Program Overviews

Who Can Be an ASN Provider

There are eligibility and requirements to becoming an ASN provider. Provider types that may enroll in the ASN program include, but are not limited to, clinics that are formally recognized as one of the following:  

• DSHS Health Service Public Health Region (PHR) Offices  
• Local Health Departments (LHD)  
• Federally Qualified Health Centers (FQHC)  
• Federally Recognized Indian Tribes  
• Rural Health Clinics (RHC)

Signing Clinician Participation

• To be eligible to enroll in ASN, the signing clinician must be one of  the following:
• Medical Doctor (MD)
• Doctor of Osteopathy (DO)
• Nurse Practitioner (NP) or Advanced Practice Nurse (APN)
• Physician Assistant (PA)
• Certified Nurse Midwife (CNM)
• Registered Pharmacist (RPh) 

A TVFC/ASN Agreement Form must be completed at the initial enrollment and updated annually during re-enrollment. A signed agreement must be on file with DSHS. A new agreement must be submitted when the original signing clinician is no longer associated with the clinic. Clinics must also enroll in the Texas Immunization Registry, ImmTrac2, before a Provider Identification Number (PIN) is assigned to participate in the TVFC/ASN programs. Texas Health and Safety Code §§161.007-161.009 all medical providers and payors to report all immunizations administered to clients who are 18 years of age and younger. 

A TVFC/ASN Agreement Form must be completed at initial enrollment and updated annually during re-enrollment. A signed agreement must be on file with DSHS. 

The ASN program supplies the vaccines listed below to enrolled sites.

The signing clinician can choose vaccine brands and presentations, as listed on the adult formulary, the “Adult Safety Net (ASN) - Available Vaccines”, stock number 11-16658.

• Coronavirus (COVID-19)
• Hepatitis A (HepA)
• Hepatitis B (HepB
• Measles, Mumps, and Rubella (MMR)
• Meningococcal Conjugate Vaccine (MCV4)
• Tetanus and diphtheria (Td)
• Tetanus, diphtheria, acellular pertussis (Tdap) 

DSHS PHRs and contracted LHDs must conduct recruitment activities to enroll new providers into the ASN programs.

Providers may also conduct off-site, mobile vaccination clinics that offer the ASN program vaccines by: 

• Offer vaccines only to uninsured adults. 
• Screen all clients before vaccination with the official Adult Eligibility Screening Record This form must be kept on record for five years.  

Follow the Provider Manual - Vaccine Storage and Handling guidelines.

Before starting your re-enrollment, gather the following information:

• TVFC/ASN PIN: This information is required to begin your re-enrollment form. If you do not know your TVFC/ASN program PIN, contact your Responsible Entity (RE). 
• Primary and backup vaccine coordinator’s information 
• First and last name 
• Unique email address 
• Phone number

Training Requirements

• Before completing the TVFC/ASN program Re-Enrollment, DSHS requires that your primary and backup vaccine coordinators complete the following: 
• All primary and backup coordinators must complete: 
• CDC’s “You Call the Shots” Modules 10 and 16 (available online - You Call the Shots), 
• The most current TVFC/ASN Provider Policy Training (available at HHS Learning Portal) 
• VAOS Training Resources for TVFC/ASN Providers
• Once you complete the modules, save copies of the Certificates of Completion as PDF files. You will be prompted to upload these certificates as you progress through the re-enrollment process.

Patient Population

For ASN: Number of uninsured and insured adults vaccinated in your facility in the previous 12 months.

Calibration Certificates or Reports of Calibration

Before completing this re-enrollment, DSHS requires all re-enrolling providers to upload current and valid certificates for all data loggers that monitor the temperatures of the storage units, including the backup. 

• Data logger calibration certificates must have unexpired calibration dates and a serial number that MATCHES the corresponding data logger. 
• Dual-probe: Please indicate if your data loggers are “dual-probe” loggers. State in writing that this device is a dual-probe data logger.

Vaccine Storage Units

• Number of refrigerators and freezers that store TVFC and/or ASN vaccine. 
• Information on the make and model of each storage unit. 
• Number of data loggers, including a backup, that monitor the temperatures of the refrigerators and freezers. 
• Facilities that are Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) must also submit a copy of the Centers for Medicare & Medicaid Services (CMS) letter designating the sites as such. 

• The letter should have the following components: 

• CMS letterhead 
• The name of your facility with the address 
• The type of facility (RHC or FQHC) 
• Indication of your facility’s approval as a FQHC or RHC 
• The following phrase: “This is to inform you that your FQHC/RHC meets the requirements for participation in the Medicare program, effective [x date].” 

