What's happening
This bill requires health insurance to reimburse providers for both the full cost and administration of vaccines, including added costs for shipping, handling, and storage.
Why it matters
Ensures providers are fully reimbursed for all costs associated with vaccines. , including not just the vaccine itself but also significant ancillary expenses like shipping, handling, storage, supplies, and data entry—potentially making vaccine provision more financially viable for small clinics and independent practices.
Aligns reimbursement rates with federal benchmarks. , basing payments on current CDC private sector costs plus a mandated minimum markup for logistical expenses, and tying administration fees to current Medicare rates—helping standardize compensation and potentially reducing disputes over payment adequacy.
May improve patient access to immunizations. by reducing the financial barriers for providers, which in turn could encourage more healthcare professionals to offer vaccines, especially in under-served or rural areas where cost concerns have historically limited vaccine availability.
Potentially impacts insurance premiums or out-of-pocket costs. as insurers are required to cover a broader set of vaccine-related expenses, which could be passed on to consumers, but may be offset by long-term public health savings from higher immunization rates.
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Who cares
Headline styles
Cover Full Vaccine Costs
Plain English, a few words. Used as the page title.
Sponsors
18 Co-sponsors
History
- Referred to insurance
- Referred to insurance
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1158
2019-2020 Regular Sessions
IN ASSEMBLY
January 14, 2019
Introduced by M. of A. GOTTFRIED, DINOWITZ, GALEF, GUNTHER, PAULIN, L. ROSENTHAL, AUBRY, BENEDETTO, BRONSON, COLTON, JAFFEE, MONTESANO, MOSLEY, RIVERA, OTIS, QUART, LIFTON -- Multi-Sponsored by -- M. of A. CARROLL, COOK, FAHY, JONES, McDONOUGH, RAIA, RICHARDSON -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to insurance reimbursement for vaccination
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Clause (iii) of subparagraph (B) of paragraph 17 of subsection (i) of section 3216 of the insurance law, as amended by chapter 219 of the laws of 2011, is amended to read as follows:
(iii) necessary immunizations, as determined by the superintendent in consultation with the commissioner of health, consisting of at least adequate dosages of vaccine against diphtheria, pertussis, tetanus, polio, measles, rubella, mumps, haemophilus influenzae type b and hepatitis b, which meet the standards approved by the United States public health service for such biological products, including reimbursement to the health care provider for the acquisition costs of the vaccine, according to the current or most recently reported United States centers for disease control and prevention private sector cost plus a minimum of twenty-one percent for shipping, handling and storage costs, and the total cost of administration of the vaccine, including the cost of supplies, data entry, vaccine counseling, inventory management and routine nursing activities based on the current year's medicare rates as published by the United States centers for medicare and medicaid services.
§ 2. Clause (ii) of subparagraph (E) of paragraph 17 of subsection (i) of section 3216 of the insurance law, as amended by chapter 219 of the laws of 2011, is amended to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03486-01-9
A. 1158 2
(ii) immunizations that have in effect a recommendation from the advisory committee on immunization practices of the centers for disease control and prevention with respect to the individual involved, including reimbursement to the health care provider for the acquisition costs of the vaccine, according to the current or most recently reported United States centers for disease control and prevention private sector cost plus a minimum of twenty-one percent for shipping, handling and storage costs, and the total cost of administration of the vaccine, including the cost of supplies, data entry, vaccine counseling, inventory management and routine nursing activities based on the current year's medicare rates as published by the United States centers for medicare and medicaid services;
§ 3. Clause (iii) of subparagraph (B) of paragraph 8 of subsection (l) of section 3221 of the insurance law, as amended by chapter 219 of the laws of 2011, is amended to read as follows:
(iii) necessary immunizations, as determined by the superintendent in consultation with the commissioner of health, consisting of at least adequate dosages of vaccine against diphtheria, pertussis, tetanus, polio, measles, rubella, mumps, haemophilus influenzae type b and hepatitis b, which meet the standards approved by the United States public health service for such biological products, including reimbursement to the health care provider for the acquisition costs of the vaccine, according to the current or most recently reported United States centers for disease control and prevention private sector cost plus a minimum of twenty-one percent for shipping, handling and storage costs, and the total cost of administration of the vaccine, including the cost of supplies, data entry, vaccine counseling, inventory management and routine nursing activities based on the current year's medicare rates as published by the United States centers for medicare and medicaid services.
§ 4. Clause (ii) of subparagraph (E) of paragraph 8 of subdivision (l) of section 3221 of the insurance law, as amended by chapter 219 of the laws of 2011, is amended to read as follows:
(ii) immunizations that have in effect a recommendation from the advisory committee on immunization practices of the centers for disease control and prevention with respect to the individual involved, including reimbursement to the health care provider for the acquisition costs of the vaccine, according to the current or most recently reported United States centers for disease control and prevention private sector cost plus a minimum of twenty-one percent for shipping, handling and storage costs, and the total cost of administration of the vaccine, including the cost of supplies, data entry, vaccine counseling, inventory management and routine nursing activities based on the current year's medicare rates as published by the United States centers for medicare and medicaid services;
§ 5. Subparagraph (C) of paragraph 2 of subsection (j) of section 4303 of the insurance law, as amended by chapter 219 of the laws of 2011, is amended to read as follows:
(C) necessary immunizations, as determined by the superintendent in consultation with the commissioner of health, consisting of at least adequate dosages of vaccine against diphtheria, pertussis, tetanus, polio, measles, rubella, mumps, haemophilus influenzae type b and hepatitis b, which meet the standards approved by the United States public health service for such biological products, including reimbursement to the health care provider for the acquisition costs of the vaccine, according to the current or most recently reported United States centers
A. 1158 3
for disease control and prevention private sector cost plus a minimum of twenty-one percent for shipping, handling and storage costs, and the total cost of administration of the vaccine, including the cost of supplies, data entry, vaccine counseling, inventory management and routine nursing activities based on the current year's medicare rates as published by the United States centers for medicare and medicaid services.
§ 6. Subparagraph (B) of paragraph 3 of subsection (j) of section 4303 of the insurance law, as added by chapter 219 of the laws of 2011, is amended to read as follows:
(B) immunizations that have in effect a recommendation from the advisory committee on immunization practices of the centers for disease control and prevention with respect to the individual involved, including reimbursement to the health care provider for the acquisition costs of the vaccine, according to the current or most recently reported United States centers for disease control and prevention private sector cost plus a minimum of twenty-one percent for shipping, handling and storage costs, and the total cost of administration of the vaccine, including the cost of supplies, data entry, vaccine counseling, inventory management and routine nursing activities based on the current year's medicare rates as published by the United States centers for medicare and medicaid services;
§ 7. This act shall take effect on the first of January after it shall have become a law and shall apply to any contract entered into, delivered, amended or modified on or after the date it takes effect.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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