§ 1130. Immunization funding
(a) As used in this section:
(1) “Health care facility” shall have the same meaning as in section 9402 of this title.
(2) “Health care professional” means an individual, partnership, corporation, facility,
or institution licensed or certified or authorized by law to provide professional
health care services.
(3) “Health insurer” shall have the same meaning as in section 9402 of this title, but does not apply to insurers providing coverage only for a specified disease or
other limited benefit coverage.
(4) “Immunizations” means vaccines and the application of the vaccines as recommended
by the practice guidelines for children and adults established by the Advisory Committee
on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention
(CDC).
(5) “State health care programs” means any health care program providing immunizations
with funds available through State and federal sources.
(6) “Covered lives” means the number of Vermont residents covered under a health insurance
plan provided or administered by a health insurer.
(b)(1) The Department of Health shall administer an immunization program with the goals of
ensuring universal access to vaccines for all Vermonters at no charge to the individual
and reducing the cost at which the State may purchase vaccines. The Department shall
purchase, provide for the distribution of, and monitor the use of vaccines as provided
for in this subsection and subsection (c) of this section. The cost of the vaccines
and an administrative surcharge shall be reimbursed by health insurers as provided
for in subsections (e) and (f) of this section.
(2) The Department shall solicit, facilitate, and supervise the participation of health
care professionals, health care facilities, and health insurers in the immunization
program in order to accomplish the State’s goal of universal access to immunizations
at the lowest practicable cost to individuals, insurers, and State health care programs.
(3) The Department shall gather and analyze data regarding the immunization program for
the purpose of ensuring its quality and maximizing protection of Vermonters against
diseases preventable by vaccination.
(c) The immunization program shall purchase vaccines from the federal Centers for Disease
Control and Prevention at the lowest available cost. The Department shall determine
annually which vaccines for adults shall be purchased under the program.
(d) The immunization program shall provide for distribution of the vaccines to health
care professionals and health care facilities for administration to patients.
(e) Health insurers shall remit to the Department the cost of vaccines, as established
by the Commissioner of Health based on the recommendation of the Immunization Funding
Advisory Committee established in subsection (g) of this section.
(f) The Department shall charge each health insurer a surcharge for the costs and administration
of the immunization program. The surcharge shall be deposited into an existing special
fund and used solely for the purpose of administering the program.
(g)(1) The Immunization Funding Advisory Committee is established to provide the Commissioner
of Health with an annual per-member per-month cost for vaccines for the pediatric
population, an annual per-member per-month cost for vaccines for the adult population,
and a recommendation for the amount of the yearly vaccine assessment. The Committee
shall comprise the following nine members:
(A) the Executive Officer of the Board of Pharmacy;
(B) the Executive Director of the Green Mountain Care Board;
(C) a representative of the Vermont Blueprint for Health, nominated by the Director of
the Blueprint and appointed by the Commissioner of Health;
(D) three representatives of health insurers, one from each of the State’s largest private
health insurers, as determined by the number of covered lives, appointed by the Commissioner
of Health;
(E) a representative of the American Academy of Pediatrics, Vermont chapter, appointed
by the Commissioner of Health;
(F) a representative of the American Academy of Family Medicine, Vermont chapter, appointed
by the Commissioner of Health; and
(G) a representative of employers that self-insure for health coverage, appointed by the
Commissioner of Health.
(2) The Committee shall select a chair from among its members at the first meeting of
each calendar year. The Committee shall receive administrative support from the Department
of Health.
(3) By January 1 of each year, the Committee shall provide to the Commissioner the annual
fiscal assessment and the per-member per-month cost for pediatric vaccines based on
the total number of pediatric covered lives reported by health insurers and the per-member
per-month cost for adult vaccines based on the total number of adult covered lives
reported by health insurers.
(h) If federal purchase requirements do not further the goal of ensuring universal access
to vaccines for all, the Commissioner may, following consultation with the Immunization
Funding Advisory Committee, discontinue the program with six months’ advance notice
to all health care professionals and to all health insurers with Vermont covered lives.
(i) The Department may adopt rules under 3 V.S.A. chapter 25 to implement this section. (Added 2005, No. 191 (Adj. Sess.), § 23; amended 2007, No. 70, § 29; 2009, No. 61, § 42; 2009, No. 156 (Adj. Sess.), § I.20; 2011, No. 157 (Adj. Sess.), § 4; 2011, No. 162 (Adj. Sess.), § C.200, eff. May 17, 2012; 2013, No. 79, § 17, eff. Jan. 1, 2014; 2013, No. 179 (Adj. Sess.), § E.312.1.)