Thank you for your continued support of the TVFC and ASN Programs. You help keep Texans healthy by preventing and controlling vaccine-preventable diseases. 

If you have any questions, please contact your RE. For technical assistance, please email the Vac Call Center at VacCallCenter@dshs.texas.gov

Formulary

The current DSHS Adult Safety Net vaccine includes the following vaccines:  

• SARS-CoV (COVID-19) 
• Hepatitis A vaccine  

• Hepatitis B vaccine  
• Combination hepatitis A-hepatitis B vaccine  
• Measles, mumps, & rubella (MMR) vaccine  
• Meningococcal vaccine  
• Tetanus, diphtheria and pertussis (Tdap) vaccine  
• Tetanus-diphtheria (Td) vaccine

Although ASN providers are not required to report to ImmTrac2, it is imperative for ASN program providers to actively consent adult patients and report vaccine doses to Immtrac2.

All ASN program providers are required to report adult vaccine doses administered in a timely and accurate manner into the Vaccine Allocation and Ordering System (VAOS).

Sites that are co-located at a single address are expected to enroll as one entity. Exceptions to this include the following situations:

• A co-located clinic with more than one signing clinician whose staff are exclusive to each signing clinician should not enroll under one PIN
• A co-located clinic with more than one refrigerator or freezer unit that contains TVFC/ASN program vaccines that are used by exclusive staff should not enroll under one PIN
• A co-located clinic with “pods” where each pod contains refrigerator or freezer units that store TVFC/ASN program vaccines with specific staff assigned to the “pod” should not enroll under one PIN. Clinics that accept Medicaid and Children’s Health Insurance Program (CHIP) must enroll in the TVFC program. They may not refer children to DSHS PHR clinics, LHD sites, or other entities. 

Storage and Handling of Adult Safety Net Program (ASN) Vaccines

Providers must adhere to the vaccine storage and handling guidelines as required by the Texas Vaccines for Children (TVFC) program and the Centers for Disease Control and Prevention (CDC). 

• Provider Manual - Vaccine Storage and Handling Guidelines 
• CDC - Vaccine Storage and Handling

Administering ASN Program Vaccines

Providers enrolled in the ASN program must adhere to the following requirements: 

• Providers must screen patients for eligibility during each encounter by using the official Adult Eligibility Screening Record (Publication EF11-12842). 
• Keep completed copies of the Adult Eligibility Screening Record (Publication EF11-12842) on file for five years. You must make copies available upon request from DSHS or a Local Health Department to ensure program accountability and client eligibility. 
• Providers cannot charge for the cost of the vaccine. 
• Providers may charge patients an administration fee of up to $25 for each administered dose with the exception of COVID-19 vaccine. If a client is unable to pay for the administration fee, the provider cannot deny the vaccine to the client.  
• COVID-19 vaccine administration fees cannot be charged to the uninsured and underinsured adults through the ASN program.

Who Can Be an TVFC Provider

There are eligibility and requirements to becoming an TVFC provider. Provider types that may enroll in the TVFC program include, but are not limited to, clinics that are formally recognized as one of the following:  

• DSHS Health Service Public Health Region (PHR) Offices  
• Local Health Departments (LHD)  
• Federally Qualified Health Centers (FQHC)  
• Federally Recognized Indian Tribes  
• Rural Health Clinics (RHC)

Signing Clinician Participation

• To be eligible to enroll in ASN, the signing clinician must be one of  the following:
• Medical Doctor (MD)
• Doctor of Osteopathy (DO)
• Nurse Practitioner (NP) or Advanced Practice Nurse (APN)
• Physician Assistant (PA)
• Certified Nurse Midwife (CNM)
• Registered Pharmacist (RPh) 

Training Requirements

Before completing the TVFC/ASN Program Re-Enrollment, the DSHS requires that your primary and backup vaccine coordinators complete the following: 

• All primary and backup coordinators are required to complete:  
• CDC’s “You Call the Shots” Modules 10 and 16 (available online - You Call the Shots), 
• The most current TVFC/ASN Provider Policy Training (available at HHS Learning Portal) 
• VAOS Training Resources for TVFC/ASN Providers
• Once the modules are completed, save copies of the Certificates of Completion as PDF files. You will be prompted to upload these certificates as you progress through the re-enrollment process.

Patient Population

• For TVFC: Number of children that were vaccinated in your facility in the previous 12 months in the following categories, separated by age groups (under 1 year of age, 1 to 3 years of age, 4 to 6 years of age, and 7 to 18 years of age). This information can be collected from your 
  doses administered data, Medicaid claims, encounter data, or your billing system. 

