Revision: June 22, 2020, 3:29 p.m.
HB 1655-FN - AS AMENDED BY THE HOUSE
12Mar2020... 1001h
2020 SESSION
20-2207
01/03
HOUSE BILL 1655-FN
AN ACT expanding the New Hampshire vaccine association to include adult vaccines.
SPONSORS: Rep. Knirk, Carr. 3; Rep. R. Osborne, Graf. 7; Rep. Indruk, Hills. 34; Rep. Weston, Graf. 8; Rep. Muscatel, Graf. 12; Rep. Woods, Merr. 23; Rep. Fargo, Straf. 14; Sen. Sherman, Dist 24; Sen. Hennessey, Dist 5
COMMITTEE: Health, Human Services and Elderly Affairs
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ANALYSIS
This bill expands the New Hampshire vaccine association to include adult vaccines.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
12Mar2020... 1001h 20-2207
01/03
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty
AN ACT expanding the New Hampshire vaccine association to include adult vaccines.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Hampshire Vaccine Association; Definitions. Amend RSA 126-Q:1, III and IV to read as follows:
III. "Assessable lives" means:
(a) All children under 19 years of age residing in the state who have assessable coverage written or administered by an assessable entity, with the exception of children whose vaccines are paid for under the federal Vaccines for Children program, established under 42 U.S.C. section 1396s.
(b) All adults, age 19 through 64, excluding Medicare beneficiaries, residing in the state who have assessable coverage written or administered by an assessable entity.
IV. "Assessment" means the assessable entity's liability with respect to [childhood] vaccines determined in accordance with this chapter. [For purposes of rate setting and medical loss ratio calculations, all association assessments are considered pharmaceutical or medical benefit costs and not regulatory costs.] In the event of any insolvency or similar proceeding affecting any payer, assessments shall be included in the highest priority of obligations to be paid by or on behalf of such payer.
2 New Hampshire Vaccine Association; Definitions. Amend RSA 126-Q:1, VIII to read as follows:
VIII. "Estimated vaccine cost" means the estimated cost to the state over the course of a state fiscal year of the ordering, purchase, distribution, and [administration] administrative oversight of vaccines purchased at the federal discount rate by the department of health and human services.
3 New Hampshire Vaccine Association; Definitions. Amend RSA 126-Q:1, XI to read as follows:
XI. "Vaccine" means any preparations of killed microorganisms, living attenuated organisms, or living fully virulent organisms that are approved by the federal Food and Drug Administration and recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and have been authorized by the commissioner of the department of health and human services for administration to children and adults of the state of New Hampshire [under the age of 19 years] for the purposes of producing or artificially increasing immunity to particular life-threatening and disabling diseases. "Vaccine" shall not include pneumococcal polysaccharide vaccine or herpes zoster vaccine.
4 New Hampshire Vaccine Association; Creation of Association. Amend RSA 126-Q:2 to read as follows:
126-Q:2 Creation of Association. There is hereby created a nonprofit corporation to be known as the New Hampshire vaccine association. The association is formed to assess assessable entities for the cost of vaccines provided to certain children and adults in New Hampshire.
5 New Hampshire Vaccine Association; Membership, Powers, and Duties of the New Hampshire Association. Amend RSA 126-Q:3, V(m)-(o) to read as follows:
(m) Collect assessments from assessable entities as calculated under RSA 126-Q:4 and deposit said assessments less the association's administrative costs annually and reserves with the state treasurer to the credit of the vaccine purchase fund established pursuant to RSA 141-C:17-a. At the written request of the association following a majority vote of the board of directors, any funds forwarded to the state treasurer for the vaccine purchase fund remaining unexpended for [childhood] vaccines, shall promptly be returned to the association.
(n) Be authorized to enter into one or more agreements with other applicable authorities in surrounding states to reduce the risk of duplicate assessments and to assure availability of vaccines for children and adults who are residents of this state but who receive vaccination services in other states. Any costs relating to any such agreement shall be considered additional vaccine costs of the program for purposes of determining the association's assessments.
(o) Adopt procedures by which affiliated assessable entities calculate their assessment on an aggregate basis and procedures to ensure that no assessable life is counted more than once. Unless otherwise determined by the board, the assessable entity responsible for the payment of the provider's administrative costs for [childhood] vaccines shall be the entity responsible for reporting assessable lives and payment of the corresponding assessment.
6 New Hampshire Vaccine Association; Assessment Determination. Amend RSA 126-Q:4, I to read as follows:
I. The board shall determine an assessment for each assessable entity in accordance with this section, except that no assessment shall be made based on children excluded from assessable lives whose vaccines are paid for under the federal Vaccines for Children program, established under 42 U.S.C. section 1396s[. An assessment determination made pursuant to this section is a pharmaceutical cost and not a regulatory cost for purposes of calculating the carrier's medical loss ratio] or adults whose vaccines are paid for under Medicare.
