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A03839 Summary:

BILL NOA03839
 
SAME ASNo Same As
 
SPONSORDinowitz (MS)
 
COSPNSRGlick, Hevesi, Kelles, DeStefano, Raga
 
MLTSPNSRSimon
 
Amd §§3216, 3221 & 4303, Ins L
 
Requires insurance reimbursement for the total direct and indirect practice expenses associated with vaccinations.
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A03839 Actions:

BILL NOA03839
 
01/30/2025referred to insurance
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A03839 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A3839
 
SPONSOR: Dinowitz (MS)
  TITLE OF BILL: An act to amend the insurance law, in relation to insurance reimburse- ment for vaccination   PURPOSE OR GENERAL IDEA OF BILL: To require insurance companies to reimburse health care providers for the full cost of vaccination..   SUMMARY OF SPECIFIC PROVISIONS: Section one of the bill amends clause (iii) of subparagraph (B) of para- graph 17 of subsection (i) of § 3216 insurance law to require individual insurance policies that provide medical, major-medical or similar comprehensive-type coverage to provide reimbursement to health care providers for the acquisition costs of vaccines for necessary immuniza- tions, as determined by the superintendent of financial services, in consultation with the commissioner of health, consisting of at least vaccines against diphtheria, pertussis, tetanus, polio, measles, rubel- la, mumps, haemophilus influenzae type b, and hepatitis b, which meet the standards approved by the United States public health service for such biological products, 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 rendered for a covered child of an insured from the date of birth through the attainment of nineteen years. Section two of the bill amends clause (ii) of subparagraph (E) of para- graph 17 of subsection (i) of § 3216 insurance law to require every individual policy that provides hospital, surgical or medical care coverage, except for a grandfathered health plan under subparagraph (F) of this paragraph, to provide reimbursement to health care providers for the acquisition costs of vaccines for 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, 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, invento- ry 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. Section three of the bill amends clause (iii) of subparagraph (B) of paragraph 8 of subsection (1) of § 3221 insurance law to require group insurance policies that provide medical, major-medical or similar comprehensive-type coverage to provide reimbursement to health care providers for the acquisition costs of vaccines for necessary immuniza- tions, as determined by the superintendent of financial services, in consultation with the commissioner of health, consisting of at least vaccines against diphtheria, pertussis, tetanus, polio, measles, rubel- la, mumps, haemophilus influenzae type b , and hepatitis b, which meet the standards approved by the United States public health service for such biological products, 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 rendered for a covered child of an insured from the date of birth through the attainment of nineteen years. Section four of the bill amends clause (ii) of subparagraph (E) of para- graph 8 of subsection (1) of § 3221 insurance law to require every group policy that provides hospital, surgical or medical care coverage, except for a grandfathered health plan under subparagraph (G) of this para- graph, to provide reimbursement to health care providers for the acqui- sition costs of vaccines for immunizations that have in effect a recom- mendation from the advisory committee on immunization practices of the centers for disease control and prevention with respect to the individ- ual involved, 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 manage- ment and routine nursing activities based on the current year's medicare rates as published by the United States centers for medicare and medi- caid services. Section five of the bill amends subparagraph (C) of paragraph 2 of subsection (j) of § 4303 insurance law to require health service corpo- rations and medical expense indemnity corporations that provide medical, major-medical or similar comprehensive-type coverage to provide reimbursement to health care providers for the acquisition costs of vaccines for necessary immunizations, as determined by the superinten- dent of financial services, in consultation with the commissioner of health, consisting of at least vaccines 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, 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 rendered for a covered child of an insured from the date of birth through the attainment of nineteen years. Section six of the bill amends subparagraph (B) of paragraph 3 of subsection (j) of § 4303 insurance law to require every contract that provides hospital, surgical or medical care coverage, except for a grandfathered health plan under paragraph four of this subsection, to provide reimbursement to health care providers for the acquisition costs of vaccines for 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, 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. Section seven of the bill provides effective date.   JUSTIFICATION: Vaccines are among the top overhead expenses for pediatricians and pediatric nurse practitioners. It is important that insurers cover the total direct and indirect practice expenses, including a margin for the vaccine product and office costs, and the time spent counseling families on the indications and potential side effects of a vaccine. The bill is keyed primarily to prices and rates recognized by the federal Centers for Disease Control and Medicare. One of the goals of the American Academy of Pediatrics; other health care professional organizations; and local, state and federal public health agencies is to promote maximum immunization for infants, chil- dren, adolescents, young adults, and older adults. To achieve this goal, health care providers should be paid for the full cost of the vaccine and vaccine related expenses.   PRIOR LEGISLATIVE HISTORY: 2023-24: A.5126 - Insurance / S.6603 - Insurance 2021-22: A.227 (Gottfried) - Insurance 2019-20: A.1158 (Gottfried) - Insurance 2017-18: A.4061 (Gottfried) - Insurance 2015-16: A.3356 (Gottfried) - Insurance 2013-14: A.7248 (Gottfried) - Insurance   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: The first day of January after it shall have become a law.
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A03839 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          3839
 
