announced within the federal or state governments that would advocate mandatory coverage of these vaccines within private health plans.

The National Vaccine Advisory Committee (NVAC) has recommended that the private health sector assume greater responsibility for improving and sustaining high levels of immunization coverage. For example, NVAC concluded in 1999 that the nation’s immunization system is incomplete and cannot ensure the timely vaccination of the 11,000 U.S. infants born each day with a schedule that incorporates newly recommended vaccines (NVAC, 1999a). NVAC offered 15 recommendations for improving the immunization delivery system in both the public and private health sectors, including efforts to expand the scope of immunization coverage in private health plans (NVAC, 1999a). Among these recommendations were the following:

  • All health insurance plans, including Employee Retirement Income Security Act (ERISA) self-insured plans, should offer first-dollar coverage for childhood vaccines recommended in the harmonized immunization schedule (NVAC, 1999a).3

  • Managed care organizations and managed Medicaid plans should ensure complete immunization of their members based on the harmonized schedule. These efforts should include the use of effective strategies to improve and maintain immunization coverage rates, such as reminder and/or recall systems, practice-based coverage assessments, and provider incentives and education (see Chapter 4).

  • All immunization providers, public and private, should assess the immunization coverage levels within their practices annually with assistance from state and local health departments, professional associations, and managed care organizations and other insurers.

One source of continuing uncertainty within both private and public health plans is the changing nature of the recommended immunization schedule (see Chapter 2). The federal government does not set universal immunization standards for the entire population. National recommendations are developed through collaboration among governmental bodies (e.g., the Advisory Committee on Immunization Practices [ACIP]) and professional advisory organizations (e.g., the Committee on Infectious Diseases of the American Academy of Pediatrics [AAP]), whose recommendations influence the scope of coverage benefits within federal programs such as Medicaid/Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), SCHIP, and VFC. These same recommendations are considered by private health plans and state health agencies, which issue guidelines and enact requirements for their own populations, including immunization standards for school entry, day care licensing, and insur-

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