Frequently Asked Questions for Health Care Providers and Clinicians

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This document is not meant to take the place of guidance, health alerts, or advisories that are posted on the Maine CDC web site at www.maineflu.gov. The questions and answers that appear below offer clarification in response to common questions that have been expressed in response to these communications from Maine CDC.  This document will be updated periodically as we learn of questions that are being repeatedly asked about the flu. 

Where to Get More Information

Health Alert Network:  Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN).  The easiest and quickest way is to sign up is through the HAN Alert RSS feed at www.mainepublichealth.gov (midway down the center of the homepage). 

Follow Maine CDC’s Updates:

Consider Calling or Emailing Us:

  • For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821 or e-mail: disease.reporting@maine.gov . 
  • Email other questions to:  flu.questions@maine.gov

U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/flu/, http://www.flu.gov/

Topics as of October 04, 2010

Vaccine

  • Q. Will flu vaccine for the 2010-2011 season be reserved only for schools or will physicians who care for children be allotted a share of the vaccine as well? Detail +
    • A.  State-supplied flu vaccine for children will be available to schools as well as health care providers, based on the orders placed with Maine Immunization Program (MIP).

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  • Q. Who can get state-supplied seasonal flu vaccine? Detail +
    • A. Influenza vaccine is recommended for all people for the 2010-2011 season. Maine CDC does not and never has provided the majority of seasonal flu vaccine in Maine. However, the following groups are eligible for state-supplied vaccine:
      • all Maine children ages 6 months to 18 years-old;
      • employees of schools that are providing onsite vaccine clinics on school days;
      • pregnant women and their partners;
      • nursing home employees and residents;
      • adults who are uninsured or underinsured; and
      • patients of tribal health centers or municipal health departments.
    • Please note that, as in years past, the only state-supplied vaccine available for health care workers is for those who work in nursing homes. However, we strongly encourage all health care personnel, including EMS, to be vaccinated.

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  • Q. Can I bill insurance for vaccine I receive from the state? Detail +
    • A. You may not bill insurance for the vaccine, but you may bill insurance for an administration fee.

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  • Q. Can I charge an out-of-pocket fee for vaccine I receive from the state? Detail +
    • A. It is reasonable and allowable to charge an administration fee for administration of state-supplied vaccine in some circumstances, provided that:
      • MaineCare eligible children are not charged an out of pocket administration fee;
      • administration fees do not exceed the regional Medicare maximum ($14.37/vaccine administration); and
      • no one is denied vaccine because of their inability to pay an administration fee.
    • Maine CDC and the Office of MaineCare Services have worked together to enable roster billing for administration fees provided to MaineCare-eligible individuals.
    • Due to the large number of private insurers, Maine CDC has not been able to arrange for roster billing arrangements with private insurers. For more information on how to bill private insurers for flu vaccine administration, contact the insurer directly.

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  • Q. Why do we have to fill out this paperwork? Detail +
    • A. The information on the required forms will enable Maine CDC to deliver vaccines to the right place at the right time. The ordering process for vaccines does not provide any information about the time or location of clinics and would not be sufficient for delivery at the right time and place.

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  • Q. Isn’t it redundant to have schools and health care providers fill out these forms? Detail +
    • A. Not all schools are working with health care providers and not all health care providers are working with schools. We have to get information from both groups in order to ensure that vaccine is going where it needs to go and that the people handling it have been trained to keep it viable.

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  • Q. Why do we have to complete this Memorandum of Agreement? Detail +
    • A. The purpose of the memorandum of agreement is to assure that there are agreed upon plans in place for appropriate storage of the vaccine, for disposing of sharps, for reporting vaccine usage, and for billing administration fees. This agreement was developed because every school district is implementing school vaccine clinics in their own ways. Based on feedback from last year’s vaccine clinics, this agreement was developed to cover the most critical responsibilities that needed agreement before a clinic takes place. In addition, the newly developed MaineCare billing process requires that parties agree on which entity receives payment for MaineCare vaccine administration fees.

