SENATE JUDICIARY COMMITTEE SUBSTITUTE FOR
SENATE BILL 121
52nd legislature - STATE OF NEW MEXICO - first session, 2015
AN ACT
RELATING TO PUBLIC HEALTH; ENACTING THE VACCINE PURCHASING ACT; ESTABLISHING A VACCINE PURCHASING PROGRAM; CREATING THE VACCINE PURCHASING FUND; REQUIRING REPORTING OF THE NUMBER OF INSURED CHILDREN; REQUIRING HEALTH INSURERS AND GROUP HEALTH PLANS TO REIMBURSE THE STATE FOR COSTS OF VACCINES PURCHASED BY THE STATE FOR INSURED CHILDREN; PROVIDING FOR PENALTIES; MAKING AN APPROPRIATION; DECLARING AN EMERGENCY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. [NEW MATERIAL] SHORT TITLE.--This act may be cited as the "Vaccine Purchasing Act".
SECTION 2. [NEW MATERIAL] DEFINITIONS.--As used in the Vaccine Purchasing Act:
A. "advisory committee on immunization practices" means the group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States, established under Section 222 of the federal Public Health Service Act;
B. "department" means the department of health;
C. "fund" means the vaccine purchasing fund;
D. "group health plan" means an employee welfare benefit plan to the extent that the plan provides medical care to employees or their dependents under the Employee Retirement Income Security Act of 1974 directly or through insurance, reimbursement or other means;
E. "health insurance coverage" means benefits consisting of medical care provided directly or through insurance or reimbursement or other means under any hospital or medical service policy or certificate, hospital or medical service plan contract or health maintenance organization contract offered by a health insurance issuer;
F. "health insurer" means any entity subject to regulation by the office of superintendent of insurance that:
(1) provides or is authorized to provide health insurance or health benefit plans;
(2) administers health insurance or health benefit coverage; or
(3) otherwise provides a plan of health insurance or health benefits;
G. "insured child" means a child under the age of nineteen who is eligible to receive health insurance coverage from a health insurer or medical care pursuant to a group health plan;
H. "office of superintendent" means the office of superintendent of insurance;
I. "policy" means any contract of health insurance between a health insurer and the insured and all clauses, riders, endorsements and parts thereof;
J. "provider" means an individual or organization licensed, certified or otherwise authorized or permitted by law to provide vaccinations to insured children; and
K. "vaccines for children program" means the federally funded program that provides vaccines at no cost to eligible children pursuant to Section 1928 of the federal Social Security Act.
SECTION 3. [NEW MATERIAL] STATEWIDE VACCINE PURCHASING PROGRAM.--
A. The department shall establish and administer a statewide vaccine purchasing program to:
(1) expand access to childhood immunizations recommended by the advisory committee on immunization practices;
(2) maintain and improve immunization rates;
(3) facilitate the acquisition by providers of vaccines for childhood immunizations recommended by the advisory committee on immunization practices; and
(4) leverage public and private funding and resources for the purchase, storage and distribution of vaccines for childhood immunizations recommended by the advisory committee on immunization practices.
B. The department shall:
(1) purchase vaccines for all children in New Mexico, including children eligible for the vaccines for children program and insured children;
(2) invoice each health insurer and group health plan to reimburse the department for the cost of vaccines provided directly or indirectly by the department to such health insurer's or group health plan's insured children;
(3) maintain a list of registered providers who receive vaccines for insured children that are purchased by the state and provide such list to each health insurer and group health plan with every invoice;
(4) report the failure of a health insurer to reimburse the department within thirty days of the date of the invoice to the office of superintendent;
(5) report the failure of a health insurer or group health plan to reimburse the department within thirty days of the date of the invoice to the office of the attorney general for collection; and
(6) credit all receipts collected from health insurers and group health plans pursuant to the Vaccine Purchasing Act to the fund.
C. No later than July 1, 2015 and July 1 of each year thereafter, the department shall estimate the amount to be expended annually by the department to purchase, store and distribute vaccines recommended by the advisory committee on immunization practices to all insured children in the state, including a reserve of ten percent of the amount estimated.
D. No later than September 1, 2015 and each quarter thereafter, the department shall invoice each health insurer and each group health plan for one-fourth of its proportionate share of the estimated amount and reserve pursuant to Subsection C of this section, calculated pursuant to Subsection B of Section 6 of the Vaccine Purchasing Act.
E. The department may update its estimated amount to be expended annually and its reserve to take into account increases or decreases in the cost of vaccines or the costs of additional vaccines that the department determines should be included in the statewide vaccine purchasing program and adjust the amount invoiced to each health insurer and group health plan the following quarter.
SECTION 4. [NEW MATERIAL] VACCINE PURCHASING FUND.--
A. The "vaccine purchasing fund" is created in the state treasury. The fund consists of amounts reimbursed to the state by health insurers and group health plans pursuant to the Vaccine Purchasing Act and of appropriations from, and transfers made to, the fund. Money in the fund shall be expended only for the purposes specified in the Vaccine Purchasing Act, by warrant issued by the secretary of finance and administration pursuant to vouchers approved by the secretary of health.
