BILL NUMBER: S5852
SPONSOR: SKOUFIS
 
TITLE OF BILL:
An act to amend the insurance law, in relation to insurance reimburse-
ment for vaccination
 
PURPOSE:
To require insurance companies to reimburse healthcare providers for the
full cost of vaccination.
 
SUMMARY PROVISIONS:
Section 1: Amends clause (iii) of subparagraph (B) of paragraph 17 of
subsection (i) of § 3216 insurance law to include reimbursement to
health care providers for the acquisition costs of the vaccine, accord-
ing 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 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 to ensure health care providers will be reimbursed for
immunizations recommended by the CDC's Advisory Committee on Immuniza-
tion Practices. Reimbursement will cover the vaccine acquisition cost
based on the latest CDC private sector pricing, plus a minimum of 21%
for shipping, handling, and storage. Additionally, providers will be
compensated for the full cost of vaccine administration, including
supplies, data entry, counseling, inventory management, and routine
nursing activities, based on the current Medicare rates set by the
Centers for Medicare & Medicaid Services.
Section 3: Clause (iii) of subparagrapgh (B) of paragraph 8 of
subsection (i) of section 3221 of the insurance law, to ensure health
care providers will be reimbursed for the acquisition and administration
of essential immunizations, as determined by health authorities, includ-
ing vaccines for diphtheria, pertussis, tetanus, polio, measles, rubel-
la, mumps, Haemophilus influenzae type B, and hepatitis B. Reimbursement
will be based on the latest CDC private sector pricing, with an addi-
tional 21% for shipping, handling, and storage costs. According to
current Medicare rates, providers will also be compensated for adminis-
tration-related expenses, such as supplies, data entry, counseling,
inventory management, and routine nursing activities.
Section 4: Clause (ii) of subparagraph (E) of paragraph 8 of subsection
(1) of section 3221 of the insurance law, to ensure Health care provid-
ers will be reimbursed for vaccines recommended by the CDC's Advisory
Committee on Immunization Practices. Reimbursement will cover the acqui-
sition cost based on the latest CDC private sector pricing, plus an
additional 21% for shipping, handling, and storage. Additionally,
providers will be compensated for administration costs, including
supplies, data entry, counseling, inventory management, and routine
nursing activities, following current Medicare rates.
Section 5: Subparagraph (c) of subsection (j) of section 4303 of the
insurance law, to include, necessary immunizations, including vaccines
for diphtheria, pertussis, tetanus, polio, measles, rubella, mumps,
Haemophilus influenzae type B, and hepatitis B, must meet U.S. Public
Health Service standards. Health care providers will be reimbursed for
vaccine acquisition costs based on the latest CDC private sector pric-
ing, plus 21% for shipping, handling, and storage. Following current
Medicare rates, reimbursement will also cover administration costs,
including supplies, data entry, counseling, inventory management, and
routine nursing activities.
Section 6: Subparagraph (B) of paragraph 3 of subsection 4303 of the
insurance law, to provide immunizations recommended by the CDC's Advi-
sory Committee on Immunization Practices will be reimbursed based on the
latest CDC private sector pricing. Health care providers will receive
compensation for vaccine acquisition costs, plus a minimum of 21% for
shipping, handling, and storage. Following current Medicare rates,
reimbursement will also cover administration expenses, including
supplies, data entry, counseling, inventory management, and routine
nursing activities.
Section 7: Sets 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 Acad-
emy of Pediatrics, other healthcare professional organizations, and
local, state, and federal public health agencies is to promote maximum
immunization for infants, children, adolescents, young adults, and older
adults. To achieve this goal, healthcare providers should be paid for
the full cost of the vaccine and vaccine-related expenses.
 
LEGISLATIVE HISTORY:
Senate:
2013: No Senate Same-As
2014: No Senate Same-As
2015: No Senate Same-As
2016: No Senate Same-As
2017: No Senate Same-As
2018: No Senate Same-As
2019: No Senate Same-As
2020: No Senate Same-As
2021: No Senate Same-As
2022: No Senate Same-As
2023: S6603, Referred to Insurance
2024: S6603, Referred to Insurance
Assembly:
2013: A7248, Referred to Insurance
2014: A7248, Referred to Insurance
2015: A3356, Referred to Insurance
2016: A3356, Referred to Insurance
2017: A4061, Referred to Insurance
2018: A4061, Referred to Insurance
2019: A1158, Referred to Insurance
2020: A1158, Referred to Insurance
2021: A227, Referred to Insurance
2022: A227, Referred to Insurance
2023: A2516, Referred to Insurance
2024: A2516, Referred to Insurance
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
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.

Statutes affected:
S5852: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(l) insurance law, 4303 insurance law, 4303(j) insurance law