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.
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.
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.
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.
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) "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.
(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.
(A) an entity that provides the state health care plan described in RI Gen Law
(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
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.
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.
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.
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.
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.
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.
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.
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.
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.”
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”
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.
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.
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.
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.
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.
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.