• Enrolled in Medicaid or Medicaid-eligible 
• Uninsured 
• American Indian/Alaskan Native 
• Underinsured 
• Enrolled in CHIP 
• Insured – This information serves as verification for accountability of the TVFC/ASN Program to ensure federal- or state-supplied vaccines are not administered to ineligible clients.

Vaccine Storage Units

• Number of refrigerators and freezers that store TVFC and/or ASN vaccine 
• Information on the make and model of each storage unit 

• Number of data loggers, including a backup, that monitors the temperatures of the refrigerators and freezers.

Calibration Certificates or Reports of Calibration

Before completing this re-enrollment, DSHS requires all re-enrolling providers to upload current and valid certificates for all data loggers used to monitor the storage unit temperatures, including the backup. 

• Data logger calibration certificates must have unexpired calibration dates and a serial number that MATCHES the corresponding data logger. 
• Dual-probe: Please indicate if your data loggers are “dual-probe” loggers by stating in writing that this device is a dual-probe data logger. 
• Facilities that are Federally Qualified Health Centers (FQHC) and a Rural Health Center (RHC) must also submit a copy of the Centers for Medicare & Medicaid Services (CMS) letter designating the sites as such. 

• The letter should have the following components: 

• CMS letterhead 
• The name of your facility with the address 
• The type of facility (RHC or FQHC) 
• Indication of your facility’s approval as a FQHC or RHC 
• The following phrase: “This is to inform you that your FQHC/RHC meets the requirements for participation in the Medicare program, effective [x date].” 

Thank you for your continued support of the TVFC program. You help keep Texans healthy by preventing and controlling vaccine-preventable diseases. 

If you have any questions, please contact your RE. For technical assistance, please email the Vac Call Center at VacCallCenter@dshs.texas.gov.

Update your TVFC Provider Information

Please notify your RE immediately if there is a new signing clinician, new prescribing provider, change in shipping information, change in facility name, patient population data change, or a change in staff that are assigned the duties as a primary or backup vaccine coordinator. New primary or backup vaccine coordinators are required to complete the CDC “You Call the Shots” Modules 10 and 16, the most current Vaccine Education Online TVFC Provider Policy Training module, and the Vaccine Allocation and Ordering System (VAOS) Training. 

Failure to properly update current clinic information may result in delays and possible negligent vaccine loss.

Formulary

• COVID-19  
• DTaP 
• Hepatitis A 
• Hepatitis B 
• Hib 
• HPV 
• Influenza 
• Measles, Mumps and Rubella 
• Meningococcal Conjugate Vaccine (MCV4)
• Meningococcal type B (MenB) 
• Pneumococcal 
• Polio 
• RSV
• Rotavirus 
• Tdap/Td 
• Varicella (Chickenpox)

The following organizations are eligible to participate in the TVFC program. This list is not exhaustive. If your organization does not appear on this list, please contact VacCallCenter@dshs.texas.gov. 

Organizations 

• Behavioral Health Clinic 
• Birthing Hospital or Birthing Center 
• Community Vaccinator (non-health department) 
• Correctional Facility 
• DSHS Public Health Department Clinic  
• DSHS Public Health Department clinic as agent for FQHC/RHC-deputized 
• Emergency Medical Services (EMS) Facility 
• Family Planning Clinic (non-health department) 
• Federally Qualified Health Center (FQHC) 
• Harris Health System 
• HHSC Family Planning Clinic 
• Hospital 
• Indian Health Service, Tribal, or Urban Clinic 
• Juvenile Detention Center 
• Local Health Department (LHD) 
• Local Health Department (LHD) as agent for 
• FQHC/RHC-deputized 
• Migrant Health Center 
• Mobile Provider 
• Pharmacy 
• Private Practice 
• Refugee Health Clinic 
• Residential/Congregate Care Facility 
• Retail Health Clinic 
• Rural Health Clinic (RHC)  
• School-Based Clinic (permanent clinic location) 
• State Hospital 
• STD/HIV Clinic (non-health department) 
• Student Health Services 
• Teen Health Center (non-health department) 
• University Health System 
• Urgent/Immediate Care Center 
• Women, Infant and Children (WIC) Clinic 

TVFC organizations are required to comply with TVFC program requirements. These requirements require a signing clinician. This clinician must assign a primary and backup vaccine coordinator.  

