Bill S.1922

FILED ON: 11/19/2013

SENATE . . . . . . . . . . . . . . No. 1922

The Commonwealth of Massachusetts

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In the Year Two Thousand Thirteen

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An Act establishing the childhood vaccine program.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Chapter 111 of the General Laws is hereby amended by inserting after section 24M the following section:—

Section 24N. (a) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:

“Children”, individuals less than 19 years of age.

“Estimated vaccine cost”, the estimated cost over the course of a fiscal year for the purchase, storage and distribution of vaccines for all children in the commonwealth.

“Payments Subject to Surcharge”, as defined in section 64 of chapter 118E.

“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 recommended by the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services.

“Surcharge payors”, those entities defined as surcharge payors under section 64 of chapter 118E, who made payments subject to surcharge of $1,000,000 or more during the most recent period for which data is available on July 1 of the current fiscal year.

“Total non-federal program cost”, the estimated annual cost of vaccines needed for routine childhood immunizations for children covered by surcharge payors in the commonwealth less the amount of federal revenue available to the commonwealth for purchase, storage, distribution and administration of such vaccines.

(b) There shall be established in the commonwealth a separate trust fund to be known as the Vaccine Purchase Trust Fund to support a universal purchase system for childhood vaccines in the commonwealth. The fund shall be expended to cover the costs to purchase, store and distribute vaccines for routine childhood immunizations and to administer the fund and the immunization registry, established under section 24M of chapter 111. The fund shall consist of all monies paid to the commonwealth under section 4 and any interest earnings on such monies. The fund shall be maintained by the commissioner of public health or a designee. The monies shall be expended under the direction of the department of public health, without prior appropriation, solely to cover total non-federal program costs; provided, however, that the amount to be expended for storing and distributing vaccines for routine childhood immunizations, if such costs are not covered by federal contribution, and for the costs of administering the immunization registry, shall not exceed 10 per cent of the total amount of the fund expended for the purchase of vaccines needed for routine childhood immunizations for all children in the commonwealth. 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 public health or a designee shall report annually to the house and senate committees on ways and means and the house and senate chairs of the joint committee on health care financing the amount of funds collected and any expenditures made from the fund.

(c) There shall be a vaccine purchase advisory council consisting of the commissioner of public health or a designee, who shall serve as chair; the medical director of the universal immunization program of the department of public health established under section 24I of chapter 111; the executive director for the center for health information and analysis or a designee; the executive director of the commonwealth health insurance connector authority or a designee; 3 persons to be appointed by the commissioner of insurance, each of whom shall be a representative of 1 of the 3 health insurance companies having the most insured lives in the commonwealth; and 8 persons to be appointed by the commissioner of public health, 1 of whom shall be a representative of an employer that self-insures for health coverage who shall be appointed from lists of nominees submitted by statewide associations of employers, 1 of whom shall be a representative of the pharmaceutical manufacturing industry with expertise in researching, developing and manufacturing vaccines, 1 of whom shall be a member of the Massachusetts Medical Society, 1 of whom shall be a member of the Massachusetts chapter of the American Academy of Pediatrics, 1 of whom shall be a member of the Massachusetts Academy of Family Physicians, and 3 of whom shall be physicians licensed to practice in the commonwealth and who shall have expertise in the area of childhood vaccines. The council shall recommend the types of vaccines 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 commissioner of public health shall determine the final vaccines to be purchased.

(d) Under regulations adopted by the commissioner of public health, each surcharge payor in the commonwealth shall pay to the commissioner of public health, for deposit in the Vaccine Purchase Trust Fund, a routine childhood immunizations surcharge assessed by the commissioner. By January 1 of each year, the commissioner of public health shall determine the total amount of such surcharge for the current fiscal year by determining the final amount required to be included in the Vaccine Purchase Trust Fund for the current fiscal year to cover the estimated costs to purchase, store and distribute vaccines for routine childhood immunizations and to administer the fund and the immunization registry, established under section 24M of chapter 111. Such amount shall exclude any costs anticipated to be covered by federal contribution, shall take into consideration the limitations on expenditures described in Section 2, and shall take into account any anticipated surplus or deficit in the trust fund. Such amount shall not be more than 4 per cent greater than the surcharge amount for the prior fiscal year unless the commissioner of public health submits a detailed report to the legislature explaining the need for such increase. If the reason for such increase is due to the purchase of new vaccines, as recommended by the vaccine purchase advisory council, such report shall include an analysis of cost savings generated by use of the state vaccine purchasing discount.

The commissioner shall annually provide surcharge payors notice of the assessment amount for the trust fund year not later than March 1. Surcharge payors shall pay the surcharge on a schedule determined by regulation, provided that such schedule shall ensure sufficient funds for the trust fund to fulfill the purposes described in section 2. Each surcharge payor shall pay a portion of the total amount of the surcharge proportional to their payments subject to surcharge during the most recent period for which data is available, as further defined in regulation.

(e) The department of public health may adopt rules and regulations as necessary to implement the universal purchase and distribution system under this chapter 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.

(f) Every surcharge payor, to the extent not preempted by federal law, shall provide benefits for: (i) routine childhood immunizations for residents of the commonwealth; and (ii) immunizations for residents of the commonwealth who are 19 years of age and older according to the most recent schedules recommended by the Advisory Committee on Immunization Practices of the United States 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.

SECTION 2. Notwithstanding any general or special law to the contrary, the department of public health is authorized to make additional assessments for fiscal year 2014, in an aggregate amount not to exceed $1,500,000, on surcharge payors, as defined in section 24N of chapter 111 of the General Laws, for the costs of the immunization registry established under section 24M of chapter 111 of the General Laws.

SECTION 3. Notwithstanding any general or special law to the contrary, the department of public health is authorized to make expenditures from the start of each fiscal year from the Vaccine Purchase Trust Fund established under section 24N of chapter 111 of the General Laws in anticipation of assessments on surcharge payors pursuant to said section 24N.

SECTION 4. Notwithstanding any general or special law to the contrary, in fiscal year 2015, the commissioner of public health shall not increase the total amount of the routine childhood immunizations surcharge under section 24N of chapter 111 of the General Laws more than 7 per cent over the total of item 4580-1000 in the fiscal year 2014 general appropriations act, any supplemental fiscal year 2014 funding to said item 4580-1000 and the amount assessed for fiscal year 2014 for the immunization registry established under section 24M of chapter 111, unless the commissioner of public health submits a detailed report to the legislature explaining the need for such increase; and provided further, that in state fiscal year 2016, the commissioner of public health shall not increase the total amount of the surcharge more than 7 per cent over the total of the fiscal year 2015 surcharge amount unless the commissioner of public health submits a detailed report to the legislature explaining the need for such increase.

SECTION 5. The routine childhood immunizations surcharge assessment required under section 24N of chapter 111 of the General Laws shall take effect on March 1, 2014.