7 New Hampshire Vaccine Association; Assessment Determination. Amend RSA 126-Q:4, V to read as follows:
V. The board may determine an interim assessment for new vaccines or unanticipated shortfalls in the association's ability to meet [childhood] vaccine funding needs. The board shall calculate the interim assessment in accordance with paragraph II, and the interim assessment is payable the calendar quarter that begins no less than 30 days following the establishment of the federal contract price. The board shall not impose more than one interim assessment per year, except in the case of a public health emergency declared in accordance with state or federal law.
8 New Hampshire Vaccine Association; Vaccine Purchase Fund. Amend RSA 141-C:17-a to read as follows:
141-C:17-a Vaccine Purchase Fund. There is hereby established a vaccine purchase fund for the ordering, purchase, distribution, and administrative oversight of antitoxins, serums, vaccines, and immunizing agents, which are to be provided to the public at no cost except for the actual cost of administering such agents, under RSA 141-C:17. Any funds provided to the department for this purpose and deposited in the fund shall not be used for any other purpose. Moneys in the fund shall be continually appropriated to the commissioner of the department of health and human services.
9 Effective Date. This act shall take effect July 1, 2021.
20-2207
Amended 6/9/20
HB 1655-FN- FISCAL NOTE
AS AMENDED BY THE HOUSE (AMENDMENT #2020-1001h)
AN ACT expanding the New Hampshire vaccine association to include adult vaccines.
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | $0 | $0 | Approximately $10,700,000 | Approximately $10,700,000 |
Expenditures | $0 | $0 | Approximately $10,700,000 | Approximately $10,700,000 |
Funding Source: | [ ] General [ ] Education [ ] Highway [ X ] Other - Insurance assessments paid to the vaccine purchase fund under RSA 141-C:17-a. | |||
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METHODOLOGY:
This bill expands the NH Vaccine Association, which currently purchases vaccines for children under the age of 19, to all adults within the State. As with the existing children's program, insurance companies would be required to contribute to a vaccine purchasing pool, and would contribute to the program based on the number of assessable lives covered. Funds raised would be used to support the cost of ordering, purchasing, and distributing vaccines purchased at the federal discount rate by the state Department of Health and Human Services. For the children's vaccine program currently in place, the Department provides oversight to approximately 250 provider offices throughout the State. The Department anticipates an additional 350-400 provider offices will be enrolled to handle the additional vaccines provided to adults.
The Department anticipates the bill will result in several million dollars of revenue to the state's dedicated non-lapsing vaccine purchasing fund for the specific purpose of purchasing vaccines and overseeing the program. The cost of the program will depend on the specific vaccines covered and the take up rate by the adult population. Based on the average assessment rate of $14.16 for vaccine programs in place in Alaska, Rhode Island, and Vermont, as well as the estimated number of adult assessable lives in NH (755,317), the Department estimates the program may cost approximately $10.7 million annually. The Department cautions that this number is a rough estimate only, and notes that for comparative purposes, the children's program purchases approximately $19 million in vaccines each year. The estimated cost of $10.7 million is inclusive of the following four new positions the Department expects will be needed to oversee the expanded program:
| FY 2021 | FY 2022 | FY 2023 |
Program Specialist III (LG 23) |
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Salary | $46,800 | $48,800 | $51,000 |
Benefits | $28,400 | $29,800 | $31,300 |
Other | $8,800 | $4,100 | $4,100 |
Position Total | $84,000 | $82,700 | $86,400 |
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Program Specialist IV (LG 25) |
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Salary | $51,000 | $53,200 | $55,600 |
Benefits | $29,200 | $30,700 | $32,200 |
Other | $8,800 | $4,100 | $4,100 |
Position Total | $89,000 | $88,000 | $91,900 |
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Technical Support Specialist (LG 23) |
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Salary | $46,800 | $48,800 | $51,000 |
Benefits | $28,400 | $29,800 | $31,300 |
Other | $16,200 | $11,500 | $4,900 |
Position Total | $91,400 | $90,100 | $87,200 |
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Public Health Nurse Consultant (LG 12) |
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Salary | $51,000 | $53,200 | $55,600 |
Benefits | $29,200 | $30,700 | $32,200 |
Other | $16,200 | $11,500 | $11,500 |
Position Total | $96,400 | $95,400 | $99,300 |
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Total Position Costs: | $360,800 | $356,200 | $364,800 |
The Insurance Department states that to the extent insurer costs increase above what they are currently paying for vaccine assessments, premium rates and/or benefit designs may change. To the extent that premium rates change, the bill will have an indeterminable impact on insurance premium tax revenue.
As amended, this bill takes effect July 1, 2021, so its fiscal impact will take place beginning in FY 2022.
AGENCIES CONTACTED:
Department of Health and Human Services and Insurance Department