SECTION 1. The General Laws, as appearing in the 2008 Official Edition, shall be amended by adding after section chapter 118H the following new chapter:
Section 1: Definitions. The following words, as used in this section, unless a different meaning is required by the context or is specifically prescribed, shall have the following meanings:
“Child or Children”, individuals less than nineteen years of age.
“Clinician”, a health care professional licensed under chapter 112.
“Estimated vaccine cost,” the estimated cost over the course of a fiscal year of the purchase, storage, and distribution of vaccines for all children in the commonwealth.
“Facility”, a hospital, clinic or nursing home licensed under chapter 111 or a home health agency.
“Health care provider”, a clinician, a facility or a physician group practice.
“Health insurer”, includes surcharge payors as defined in section 34 of chapter 118G of the General Laws. For the purposes of this act, health insurer shall not include any entity to the extent it offers a policy, certificate or contract of insurance that provides coverage solely for dental care services or vision care services.
“Insured”, an enrollee, covered person, member, policyholder, subscriber or beneficiary of a health insurer.
“Participating provider”, a provider who, under a contract with a health insurer or with its contractor or subcontractor, has agreed to provide health care services to insureds with an expectation of receiving payment, other than coinsurance, copayments or deductibles, directly or indirectly, from the carrier.
“Physician group practice”, two or more physicians who deliver patient care, make joint use of equipment and personnel and by agreement divide income earned by the physicians in the group.
"Routine childhood immunizations," immunizations for children until their nineteenth birthday, including, but not limited to: (1) the immunizations recommended by the federal Vaccines for Children Program; and (2) any immunizations as recommended by the Advisory Committee on Immunization Practices of the U.S. Department of Health and Human Services.
“Total non-federal program cost”, the estimated annual cost of vaccines needed for routine childhood immunizations for children covered by health insurers in the Commonwealth less the amount of federal revenue available to the commonwealth for purchase, storage, distribution and administration of such vaccines.
“Vaccine Purchase Trust Fund”, a fund to support a universal purchase system for childhood vaccines in the commonwealth.
Section 2:(a) There shall be established by the commonwealth a separate trust fund to be known as the Vaccine Purchase Trust Fund, in this section called the “Fund,” to support a universal purchase system for childhood vaccines in the Commonwealth. The specific purpose of the Fund shall be to cover the costs to purchase, store and distribute vaccines for routine childhood immunizations and to administer the Fund and the Massachusetts Immunization Registry, as established under section 24M of chapter 111. The fund shall consist of all monies paid to the commonwealth under subsection (c) and any interest earnings on such monies. The Fund shall be maintained by the commissioner of the division of health care finance and policy or his designee. The monies shall be expended under the direction of the department of public health, without prior appropriation, solely for the purposes described in this section. Any balance in the Fund at the close of a fiscal year shall be available for expenditure in subsequent fiscal years and shall not be transferred to any other fund or revert to the General Fund. The commissioner of the division of health care finance and policy or his or her designee shall report annually to the house and senate committees on ways and means the amount of funds collected and any expenditures made from the Fund.
(b) There shall be established a vaccine purchase advisory council consisting of the commissioner of public health or his designee; the medical director of the Massachusetts immunization program of the department of public health; the commissioner of the division of health care finance and policy or his or her designee; the executive director of the commonwealth health insurance connector authority or his designee; the medical directors of the three health insurance companies having the most covered lives in the commonwealth; four health care provider representatives appointed by the commissioner of public health, one of whom shall be a member of the Massachusetts Medical Society; one of whom shall be a member of The Massachusetts Chapter of the American Academy of Pediatrics; one of whom shall be a member of the Massachusetts Academy of Family Physicians; and one of whom shall be a physician licensed to practice in the commonwealth and who shall have expertise in the area of childhood vaccines. The commissioner of public health, or his designee, shall be the chair of the council. The council shall recommend the types of vaccine(s) to be purchased based on a list of routine childhood immunizations and shall take into account provider preference, cost, availability, and other factors as determined by the council. The council shall recommend the amount of funding needed each fiscal year by calculating the total non-federal program cost. The council shall have independent authority to make recommendations required by this subsection. The commissioner of the department of public health shall determine the final vaccine(s) to be purchased. The commissioner of the division of health care finance and policy shall determine the final amount required to be included in the Vaccine Purchase Trust Fund for the next fiscal year to cover vaccines required for purchase, storage and distribution pursuant to this subsection.
(c) Pursuant to regulations to be promulgated by the commissioner of the division of health care finance and policy, each health insurer in the commonwealth shall pay to the commissioner of the division of health care finance and policy, for deposit in the Vaccine Purchase Trust Fund, a child immunizations fee assessed by the commissioner of the division of health care finance and policy. The regulations shall establish dates for assessing and contributing such fee and shall permit and enable expenditure of funds by the department of public health. The annual contribution into the trust fund initially shall be deposited by July 1, 2012 and annually thereafter. Such fee shall be a percentage of the final amount determined by the commissioner of the division of health care finance and policy pursuant to subsection (b) of this section, and shall be calculated based on the number of children not eligible for federally purchased vaccines who are insured by each health insurer as a percentage of total children insured by all health insurers in the commonwealth that are not eligible for federally purchased vaccines.
(d) The department of public health may promulgate rules and regulations as necessary to implement the universal purchase and distribution system, in accordance with this section and other applicable state and federal laws. The rules and regulations shall establish the system by which vaccines are distributed for children in the commonwealth.
Section 3: (a) Every health insurer, as defined in section one, to the extent not preempted by federal law, shall provide benefits for (1) routine childhood immunizations for Massachusetts residents and (2) immunizations for Massachusetts residents who are 19 years of age and over according to the most recent schedules recommended by the Advisory Committee on Immunization Practices of the U.S. Department of Health and Human Services. These benefits shall be exempt from any copayment, coinsurance, deductible, or dollar limit provisions in the health insurance policy or contract.
(b) Health insurers, to the extent not preempted by federal law, shall pay to health care providers 100% of the reasonable and customary payments for those immunizations described in Section 3(a), excluding those costs covered by the commonwealth or the federal government,, and any reasonable and customary costs associated with the administration of the vaccines. Notwithstanding any general or special law to the contrary, a health insurer shall provide such reimbursement to any health care provider who administers covered immunizations in any facility, heath care provider’s office or any other setting in the commonwealth and shall not limit such reimbursement to providers that are participating providers.
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