports. Please note that if an entity has zero contribution enrollees for one quarter only, then it should file a normal quarterly report with “0” values.

If, however, an entity does not administer medical benefits or is otherwise exempt by RI statute so that it has zero contribution enrollees, it should file one of two types of Zero Contribution Enrollees 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 contribution enrollees and will continue to have zero contribution enrollees for the balance of the year, then it should file an Annual Zero Contribution Enrollees 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 contribution enrollees and expects to never have contribution enrollees, it should file a Permanent Zero Contribution Enrollees Report to eliminate the need for further compliance follow up. A guide to Zero Contribution Enrollees Reports is available in the “Filing Guides” section under the “FOR PAYERS” tab.
Hide details for C5. If an entity files a Permanent Zero Contribution Enrollees Report, but it later has contribution enrollees, what should it do?C5. If an entity files a Permanent Zero Contribution Enrollees Report, but it later has contribution enrollees, what should it do?
Contact Help@RIvaccine.org so that its status can be changed and the entity can start reporting regularly, beginning with the first quarter in which it has contribution enrollees.
Hide details for C6. If my company has filed an Annual Zero Contribution Enrollees Report, when should we file our next report?C6. If my company has filed an Annual Zero Contribution Enrollees Report, when should we file our next report?
An Annual Zero Contribution Enrollees Report covers one 12-month period. You should plan to file your report again by June 30 of each calendar year. If, however, your company gains some contribution enrollees during the course of the year, it should start filing for each quarter in which it has contribution enrollees.

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Government Programs
Hide details for G1. Has RIVAP changed anything for the federally funded Vaccines for Children (VFC) program or state-sponsored medical plans?G1. Has RIVAP changed anything for the federally funded Vaccines for Children (VFC) program or state-sponsored medical plans?
No. RIVAP is a financing mechanism for a portion of Rhode Island’s universal vaccine purchasing system for insured children and adults. The federally funded Vaccines for Children program is not affected by the Vaccine Assessment Account. All providers receiving vaccines through this program must enroll annually in the VFC and/or SSV program and adhere to all program requirements.
Hide details for G2. Do providers still need to screen for VFC eligibility?G2. Do providers still need to screen for VFC eligibility?
Yes. VFC status screening is still a federal requirement for every visit and hasn’t changed.

Providers
Hide details for P1. Does this program affect how providers receive vaccines? P1. Does this program affect how providers receive vaccines?
No. This is simply a change to the funding method for Rhode Island’s existing program.
Hide details for P2. What are the benefits for my practice in receiving vaccine through RIVAP?P2. What are the benefits for my practice in receiving vaccine through RIVAP?
RIVAP is able to buy vaccines at discounted rates from a bulk contract, as opposed to buying at market prices. Providers can then receive state-distributed vaccines for all covered patients and avoid the financial and administrative burdens of purchasing vaccines and maintaining separate vaccine storage and tracking systems.
Hide details for P3. Can providers still purchase vaccines privately?P3. Can providers still purchase vaccines privately?
Nothing in the statute prohibits this. However, it is uncertain what reimbursement rates will be set by payers since supply at $0 cost is available to providers statewide. This topic may be addressed by regulation in the future but at the current time, providers would need to negotiate this privately with payers.
Hide details for P4. How will this program affect patients?P4. How will this program affect patients?
Patients will not be charged for the cost of the vaccine; this program does not change any billing practices with respect to vaccine administration by providers.
Hide details for P5. How will providers be compensated for the administration of vaccines?P5. How will providers be compensated for the administration of vaccines?
Since the assessment only covers the cost of the vaccine, providers will bill either the payers or the patients directly for vaccine administration fees, as is their current practice.
Hide details for P6. Should providers who bill $0.00 or $0.01 for state-supplied vaccines continue to do so?P6. Should providers who bill $0.00 or $0.01 for state-supplied vaccines continue to do so?
Yes. Kindly confirm regarding your past practices. However, please do not bill for the vaccines.
Hide details for P7. How can I get updated information on RIVAP? P7. How can I get updated information on RIVAP?
There are several ways to remain updated:

Vaccines
Hide details for V1. Does RIVAP set vaccine policy?V1. Does RIVAP set vaccine policy?
No. The RI DOH's Immunization Program provides vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). KidsVax® takes no position for or against the administration of any particular vaccine to any specified individual.
Hide details for V2. Does this program establish a vaccine mandate?V2. Does this program establish a vaccine mandate?
No, RIVAP does not set vaccine policy or create vaccine laws. It facilitates the state’s universal purchase of vaccines by collecting assessments from insurers, third-party administrators, and other payers to fund the cost of vaccines made available by RIVAP.
Hide details for V3. How does RIVAP impact my taxes?V3. How does RIVAP impact my taxes?
RIVAP does not impact taxes as it is not funded by taxpayers. RIVAP 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. The costs for RIVAP administration are built into the assessment rates.








RIVAP Tax ID: 05-6000522


Copyright 2015 Rhode Island Vaccine Program