                               2025-2026 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 30, 2025
                                       ___________
 
        Introduced  by M. of A. DINOWITZ, GLICK, HEVESI, KELLES, DeSTEFANO, RAGA
          -- Multi-Sponsored by -- M. of A. SIMON -- read once and  referred  to
          the Committee on Insurance
 
        AN  ACT  to amend the insurance law, in relation to insurance reimburse-
          ment for vaccination
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Clause  (iii)  of  subparagraph  (B)  of  paragraph 17 of
     2  subsection (i) of section 3216 of the insurance law, as amended by chap-
     3  ter 219 of the laws of 2011, is amended to read as follows:
     4    (iii) necessary immunizations, as determined by the superintendent  in
     5  consultation  with  the  commissioner  of health, consisting of at least
     6  adequate dosages of  vaccine  against  diphtheria,  pertussis,  tetanus,
     7  polio,  measles, rubella, mumps, haemophilus influenzae type b and hepa-
     8  titis b, which meet the standards approved by the United  States  public
     9  health  service for such biological products, including reimbursement to
    10  the health care provider for  the  acquisition  costs  of  the  vaccine,
    11  according to the current or most recently reported United States centers
    12  for disease control and prevention private sector cost plus a minimum of
    13  twenty-one  percent  for  shipping,  handling and storage costs, and the
    14  total cost of administration of  the  vaccine,  including  the  cost  of
    15  supplies,  data  entry,  vaccine  counseling,  inventory  management and
    16  routine nursing activities based on the current year's medicare rates as
    17  published by  the  United  States  centers  for  medicare  and  medicaid
    18  services.
    19    § 2. Clause (ii) of subparagraph (E) of paragraph 17 of subsection (i)
    20  of  section  3216 of the insurance law, as amended by chapter 219 of the
    21  laws of 2011, is amended to read as follows:
    22    (ii) immunizations that have in effect a recommendation from the advi-
    23  sory committee on immunization practices  of  the  centers  for  disease
    24  control  and prevention with respect to the individual involved, includ-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07727-01-5

