NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A5126
SPONSOR: Dinowitz 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) or para-
graph 17 or subsection (i) of § 3216 insurance law to include reimburse-
ment to health care providers for the acquisition costs of the vaccine,
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 two 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:
2021-2022: A227 referred to Insurance committee
2019-2020: A1158 referred to Insurance committee
2017-18: A4061 referred to Insurance committee
2015-16: A3356 - referred to Insurance committee
2013-14: A7248 - referred to Insurance committee
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
The first day of January after it shall have become a law.
