Budget Amendment ID: FY2026-S3-599

EHS 599

Universal Adult Vaccine Program

Messrs. Driscoll and Cyr and Ms. Rausch moved that the proposed new text be amended moves to amend the bill by inserting after section 90 the following section:-

"SECTION XX. Subsection (c) of section 24N of chapter 111 of the General Laws, as amended by section 111 of chapter 140 of the acts of 2024, is hereby amended by striking out the figure "7" and inserting in place thereof the following figure:- 9.

Said subsection (c) of said section 24N of chapter 111 of the General Laws, as so amended, is hereby amended by inserting after the word, "Physicians", the first time it appears, the following words:- 2 of whom shall both be physicians licensed to practice in the commonwealth and have expertise in the area of adult vaccines.

Said section 24N of said chapter 111 of the General Laws, as so amended, is hereby further amended by striking out after the words "vaccines. The council", and inserting in place thereof the following words:- vaccines. The commissioner.

Said subsection (c) of said section 24N of said chapter 111 of the General Laws, as so amended, is hereby further amended by striking out the word "childhood", the second and third time it appears.

Said subsection (c) of said section 24N of said chapter 111 of the General Laws, as so amended, is hereby further amended by inserting after the word, "account," the following words:- immunizations routinely recommended by the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices,.

Said chapter 111 of the General Laws is hereby amended by inserting after section 24N the following section:-

Section 24N 1/2. (a) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:

"Adult", individuals who are at least 19 years of age and younger than 65 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 adults in the commonwealth.

"MassHealth", the medical assistance and benefit programs administered by the MassHealth agency pursuant to Title XIX of the Social Security Act (42 U.S.C. § 1396a et seq.), Title XXI of the Social Security Act (42 U.S.C. § 1397aa et seq.), M.G.L. c. 118E, and other applicable laws and waivers to provide and pay for medical services to eligible members.

"Routine adult immunizations", immunizations for adults as defined in this section which shall include but need not be limited to immunizations that protect against respiratory diseases such as SARS-CoV-2, influenza and Respiratory Syncytial Virus (RSV) in addition to other immunizations recommended by the vaccine program advisory council and approved by the commissioner.

"Total non-federal program cost", the estimated annual cost of vaccines needed for routine adult immunizations for adults in the commonwealth less the amount of federal revenue available to the commonwealth for purchase, storage, distribution and administration of the vaccines.

(b) There shall be established in the commonwealth a separate, non-budgeted special revenue fund known as the Adult Vaccine Purchase Fund, which shall be administered by the commissioner of public health or a designee. Amounts credited to the fund shall be expended, without further appropriation, to support a vaccine purchase system for routine adult immunizations as defined in this section.

The fund shall be credited with: (i) all appropriations directed to the fund; (ii) all monies transferred from the executive office of health and human services pursuant to section 66 of chapter 118E; (iii) any voluntary contributions to the fund including, but not limited to, contributions from MassHealth, third-party payers or third-party administrators, as defined in section 1 of chapter 12C; and (iv) any interest earnings on such monies. Amounts credited to the fund shall be expended, without further appropriation, to cover the costs to purchase, store and distribute vaccines for routine adult immunizations and to support a vaccine clinic management platform.

Funds shall be expended solely to cover total non-federal program costs; provided, however, that the amount to be expended for storing and distributing vaccines for routine adult immunizations, if such costs are not covered by federal contributions, and for the costs of supporting a vaccine clinic management platform and programs to promote equitable access to vaccine, shall not exceed 10 per cent of the total amount of the fund expended for the purchase of vaccines needed for routine adult immunizations.

The department may incur expenses, and the comptroller may certify for payment, amounts in anticipation of the most recent estimate of expected receipts, as certified by the secretary of administration and finance; provided, however, that no expenditure shall be made from the fund which shall cause the fund to be in deficit at the close of a fiscal year. 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 annually report the amount of funds collected and any expenditures made from the fund to the clerks of the house of representatives and senate and to the house and senate committees on ways and means, the house and senate chairs of the joint committee on public health and the house and senate chairs of the joint committee on health care financing.

