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.
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.