Signing clinicians must be one of the following: 

• Medical Doctor (MD) 
• Doctor of Osteopathy (DO) 
• Nurse Practitioner (NP) 
• Certified Nurse Midwife (CNM) 
• Physician Assistant (PA) 
• Registered Pharmacist (RPh) 

Primary vaccine coordinators and backup vaccine coordinators ensure all vaccines are stored and handled correctly. These staff members are required to physically be at the clinic site and fully trained in routine and emergency procedures.  

Full eligibility requirements for signing clinicians, organizations, and vaccine coordinators are located in Chapter 1 of the 2024 TVFC/ASN Provider Manual. 

Before starting your re-enrollment, gather the following information: 

TVFC/ASN PIN:  

• This information is required to begin your re-enrollment form. If you do not know your TVFC/ASN Program PIN, contact your Responsible Entity (RE). 
• Primary and backup vaccine coordinator’s information  
• First and last name  
• Unique email address 
• Phone number 

Whether you’re a healthcare provider, school nurse, or administrator, ImmTrac2 makes a seemingly impossible task easy.  

At your fingertips, you can access immunization records and explore features like:  

• History and forecasting  
• Easy password updates  
• Free and secure features  
• Enhanced recall and reminder functionality  
• Specific reporting 
• Improved EMR Data Exchange

Note: ImmTrac2 has updated its registration and renewal process to an online form. Please use the online form to register or renew your facility with ImmTrac2. ImmTrac2 site renewal is required every two years.

Organizational Code Search

As a TVFC Provider, you can check if you are already registered and obtain your ImmTrac2 Org Code for TVFC enrollment. Navigate to the Organizational Code Search and search in the drop-down lists by TVFC PIN or by Facility’s Name.

Enrolling

• Register online if your organization has never accessed ImmTrac2 
• Renew your organization's access by logging in and selecting "Registration" in the menu bar 
• Once completed, the access agreement is only required every two years

Register with ImmTrac2 as an Authorized Organization

ImmTrac2, the Texas Immunization Registry, is an important component of Texas's strategy to improve vaccination coverage rates. The registry is available at no cost. ImmTrac2 consolidates immunization records from multiple sources throughout the state. It offers many benefits to authorized organizations such as healthcare providers, schools, and child-care facilities. ImmTrac2 allows authorized organizations easy internet access to immunization histories of participating clients and offers "Reminder" and "Recall" capabilities for clients.

What is electronic data exchange?

Electronic data exchange is a connection between systems exchanging data with one another. For the Texas Immunization Registry, electronic data exchange occurs between organizations, such as physician’s offices, hospitals, and local health departments, utilizing their EHR systems to exchange patient and immunization information with the registry.

Registry eligibility

Ensure that your organization’s information is up to date with the registry as follows:  

1. The main headquarters or stand-alone facility is:  

• Registered with the Texas Immunization Registry and the site agreement is not expired; or  
• Renewed (i.e., site agreement) with the registry. 

2. All associated facilities are registered as sub-sites of the main organization (i.e., not as separate or stand-alone facilities) with the registry. 

3. Organization staff have active ImmTrac2 user accounts to log into the registry. 

Identify staff at your organization who will be the lead contacts and/or team for establishing and overseeing the data exchange connection with the registry. These staff will collaborate with the registry throughout the data exchange process.  

Suggested staff members include, but are not limited to, staff who oversee other types of data exchange for the organization, senior or lead clinical staff, subject matter experts, trainers, or IT support staff.  

For assistance with ImmTrac2 registrations, renewals, or user accounts, contact the Texas Immunization Registry’s Customer Service at 800-348-9158. Also available for detailed information on site renewals is the publication stock #11-15252 ImmTrac Site Renewal Guide (PDF) on the provider materials page.

Data exchange eligibility

To engage in electronic data exchange, your organization must have an EHR system that meets the Texas Immunization Registry standards and requirements as follows:  

4. Through its EHR system, your organization must submit patient and immunization information in Health Level Seven (HL7) 2.5.1 Release 1.5 files to the registry.  

5. Your organization, through your EHR system, must submit immunization data to the registry according to the uni or bi-directional requirements.    

6. Uni-directional: Batch files mean data is combined into one file that is submitted via File Transfer Protocol (FTP) on a weekly, bi-weekly, monthly, or yearly basis.  

7. Bi-directional: Real-time means data is submitted via web services (SOAP) as they are administered.  

8. Your organization’s patient and immunization data does not have data quality issues or errors. Your organization must take and own responsibility for the patient and immunization data it submits as part of establishing a data exchange connection with the registry. To ensure your organization is submitting great data quality, it must identify any data quality errors and correct them in a timely fashion.  

For any questions about EHR compatibility, requirements, or formatting, please contact your EHR vendor.  