        A. 3839                             2
 
     1  ing reimbursement to the health care provider for the acquisition  costs
     2  of  the  vaccine,  according  to  the  current or most recently reported
     3  United States centers for disease control and prevention private  sector
     4  cost  plus  a  minimum  of twenty-one percent for shipping, handling and
     5  storage costs, and the total cost  of  administration  of  the  vaccine,
     6  including the cost of supplies, data entry, vaccine counseling, invento-
     7  ry management and routine nursing activities based on the current year's
     8  medicare  rates  as  published by the United States centers for medicare
     9  and medicaid services;
    10    § 3. Clause (iii) of subparagraph (B) of paragraph 8 of subsection (l)
    11  of section 3221 of the insurance law, as amended by chapter 219  of  the
    12  laws of 2011, is amended to read as follows:
    13    (iii)  necessary immunizations, as determined by the superintendent in
    14  consultation with the commissioner of health,  consisting  of  at  least
    15  adequate  dosages  of  vaccine  against  diphtheria, pertussis, tetanus,
    16  polio, measles, rubella, mumps, haemophilus influenzae type b and  hepa-
    17  titis  b,  which meet the standards approved by the United States public
    18  health service for such biological products, including reimbursement  to
    19  the  health  care  provider  for  the  acquisition costs of the vaccine,
    20  according to the current or most recently reported United States centers
    21  for disease control and prevention private sector cost plus a minimum of
    22  twenty-one percent for shipping, handling and  storage  costs,  and  the
    23  total  cost  of  administration  of  the  vaccine, including the cost of
    24  supplies, data  entry,  vaccine  counseling,  inventory  management  and
    25  routine nursing activities based on the current year's medicare rates as
    26  published  by  the  United  States  centers  for  medicare  and medicaid
    27  services.
    28    § 4. Clause (ii) of subparagraph (E) of paragraph 8 of subsection  (l)
    29  of  section  3221 of the insurance law, as amended by chapter 219 of the
    30  laws of 2011, is amended to read as follows:
    31    (ii) immunizations that have in effect a recommendation from the advi-
    32  sory committee on immunization practices  of  the  centers  for  disease
    33  control  and prevention with respect to the individual involved, includ-
    34  ing reimbursement to the health care provider for the acquisition  costs
    35  of  the  vaccine,  according  to  the  current or most recently reported
    36  United States centers for disease control and prevention private  sector
    37  cost  plus  a  minimum  of twenty-one percent for shipping, handling and
    38  storage costs, and the total cost  of  administration  of  the  vaccine,
    39  including the cost of supplies, data entry, vaccine counseling, invento-
    40  ry management and routine nursing activities based on the current year's
    41  medicare  rates  as  published by the United States centers for medicare
    42  and medicaid services;
    43    § 5. Subparagraph (C) of paragraph 2 of subsection (j) of section 4303
    44  of the insurance law, as amended by chapter 219 of the laws of 2011,  is
    45  amended to read as follows:
    46    (C)  necessary  immunizations,  as determined by the superintendent in
    47  consultation with the commissioner of health,  consisting  of  at  least
    48  adequate  dosages  of  vaccine  against  diphtheria, pertussis, tetanus,
    49  polio, measles, rubella, mumps, haemophilus influenzae type b and  hepa-
    50  titis  b,  which meet the standards approved by the United States public
    51  health service for such biological products, including reimbursement  to
    52  the  health  care  provider  for  the  acquisition costs of the vaccine,
    53  according to the current or most recently reported United States centers
    54  for disease control and prevention private sector cost plus a minimum of
    55  twenty-one percent for shipping, handling and  storage  costs,  and  the
    56  total  cost  of  administration  of  the  vaccine, including the cost of

        A. 3839                             3
 
     1  supplies, data  entry,  vaccine  counseling,  inventory  management  and
     2  routine nursing activities based on the current year's medicare rates as
     3  published  by  the  United  States  centers  for  medicare  and medicaid
     4  services.
     5    § 6. Subparagraph (B) of paragraph 3 of subsection (j) of section 4303
     6  of  the  insurance  law, as added by chapter 219 of the laws of 2011, is
     7  amended to read as follows:
     8    (B) immunizations that have in effect a recommendation from the  advi-
     9  sory  committee  on  immunization  practices  of the centers for disease
    10  control and prevention with respect to the individual involved,  includ-
    11  ing  reimbursement to the health care provider for the acquisition costs
    12  of the vaccine, according to  the  current  or  most  recently  reported
    13  United  States centers for disease control and prevention private sector
    14  cost plus a minimum of twenty-one percent  for  shipping,  handling  and
    15  storage  costs,  and  the  total  cost of administration of the vaccine,
    16  including the cost of supplies, data entry, vaccine counseling, invento-
    17  ry management and routine nursing activities based on the current year's
    18  medicare rates as published by the United States  centers  for  medicare
    19  and medicaid services;
    20    § 7. This act shall take effect on the first of January after it shall
    21  have  become  a law and shall apply to any contract entered into, deliv-
    22  ered, amended or modified on or after the date it takes effect.
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