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  • Q. What do we do with our unused/expired 2009 H1N1 vaccine? Detail +
    • A. US CDC has organized a Central Vaccine Recovery Program to recover unused doses.
    • Health care providers who received 2009 H1N1 vaccine and have signed a Provider Agreement should expect to receive pre-paid shipping labels. Providers who were not registered to receive H1N1 vaccine directly should contact the provider who redistributed vaccine to them for this information.
    • Current information on vaccine recovery is available on the Maine CDC web site at:
      http://www.maine.gov/dhhs/boh/maineflu/h1n1/h1n1-flu.shtml
    • Current information on vaccine recovery is available on the Maine CDC web site at:
      http://www.maine.gov/dhhs/boh/maineflu/h1n1/h1n1-flu.shtml

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  • Q. What about pneumococcal illness and vaccine? Detail +
    • A.
      • Flu infections can make people more likely to develop pneumococcal infections, which can cause serious complications, including death. All children younger than 5, all people between ages 5 and 64 with high risk conditions, and all people age 65 and older should receive a pneumococcal vaccine.
      • Increases in pneumococcal disease were seen during all three of the flu pandemics that occurred in the twentieth century. A report released in September showed that bacterial pneumonia is contributing to fatalities in people with H1N1 flu, similar to previous pandemics.
      • Although there is no evidence that this vaccine is harmful to either a pregnant woman or to her fetus, it is not recommended during pregnancy. Women who have underlying conditions known to put them at risk of pneumococcal disease should be vaccinated before becoming pregnant, if possible.
      • CDC has also issued a Q&A on influenza and invasive pneumococcal disease (http://www.cdc.gov/h1n1flu/vaccination/qa_pneumococcal_disease.htm).

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Testing and Management

  • Q. What are the current testing recommendations? Detail +
    • A.
      • Submit a specimen for influenza testing for patients with ILI who are hospitalized, who have died, or for whom a diagnosis of influenza would affect clinical care, infection control, or management of contacts.
      • When testing is indicated, rapid diagnostic tests that are negative should be followed by PCR testing.
      • For outbreaks in institutional settings, submit 3-4 specimens to confirm the cause of the outbreak. Once infection has been confirmed as influenza, further testing is not usually indicated.
      • Information on testing at the Health and Environmental Testing Laboratory is available at: http://www.maine.gov/dhhs/etl/micro/submitting_samples.htm
    • Additional information -- including an algorithm for testing in a Health Alert from Oct. 9 – can be found on the Health Care Providers page at www.maineflu.gov (click the link for “Health Care Providers” on the left hand side of the page)

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  • Q. What are the influenza reporting requirements? Detail +
    • A.
      • Rapid antigen test results among outpatients are not reportable. There is no need to phone or fax individual reports of outpatients with influenza by rapid antigen.
      • All PCR confirmed influenza A H1N1 cases that are confirmed by a laboratory other than HETL should be reported to Maine CDC. Faxed reports are preferable: 1-800-293-7534. Report forms can be found on the Health Care Providers page at www.maineflu.gov (click the link for “Health Care Providers” on the left hand side of the page) in the Testing and Management section
      • Specimens submitted to HETL for influenza testing require a supplemental form, called the Influenza Virus Specimen Submission form, to be submitted in addition to HETL’s requisition form. The Influenza Virus Specimen Submission Form can be found on the Health Care Providers page at www.maineflu.gov (click the link for “Health Care Providers” on the left hand side of the page) in the Testing and Management section.
      • Hospital inpatients with laboratory-confirmed influenza by any method or patients who have died and the death is suspected or confirmed by lab test to be influenza-associated should be reported immediately to Maine CDC by phone (1-800-821-5821) or fax (1-800-293-7534). Please clearly indicate that the patient is hospitalized or has died. This immediate notification allows us to act promptly on these cases.

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Treatment

  • Q. I’m a health care provider. How do I access antivirals from the state cache? Detail +
    • A. For patients with insurance coverage for prescription coverage, including MaineCare, antiviral medications are available through the normal retail routes, and the procedures are no different than normal. The antiviral medications do not require pre-authorization by any of the major insurers in Maine.
    • The State purchased cache of antivirals is initially limited to treat ill out-patients (non-hospitalized) high priority persons who are uninsured or underinsured (lacking coverage for medications) and people at high risk of complications who have been exposed who are uninsured or underinsured (lacking coverage for medications). This would include patients without insurance coverage, or with high deductibles or co-pays and insufficient funds to pay.
    • Guidance on the criteria for use, including a decision-making algorithm, instructions for prescribing medications from this cache and instructions for reporting are available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/anti-viral.shtml

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