(c) The vaccine program advisory council established in section 24N shall recommend the vaccines to be included in the program and the commissioner shall calculate the amount needed in the fund each fiscal year for routine adult immunizations by calculating the total non-federal program cost. The council shall make recommendations to the commissioner on whether the commissioner may authorize provider choice of more than 1 comparable brand or type for a routine adult immunization vaccine. In its recommendations, the council shall examine the feasibility, costs and benefits of authorizing provider choice, provide a schedule of the cost of each comparable brand or type of a vaccine recommended for provider choice and demonstrate that the estimated vaccine cost of authorizing provider choice would not be substantially greater than the estimated vaccine cost of purchasing a single brand or type of a vaccine. The commissioner of public health shall determine the final vaccines to be purchased.

(d) To the extent health care providers as defined by section 1 who are otherwise legally authorized to administer vaccines and pharmacies licensed in accordance with section 39 of chapter 112 are otherwise administering vaccines, said health care providers and licensed pharmacies shall accept and shall administer vaccines funded by the Adult Vaccine Purchase Fund. Nothing in this section shall prohibit the department from allowing other providers legally authorized to administer vaccines from requesting to obtain and use vaccines funded by said trust.

(e) The department may adopt rules and regulations as necessary to implement the universal purchase and distribution system under this section and other applicable state and federal laws.

Subsection (a) of section 24N 1/2 of chapter 111 of the General Laws, as inserted by section 62, is hereby amended by striking out the words "individuals who are at least 19 years of age and younger than 65 years of age" and inserting in place thereof the following words:- individuals who are 19 years of age and older.

Section 64 of chapter 118E, as most recently amended by section 122 of chapter 140 of the acts of 2024, is hereby amended by striking out the definition "Immunization revenue amount" and inserting in place thereof the following definition:-

"Immunization revenue amount", the estimated costs (i) to purchase, store and distribute vaccines for routine childhood immunizations and administer the Vaccine Purchase Fund, established in section 24N of chapter 111, (ii) to purchase, store and distribute vaccines for routine adult vaccinations and administer the Adult Vaccine Purchase Trust Fund established in section 24N 1/2 of chapter 111, (iii) to administer the computerized immunization registry, established in section 24M of chapter 111 and (iv) that take into consideration the limitations on expenditures described in subsection (b) of section 24N and subsection (b) of section 24N 1/2 of chapter 111, as well as any anticipated surplus or deficit in said Vaccine Purchase Fund and said Adult Vaccine Purchase Trust Fund, but excluding any costs anticipated to be covered by federal contribution."

Section 66 of said chapter 118E, as most recently amended by section 126 of chapter 140 of the acts of 2024, is hereby amended by inserting after the words "chapter 111" the following words:- "and the Adult Vaccine Purchase Trust Fund established in section 24N 1/2 of chapter 111, as applicable, as determined by the executive office of health and human services in consultation with the department of public health each year".

Said section 66 of said chapter 118E, as most recently amended by section 127 of chapter 140 of the acts of 2024, is hereby amended by inserting after the words "chapter 111" the following words:- "and the Adult Vaccine Purchase Trust Fund established in section 24N 1/2 of chapter 111, as applicable, as determined by the executive office of health and human services in consultation with the department of public health each year".

Notwithstanding any general or special law to the contrary, the secretary of health and human services shall seek all required federal approvals that the secretary deems necessary to implement sections 57 to 63, inclusive, 75 to 77, inclusive, including any required waivers under 42 CFR § 433.68 necessary to implement changes to the managed care organization services assessment described in section 68 of chapter 118E of the General Laws. Sections 57 to 62, inclusive, 75 and 76 shall not become effective until the later of the effective date of this act or the first full calendar month following the calendar month in which the secretary determines that all such federal approvals have been received. Section 77 shall not become effective until the later of the October 1, 2027, or the first full calendar month following the calendar month in which the secretary determines that all such federal approvals have been received.

Section 63 shall take effect the first full calendar month following the calendar month in which the secretary determines both that voluntary federal contributions covering adults age 65 and over are available to state adult vaccine funds such as the Adult Vaccine Purchase Fund and that all federal approvals necessary under section 121 have been received".