B. Money from the fund may be appropriated to the department to be expended only as authorized in Section 5 of the Vaccine Purchasing Act.
C. The fund shall be audited in the same manner as other state funds are audited, and all records of payments made from the fund shall be open to the public.
D. Any balance remaining in the fund shall not revert or be transferred to any other fund at the end of a fiscal year.
E. Money in the fund shall be invested by the state investment officer in accordance with the limitations in Article 12, Section 7 of the constitution of New Mexico. Income from investment of the fund shall be credited to the fund.
SECTION 5. [NEW MATERIAL] AUTHORIZED USES OF THE VACCINE PURCHASING FUND.--
A. The fund shall be used for the purchase, storage and distribution of vaccines, as recommended by the advisory committee on immunization practices, for insured children who are not eligible for the vaccines for children program. B. The department shall credit any balance remaining in the fund at the end of the fiscal year toward the department's purchase of vaccines the following year; provided that the department maintains a reserve of ten percent of the amount estimated to be expended in the following year.
C. The fund shall not be used:
(1) for the purchase, storage and distribution of vaccines for children who are eligible for the vaccines for children program;
(2) for administrative expenses associated with the statewide vaccine purchasing program; or
(3) to pass through a federally negotiated discount pursuant to 42 U.S.C. 1396s.
SECTION 6. [NEW MATERIAL] REPORTING.--
A. No later than one hundred twenty days following the enactment of the Vaccine Purchasing Act, the office of superintendent shall:
(1) promulgate rules requiring each health insurer and group health plan to report the number of children it insured who were under the age of nineteen as of December 31, 2014 and to annually report the number of children it insures who will be under the age of nineteen as of December 31 of each subsequent year to the office of superintendent, excluding from such reports children who are enrolled in medicaid or in any medical assistance program administered by the department or the human services department and children who are American Indian or Alaska Natives; and
(2) for each health insurer or group health plan, provide the department with the number of insured children reported by such health insurer or group health plan pursuant to Paragraph (1) of this subsection.
B. Each health insurer and group health plan shall reimburse the department for the cost of vaccines for childhood immunizations purchased by the state for the benefit of such health insurer's or group health plan's insured children according to such health insurer's or group health plan's policy obligations and in accordance with health insurance coverage requirements under state and federal law. The amount reimbursed by each health insurer or group health plan shall be a fraction, the denominator of which is the total number of insured children reported by all health insurers and group health plans pursuant to Subsection A of this section and the numerator of which is the number of insured children reported by such health insurer or group health plan pursuant to Subsection A of this section multiplied by the total amount as determined by the department pursuant to Subsection B of Section 3 of the Vaccine Purchasing Act.
C. A health insurer's or group health plan's reimbursement to the department pursuant to the Vaccine Purchasing Act shall be deemed payment for clinical services and activities to promote health care quality for the purpose of calculating a health insurer's or group health plan's medical loss ratio.
SECTION 7. [NEW MATERIAL] APPEAL--PENALTIES.--
A. A health insurer aggrieved pursuant to the Vaccine Purchasing Act may appeal as provided in Section 59A-4-20 NMSA 1978.
B. A health insurer or group health plan that fails to file a report required by the office of superintendent pursuant to Subsection A of Section 6 of the Vaccine Purchasing Act shall pay a late filing fee of five hundred dollars ($500) per day for each day from the date the report was due.
C. The office of superintendent may require a health insurer or group health plan subject to the Vaccine Purchasing Act to produce records that were used to prepare the report required under Subsection A of Section 6 of the Vaccine Purchasing Act. If the office of superintendent determines that there is other than a good faith discrepancy between the number of insured children reported and the number of insured children that should have been reported, the health insurer or group health plan shall pay a civil penalty of five hundred dollars ($500) for each report filed for which the office of superintendent determines there is such a discrepancy.
D. Failure of a health insurer or group health plan to make timely payment of an amount invoiced pursuant to Subsection D of Section 3 of the Vaccine Purchasing Act shall subject the health insurer or group health plan to a civil penalty of five hundred dollars ($500) for each day from the date the payment is due.
SECTION 8. [NEW MATERIAL] POWERS AND AUTHORITY.--The department and the office of superintendent shall promulgate and enforce such rules as may be necessary to carry out the provisions of the Vaccine Purchasing Act.
SECTION 9. [NEW MATERIAL] APPLICABILITY.--The provisions of the Vaccine Purchasing Act:
A. do not apply to an entity that only issues policies, certificates or subscriber contracts within New Mexico that are limited to a specific disease; hospital confinement; indemnity; accident-only; credit; dental; vision; medicare supplement; long-term care; disability income insurance; student health benefits-only coverage issued as a supplement to liability insurance; workers' compensation or similar insurance; automobile medical payment insurance; nonrenewable short-term coverage issued for a period of twelve months or less; medicaid; or any medical assistance program administered by the department or the human services department; and
B. apply to policies, plans, contracts and certificates delivered or issued for delivery or renewed, extended or amended in this state on or after January 1, 2015.
SECTION 10. EMERGENCY.--It is necessary for the public peace, health and safety that this act take effect immediately.
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