Note: The registry verifies that the above qualifications have been completed before establishing a data exchange connection with an organization.

Establish data exchange

You can find the following steps in the publication stock #11-15231 Electronic Data Exchange Resource Guide (PDF). 

1. ImmTrac2 Registration/Renewal Information  

Your organization must have an up-to-date ImmTrac2 Site Agreement for all your sites.  

2. Registration of Intent  

Organizations must fill out a Registration of Intent (ROI). The processing time is 2-5 business days after submission.  

3. Gaining Access to Registry Data Exchange Methods  

The steps to gain data exchange access to the registry are as follows:  

• Your organization receives login credentials to a data exchange account from the registry 
• The account allows your organization to send data to the registry 
• The registry sends data quality information back to your organization  

4. Testing  

The organization follows a test plan provided by the registry to ensure it can:  

• Connect to the registry 
• Send data in the correct formats 

• Receive data quality reports, such as error and consent notification files 
• Correct data quality issues 
• Regularly check the data reported  

5. Production  

After successful testing, your organization is promoted to production.  

6. Ongoing Submission of Data  

Once your organization is promoted to production, further actions by your organization and EHR vendor may be necessary to correct any data errors. Organizations should continue to monitor for data errors.  

Important: Organizations in production must regularly submit data, check the data reported, and correct data quality issues.  

Promoting Interoperability (PI) for Public Health Overview  

The Centers for Medicare and Medicaid Services (CMS) launched an incentive program to encourage Eligible Providers, Eligible Hospitals, and Critical Access Hospitals to transition to Electronic Health Record systems.

LHD contractors must implement procedures and conduct activities to increase the use of ImmTrac2, including:

• Confirm consent or offer consent to clients to participate in ImmTrac at every client encounter
• Educate adult clients and the parents or legal guardians of child clients on the benefits of participating in ImmTrac2;
• Obtain consent to participate in ImmTrac according to DSHS guidelines.
• LHDs will conduct community activities to increase participation in ImmTrac.

For more information about Increasing Use of ImmTrac2, please see the DSHS Immunization Contractors Guide for Local Health Departments and the additional resources listed below:

What is VAOS

Vaccine Allocation & Ordering System (VAOS)is a place for providers to manage their ordering, waste, transfers and other vaccination details. All vaccines used in DSHS immunization programs will be managed in VAOS.

Getting started

1. Organizations primary and secondary coordinators will receive an encrypted email from IdentityManagement@hhsc.state.tx.us 

2. The email will need to be decrypted. To decrypt the email, select the message file and choose to open it. 

3. Users will be redirected to a web browser. From here, select use a one-time passcode. 

4. A temporary code will be emailed to you. 

5. Enter your one-time code and select Continue. 

6. After selecting Continue the encrypted message will open. 

7. The message will contain the username and a temporary password for VAOS. 

8. Select the link to VAOS to be redirected to the VAOS login page. 

9. Use the provided credentials from the encrypted email to log in and change the temporary password to a password of your choosing. 

10. Use the newly created password to log in to the provider portal at https://iamonline.hhs.state.tx.us 

• Note: You may be required to complete a captcha.

Resources

There are several training materials available for VAOS in the Training page. These materials include quick start guides, PDFs, videos, recorded webinars and more.

Throughout the month, REs should frequently check VAOS for pending vaccine orders to ensure they are reviewed and approved for further processing. The recommended interval is twice daily. When a vaccine order is submitted in VAOS, it is automatically in “Pending” status for review by the RE.

It is important that REs monitor VAOS to ensure orders are not processed until they have reviewed the appropriate details, such as temperature recording forms, vaccine loss forms, comments to increase/decrease vaccine requests, etc. Orders must not be left on hold or pending for more than three days. Vaccines that are on allocation by the CDC require a strict allocation process and must not be approved over the suggested quantity amount. All orders approved over the suggested quantity will be reduced by DSHS Immunization program if the vaccine is on allocation. 

TVFC/ASN primary or backup vaccine coordinator, you are required to take the VAOS Training Quiz. The quiz covers all topics included in the below VAOS Training Resources for TVFC/ASN Providers. Review the VAOS Training Checklist to make sure you have met the VAOS obligations for TVFC/ASN primary and backup vaccine coordinators: 

VAOS Training Checklist 
1. Review each video under the VAOS Training Resources for TVFC/ASN Providers section. 
2. Login to the VAOS Training Quiz. 
3. Complete the quiz with a passing score (80% or higher). 
4. Check your email for the VAOS Training Completion Certificate. 
5. Submit the VAOS Training Completion Certificate to your responsible entity.